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Red Eye

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by

Hamida Ahmed

on 9 May 2017

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Transcript of Red Eye

The Red Eye
What is causing the red eye?
Haemorrhage
Is it painful?
Retrobulbar Haemorrhage
'behind the eye'
posterior edge not visible
usually homogenous
restricted eye movements
pupil restriction
may lead to loss of vision
Caused by:
1. iatrogenic
2. trauma
Management:
EMERGENCY
drainage
O2
IV mannitol and acetazolamide
IM/IV steroids (hydrocortisone)
Subconjuctival Haemorrhage
Congestion
Conjunctivitis
Keratitis
Acute Glaucoma
Idridocyclitis
Subconjunctival Haemorrhage
Caused by:
1. straining
2. trauma
3. hypertension
common, especially in older patients
due to
blood extravasation
from subconjunctival capillaries, not dilated vessels
spontaneous; increase in venous pressure, cough
resolves in 10-14 days
Management:
reassure patient
Conjunctivitis
acute, often infective cause
more common in young people
presents with redness,
irritation
,
eyelids stuck
together in the morning
discharge
viral: may present with lid drooping
Caused by:
1. bacteria
2. virus
3. allergies
Management:
Bacterial: topical abx
Viral; symptomatic relief eg cold press, eye drops
Allergic: antihistamines, mast cell stabilisers
Episcleritis
Episcleritis
inflammation of dense vascular tissue under conjunctiva
nodular or diffuse
tends to affect young healthy women
presents with
no discharge
, '
uncomfortable
' eye, usually not painful
may recur
often idiopathic
Management:
mild: don't treat
sodium salicylate (systemic)
local steroids or NSAIDs
Can you see normally?
redness from fornicies, unlike episcleritis
nodular lasts longer (5-6 weeks)
diffuse looks like conjunctivitis
but
redness NOT from fornicies

NO
no discharge
no discharge
discharge
YES
YES
Scleritis
inflammation of sclera
severe pain
but no discharge
visual acuity is normal!
associated with
rheumatoid arthritis
Management:
immediate management
systemic NSAIDs eg flurbiprofen
NO
often serious and needs admission
Acute Angle Closure Glaucoma
seen in
long-sighted patients
very painful
and tender to touch
previous hx of headaches, halos around lights in the evening and
vomiting
fixed dilated
pupil;
sudden
vision loss
corneal oedema makes iris look
hazy
and lack luster
Management:
IMMEDIATE admission
mitotics: pilocarpine
carbonic anhydrase inhibitors: acetazolamide
surgical: laser iridotomy in both eyes
Acute Iritis
a million names: acute anterior uveitis/iridocyclitis
painful, but not enough to cause vomiting
often in 20-40 year olds
cornea is
NOT
hazy
pupil spasms:
smaller
than normal
hurts to look at things up close
Management:
outpatient -> midriatic drops: 1% atropine (prevents adhesion of lens and iris) and local steroids
systemic steroids only if sight is in jeopardy
lasts 2 weeks
rule out
sarcoidosis
and
ankylosing spondylitis
high risk of forming
cataract
(after 3 recurrences)
Acute Keratitis
sharp
pain, like something is in eye
watering eye, hard to open
photophobia
bacteria cause necrotic white areas on cornea
viruses cause dendrites and dots
constricted pupils
contact lens wearers often affected
Caused by:
1. acute trauma
2. herpes
Management:
bacterial: antibiotics +/- steroids
viral: topical antivirals (aciclovir)
fluorescein stain shows ulcers
remember to check eyelid
Neovascular Glaucoma
the
elderly

diabetic
patient with a painful, blind eye
often secondary to central retinal vein occlusion
vision in one eye becomes blurry over hours/days
some recover, some get NVG -
100 day glaucoma
Management:
reduce intraoccular pressure
if IOP not reduced, eye must be surgically removed
rubeosis iridis - 'new vessel' due to ischaemia. this occludes angle, leading to closure
posterior edge visible!
read up!
EMERGENCY
EMERGENCY
Full transcript