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    Red Eye-Dr S Brodovsky

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    Lyndon Edano
    This document provides guidance on evaluating and diagnosing various causes of red eye. It begins by discussing an evaluation of ocular history and examination. Common causes of red eye discussed include infectious (viral vs. bacterial), allergic, dry eye, toxic, subconjunctival hemorrhage, iritis, episcleritis, and acute angle closure glaucoma. Diagnostic features and treatment approaches are provided for conditions like iritis, corneal ulcers, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, chronic conjunctivitis, allergic conjunctivitis, and endophthalmitis. Management strategies emphasize determining the cause, initiating appropriate treatment, and making referrals when

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    Red Eye-Dr S Brodovsky

    Uploaded by

    Lyndon Edano
    17 views57 pages
    This document provides guidance on evaluating and diagnosing various causes of red eye. It begins by discussing an evaluation of ocular history and examination. Common causes of red eye discussed include infectious (viral vs. bacterial), allergic, dry eye, toxic, subconjunctival hemorrhage, iritis, episcleritis, and acute angle closure glaucoma. Diagnostic features and treatment approaches are provided for conditions like iritis, corneal ulcers, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, chronic conjunctivitis, allergic conjunctivitis, and endophthalmitis. Management strategies emphasize determining the cause, initiating appropriate treatment, and making referrals when

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    This document provides guidance on evaluating and diagnosing various causes of red eye. It begins by discussing an evaluation of ocular history and examination. Common causes of red eye discussed include infectious (viral vs. bacterial), allergic, dry eye, toxic, subconjunctival hemorrhage, iritis, episcleritis, and acute angle closure glaucoma. Diagnostic features and treatment approaches are provided for conditions like iritis, corneal ulcers, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, chronic conjunctivitis, allergic conjunctivitis, and endophthalmitis. Management strategies emphasize determining the cause, initiating appropriate treatment, and making referrals when

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    17 views57 pages

    Red Eye-Dr S Brodovsky

    Uploaded by

    Lyndon Edano
    This document provides guidance on evaluating and diagnosing various causes of red eye. It begins by discussing an evaluation of ocular history and examination. Common causes of red eye discussed include infectious (viral vs. bacterial), allergic, dry eye, toxic, subconjunctival hemorrhage, iritis, episcleritis, and acute angle closure glaucoma. Diagnostic features and treatment approaches are provided for conditions like iritis, corneal ulcers, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, chronic conjunctivitis, allergic conjunctivitis, and endophthalmitis. Management strategies emphasize determining the cause, initiating appropriate treatment, and making referrals when

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 57

    Not "THE RED EYE" Again!

    Stephen Brodovsky MD, FRCSC Associate Professor Dept of Ophthalmology University of Manitoba Private Practice Cataract/Corneal/Refractive Surgery

    Ocular History & Examination


    Visual Acuity Pupils Motility Anterior segment (cornea & conjunctiva) Posterior segment Confrontation Fields Intraocular Pressure

    Usual RED EYE Lecture


    INFECTIOUS: VIRAL vs BACTERIAL ALLERGIC DRY EYE TOXIC SUBCONJUNCTIVAL HEMORRHAGE IRITIS EPISCLERITIS ACUTE ANGLE CLOSURE GLAUCOMA

    Photophobia

    ? Pupil Size ? Location of Injection

    What is your provisional Diagnosis ?

    Iritis

    If painful, usually not pink eye


    Differential Diagnosis Includes: Corneal Abrasion Bacterial or Herpetic Corneal Ulcer Episcleritis or Scleritis Acute Angle Closure Glaucoma

    Keratic Precipitates

    Keratic Precipitates

    Iritis Treatment
    Topical Steroid drops (up to q1h) and
    cycloplegic drop eg Homatropine 2% Ophthalmic referral Steroid & cycloplegic drops are tapered over 1 month Check intraocular pressure If recurrent consider medical workup

    Why is the patient having difficulty working ?


    Cycloplegic drops interfere with near
    vision Important to prevent posterior synechiae (adhesions of iris to lens)

    Photophobia &/or Ciliary Injection


    Indicates corneal
    and/or anterior chamber inflammation Always rule-out corneal staining defect with fluorescein eg abrasion, herpes dendrite, corneal ulcer

    Photophobia & Ciliary Injection


    Corneal Abrasion Corneal Ulcer Herpes Simplex

    Corneal Ulcers: Rosacea & Blepharitis

    Contact lens wearer & corneal ulcer

    ALWAYS ASK ABOUT CONTACT LENS WEAR!!!

    Chronic Irritation

    What is your provisional Diagnosis ?


