Ophtha Report

The Red Eye

Reganit, Chelsea Marie A.

Conjunctivitis• Inflammation of the conjunctiva

Viral Conjunctivitis

• Inflammation of palpebral conjunctiva and bulbar conjunctiva

• Acute • Adenovirus type 3• direct contact• Incubation 5-12 days

Viral Conjunctivitis

• Clinical presentation– Edema and hyperemia of

one of both eyes. – Conjunctival injection– Ipsilateral palpable

preauricular lymphadenopathy.

Viral Conjunctivitis

• Management:– Topical vasoconstrictors (naphazoline) and steroids

(Vexol, Flarex,)– Sulfonamide drops

Bacterial Conjunctivitis

• Etiology– Hyperacute: Neisseia gonorrhea– Acute catarrhal: S. pneumonia, Staphylococcus

– Subacute: Hemophylus influenza– Chronic: Moraxella, pseudomonas, gram negative

species

Bacterial Conjunctivitis

• Irritation• Hyperemia• tearing • Copious purulent discharge from

both eyes • Mild decrease in visual acuity

Bacterial Conjunctivitis

• Diagnosis: – Gram stain: presence of polymorphonuclear cells and

predominant organism

• Complications:– secondary keratitis, corneal ulcer

Bacterial Conjunctivitis

• Management– Broad spectrum topical antibiotics

• Polytrim (polymixin B sulfate and trimethoprim sulfate)• Gentamicin 0.3%• Tobramycin 0.3%

Chlamydial/GonococcalConjunctivitis

• Eye infection greater than 3 weeks

• Mucopurulent discharge • Conjunctival injection• palpable preauricular node • Conjunctival papillae • Chemosis

Conjunctival papillae

Chlamydial/GonococcalConjunctivitis

• Diagnosis– Fluorescent antibody stain, enzyme immunoassay

tests – Giemsa stain: Intracytoplasmic inclusion bodies in

epithelial cells, polymorphonuclear leukocytes and lymphocytes

Chlamydial/GonococcalConjunctivitis

• Management: – Oral

• Tetracycline • Azithromycin• Amoxicillin and erythromycin or Doxycycline

– Topical: erythromycin, tetracycline or sulfacetamide – Gonococcal: ceftriaxone 1g IM, and then 1gm IV 12-24

hours later– Topical Fluoroquinolone

Allergic Conjunctivitis

• Usually allergy to air born allergen• Mediated by IgE• May occur with hay fever, asthma or rhinitis

Allergic Conjunctivitis

• Conjunctival injection• Thin, watery discharge • photophobia and visual loss • Large cobblestone papillae• Lids swollen and red

Allergic Conjunctivitis

• Management– Avoid contact with allergen, cold compresses, artificial tears – Topical antihistamines, topical vasoconstrictors or

decongestants such as phenylephrine (vasoconstrict and retard release of inflammatory mediators)

– Mast cell stabilizers (Alomide and Crolom) – Severe cases : topical steroids such as Vexol, Flarex or Alrex

Blepharitis

• Can be associated with a bacterial infection such as S. aureus or a chronic skin condition

Blepharitis

• Two forms– Anterior

• affects outside lids where eyelashes attach• Caused by bacteria or seborrheic

– Posterior• meibomian glands• Leads to gland plugging and Chalazion formation

Blepharitis

• S Aureus:– Itching, lacrimation,

tearing, burning, photophobia

• Seborrheic: – lid margin erythema,

dry flakes, oily secretions on lid margins, associated dandruff

Blepharitis

• Complications– thickened lid margins– dilated and visible capillaries– eyelash loss– Ectropion and Entropion– corneal erosions

Blepharitis

• Management– Lid hygiene– Antibiotic ointment to lid margins after cleaning

ie. Bacitracin, erythromycin– Lubrication to relieve foreign body sensation

Subconjunctival Haemorrhage

• Bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space

• Idiopathic, trauma, cough, sneezing, aspirin, hypertension

• If traumatic must do thorough exam

Subconjunctival Hemorrhage

• No therapy• Reassurance that the condition is not serious

and will resolve in 1-3 weeks• Hematologic coagulation studies are not

indicated unless there are associated retinal hemorrhages or many recurrences

Corneal & Conjunctival Foreign Body

• pain, tearing, photophobia and foreign body sensation• Foreign body may be flushed out or can be removed with

a g25 needle• Treatment with antibiotics is necesssary• Flip lid if no FB seen and linear abrasion

Chemical Injury

• True ocular emergency• Requires immediate irrigation with nearest

source of water• Management dependent on acid or alkaline

offending substance

Chemical Burns

• Management – Immediate irrigation – Topical antibiotics– Cycloplegia– Removal of particulate matter

• Goal is to reepithelialize the cornea

Contact Lens Wear Associated Red Eye

• Prolonged contact lens wear or poorly fitting lenses may cause a red eye.

• Severe pain.• Tearing.• If opacity is noted or corneal infection is

suspected,treat as if infected.• Bacterial, parasite, fungus are possible

pathogens.

Bacterial Keratitis

• Red, painful eye• Watery - purulent discharge• May have corneal opacity• May have decreased vision

Bacterial Keratitis

• Diagnosis – Confirmation with scrapings and cultures– Gram stain

• Management– Initial broad spectrum treatment with antibiotics

eg. Flouroquinolone and Bacitracin, Cefazolin and Amikacin

– Modify treatment based on culture results