RED EYE Prof Dr Ilgaz YALVA RED EYE

RED EYE Prof. Dr. Ilgaz YALVAÇ

RED EYE § One of the most common ophthalmologic conditions in the primary care setting § Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye § Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial

What is RED EYE? § It is the cardinal sign of ocular inflammation § Conjunctivitis is the most common cause of red eye § Signs and symptoms are discharge, redness, pain, photophobia, itching, and visual changes § It can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. § Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye

RED EYE (Non-Vision Threatening Disorders) §Subconjunctival hemorrhage §Conjunctivitis §Dry Eye Syndrome §Blepharitis §Corneal Abrasion §Pterygium/Pingueculum

Subconjunctival Haemorrhage § Diffuse or localised area of blood under conjunctiva § Asymptomatic § Idiopathic § Trauma § Cough § Sneezing § Aspirin § Systemic Hypertension § Resolves within 10 -14 days

Subconjuntival Hemorrhage with Chemosis Keep conjunctiva moist

Subconjunctival air!

Posterior petechial hemorrhages Think embolic disease

Conjunctivitis Follicles Papillae Redness Chemosis Purulent discharge

Blepharo-conjunctivitis Acne Rosacea Blepharo-Conjunctivitis

Conjunctivitis Allergic Conjunctivitis (Polytrim)

Dry Eye Syndrome § Poor quality § Meibomian gland disease ie, Acne Rosacea § Lid related § Vitamin A deficiency § Poor quantity § Keratoconjunctivitis Sicca § Sjogren Syndrome § Rheumatoid Arthritis § Lacrimal disease ie, Sarcoidosis § Paralytic ie, VII CN palsy

Computer Vision Syndrome § Red, burning and tired eyes with staring at a computer screen for too long. § Blink less when working at a computer, which dries out the surface of eye. § Taking frequent breaks while working at a computer, modifying your workstation. § Lubricating eye drops to keep eyes moist.

Blepharitis Subacute Chronic External hordeolum Internal hordeolum

Corneal Abrasion §Surface epithelium sloughed off §Stains with fluorescein §Usually due to trauma §Pain §FB sensation §Tearing §Red eye

Pterygium Active Dormant

Pingueculum (inflammed)

RED EYE (Vision Threatening Disorders) § Episcleritis / Scleritis § Corneal Ulcers § Iritis ( Anterior Uveitis) § Angle-Closure Glaucoma § Preseptal & Orbital Cellulitis § Endophthalmitis § Trauma

Episcleritis § Superficial § Idiopathic § Collagen vascular disorder (Romatoid Artritis) § Asymptomatic, mild pain § Self-limiting or topical treatment

Corneal Ulcer § Infection § Bacterial: Adnexal infection, lid malposition, dry eye, CL § Viral: Herpes Simplex, Herpes Zoster § Fungal: § Protozoan: Acanthamoeba in CL wearer § Mechanical or trauma § Chemical: Alkali worse than acid

Corneal Ulcer v Viral Dendritic Keratitis

Corneal Ulcer v Viral Dendritic Keratitis HSV-1 H. Zoster

Iritis (Anterior Uveitis) § Photophobia, red eye, decreased vision § Idiopathic Commonest § Associated to systemic disease v. Seronegative arthropathies: AS, IBD, Psoriatic arthritis, Reiter’s v. Autoimmune: Sarcoidosis, Behcet’s Disease v. Infection: Herpes, Toxoplasmosis, TB, Syphillis, HIV

Ciliary flush Posterior synechiae Fibrin Flare Hypopyon KPs

Acute Angle-Closure Glaucoma Symptoms v. Pain v. Headache v. Nausea-Vomiting Ciliary hyperaemia Dilated pupil v. Redness v. Photophobia Corneal oedema v. Reduced vision v. Haloes around lights

Acute Angle-Closure Glaucoma q. Onset over 50 q. Severe eye pain q. Blurred vision q. Red eye q. Headache/Nausea q. Corneal edema q. Mid-dilated, fixed pupilla q“Glaukomflecken” q. Iris atrophy q. Severe AC inflammation

Preseptal cellulitis

Orbital Cellulitis v Severe pain v Proptosis v Limited EOMs v Conjunctival congestion v Diabetic?

Orbital Cellulitis Frontal, ethmoid, maxillary and orbital abscesses

Endophthalmitis v Severe pain v Photophobia v Poor vision v Recent intra-ocular surgery

Differential Diagnosis

Refer to an Ophthalmologist Red Eye with § Severe pain § Patient has vision loss § Copious purulent discharge § Corneal involvement § Traumatic eye injury § Recent ocular surgery § Distorted pupilla § Herpes infection § Recurrent infections