    Dry Eye

    History

    Ask about: Dry mouth (Sjogrens syndrome) Connective tissue disease Systemic medication that may contribute to dry eye symptoms

    Dry Eyes

    Common ocular condition Incidence increases with age History is the most important clue to Dx Treatment may be initiated by family doctor Ophthalmic consultation in refractory situations

    Keratitis in Advanced Dry Eye

    Schirmer Test

    Tear production measured

    Rule-out Blepharitis
    Erythema of lid margin Scales on Lashes Loss of Cilia

    Frequently co-exists with dry eye

    Dry Eye Treatment


    Artificial tears up to 1 drop qid (consider
    cooling drops) Ointment at bedtime Humidifier Preservative free tears up to q1h Punctal occlusion (silicone plugs) or cautery Oral pilocarpine (Salogen) Restasis (topical cyclosporin: only available thru HPB)

    Acute Red Eye

    Red Eye

    No change in vision No photophobia No pain No staining of cornea

    What is your provisional Diagnosis ?


    Sub-conjunctival hemorrhage

    Provisional Diagnosis
    Subconjunctival hemorrhage

    ? Trauma ? Valsalva Maneuver

    ? Elevated BP ? Blood Clotting

    Subconjunctival Hemorrhage Management


    Reassure patient that blood will reabsorb Referral not necessary Clotting status to be evaluated to make sure
    Coumadin dosage satisfactory Be sure that BP is OK

    Red Eye with Discharge

    What is your provisional Diagnosis ?


    Bacterial Conjunctivitis

    Clinical Pearls
    Most cases of infection are secondary
    to virus (tearing, enlarged preauricular lymph node) If need fingers to open lids in am this is suggestive of bacterial conjunctivitis Be suspicious of unilateral red eye Trichiasis ? Foreign Body ? Dacryocystitis ?

    Differential Diagnosis

    Lacrimal System Obstruction

    Bacterial Conjunctivitis Treatment


    Broad-spectrum fluoroquinolone antibiotic
    is effective for suspected bacterial case 1 drop qid for 7 to 10 days Warm compresses to clean lids of discharge Cultures usually not required unless recurrent or persistent Ciprofloxacin or Erythromycin available as an ointment for children

    Bacterial Conjunctivitis Treatment


    Lancet. 2005 Jul 2-8:366(9479):37-43 Chloramphenicol treatment for acute
    infective conjunctivitis in children in primary care: a randomised double-blind placebo controlled trial Rose PW et al, Oxford UK Placebo vs Chloramphenicol gtts 83% vs 86% cure rates at 7 days

    Bacterial Conjunctivitis Treatment


    Conclusion: Most children with acute infective conjunctivitis will get better by themselves and do not need treatment with an antibiotic

    Chronic Red Eye

    Chronic Conjunctivitis
    Differential Diagnosis

    Allergic or Toxic reaction to eye drops Dry eyes (dryness, irritation, burning) Blepharitis (scales on lashes, erythema of
    lid margin) Contact lens wear!!

    Diagnosis ?
    Chronic Conjunctivitis Secondary to toxic or allergic reaction to topical medication

    Management
    Alphagan eye drops discontinued Redness resolved in one week Ophthalmologist to start another antiglaucoma medication

    Toxic Reaction to Eye Drops


    Common scenario is treatment of
    conjunctivitis with gentamicin eye drops No improvement after one week, new medication is prescribed Toxic keratopathy results Use antibiotics for 1 week, 1 drop qid -> If no improvement -> Refer

    Itching

    What is your provisional Diagnosis ?

    Allergic Conjunctivitis

    Allergy
    Allergen IgE

    Mast cells
    Factors Released: Histamine, Chemotactic factors, Prostaglandin synthesis

    Management of Ocular Allergy


    Cold compresses Mast cell stabilizer & anti-histamine eg Patanol
    or Zaditor bid Systemic antihistamines (Can Have Drying Effect on Eyes Natural DefenderTear Film) Frequent showers to remove allergens from hair, skin, etc. If highly symptomatic referral to ophthalmologist Mild topical steroid (FML) Restasis (topical cyclosporin)

    Red Eye Summary


    Photophobia Chronic Irritation Acute Red Eye Red Eye with Discharge Chronic Red Eye Itching

    Decreased Vision Post-Cataract Surgery

    History of Perfect Vision then Unable to Distinguish Material in first week after Surgery

    What is your provisional Diagnosis ?

    Endophthalmitis

    What is your management ?


    Referral to ophthalmologist in A. 1 week B. 2 days C. 1 day D. Same day

    Complications Post-Cataract Surgery



    Endophthalmitis Retinal detachment Macular edema Corneal edema

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