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Transcript of eye
85671 aziza khalifa
85528 outline: * anatomy of eye and blood supply * definition and pathophysiology of
red eye * symptoms and signs of red eye * common causes of red eye * approach the patient (history, examination and investigations) * case scenario what does red eye mean? is it important
about red eye? red eye: is a non-specific term to describe an eye that appears red due to illness, injury, or some other condition pathophysiology Caused by dilation of blood vessels in the eye Conjunctival injection mainly
affects the posterior conjunctival
blood vessels Ciliary injection involves
branches of the anterior ciliary
arteries and indicates
inflammation of the cornea,
iris, or ciliary body symptoms * Blurred vision * Blurred vision refers to a lack of sharpness of vision resulting in the inability to see fine detail
* Blurred vision often indicates serious ocular disease
* Blurred vision that improve with blinking suggest a discharge or mucus on the ocular surface * Sever pain * photophobia * Colored halos * exudation * itching signs * Ciliary flush * Conjunctival
hyperemia * Corneal
opacification * Corneal epithelial
disruption * Pupillary
abnormalities * Shallow anterior
chamber depth * Elevated IOP * proptosis * discharge * Preauricular LN
enlargement * Associated
systemic problems Pain may indicate keratitis , ulcer,
iriodcyclitis or acute glacomaor.
Patient with conjunictivitis complain
of a scratching or mild irritation
but not of severe pain. Exudation, also called mattering, is
a typical result of conjunctival or
eyelid inflammation and does not
occur in iridocyclitis or glaucoma.
Patients will often complain that
their lids are “ stuck together” on
awakening from sleep. Although it is a nonspecific symptom, itching usually indicates an allergic conjunctivitis. Photophopia is an abnormal sensitivity to light that accompanies iritis, either alone or secondary to corneal inflammation. Patients with conjunictivitis have normal light
sensitivity. Colored halos rainbow- like fringes. colored
halos seen around a point of light are usually
a symptom of corneal edema, often resulting from an abrupt in IOP. Therefore,
colored halos are a danger symptom
suggesting acute glaucoma as the
cause of a red eye. Red Eye Disorders:
An Anatomical Approach
*Sclera and subsclera
*Anterior Chamber Conjunctivitis Nonspecific term for inflammation and erythema of the conjunctiva. Several causes:
*Chemical History and symptoms can help determine the etiology
*Thick yellow discharge
*Gritty feeling in the eyes
*Sensitivity to light
*Correct diagnosis has direct implications for treatment and possible spread to close contacts History
*Any recent contact with some one with a red eye (within the past 2-3 weeks)?
*How did it start?
*Has it spread from one eye to the other?
*Any tearing or discharge?
*Any changes in vision?
*Does it itch?
*Has the patient been rubbing his/her eyes? Discharge Cause
White mucous Allergies Bacterial Conjunctivitis Common causes
*Hemophilus: may cause hemorrhage on the conjuctiva and occasionally the lids
*Chlamidia Risk factors include:
*Frequent exposure to infected
*Contact lens overwear
*Dry Eyes (keratoconjunctivitis sicca) 1-Hordeolum
5-Trichiasis Hordeolum is an inflammation & secondary infection of the sebaceous
glands of Zeis at the base of the
eyelashes, or an infection of the
apocrine sweat glands of Moll Internal
hordeolum Styes are commonly caused by the
blocking of an gland at the base
of the eyelash. Styes can be triggered
by poor nutrition, sleep
deprivation, lack of hygiene * Is a small abscess caused by acute staphylococcal infection of a lash follicle and its associated gland of Zeis or Moll. * Sings : -Tender , inflamed swelling in the lid margin ( points anteriorly through the skin) * Treatment :
- warm compresses
- apply topical antibiotic ointment
- incision and curettage . * Is a small abscess caused
by acute staphylococcal
infection of meibomian gland * Sings : Tender , red , inflamed swelling within the tarsal plate . * Treatment : by incision and curettage . also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Chalazia differ from styes (hordeola) in that they are subacute and usually painless nodules. They may become acutely inflamed but, unlike a stye, chalazia usually point inside the lid rather than on the lid margin. Swelling on the eyelid
Sensitivity to light
Heaviness of the eyelid
A chalazion or meibomian cyst can sometimes be mistaken for a stye. Management:
lid massage (to encourage the glands to open up and drain,
topical mild steroid drops usually suffices.
surgery The narrow opening through which a meibomian gland secretes its material can become clogged from narrowing of the opening or hardening of the sebaceous liquid near the opening. If this occurs, the gland will have a backup of the material it secretes and it will swell. This leads to thickening of the walls of the gland and leakage of oil into the lid itself, causing inflammation both within the gland and the eyelid. This inflamed enlargement is a chalazion. Dacryocystitis is an inflammation of the nasolacrimal sac, frequently
caused by nasolacrimal duct
obstruction or infection It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora. When nasolacrimal duct obstruction is secondary to a congenital barrier it is referred to as dacrocystoceles. It is most
commonly caused by
Staphylococcus aureus and
Streptococcus pneumoniae. Acute
Sudden onset pain ,Tender , red , tense swelling over lacrimal sac at medial canthus
Fever , excessive tearing , crusting
Pus discharge through the punctum
Systemic broad-spectrum antibiotic
Darcyo-cysto-rhino-stomy (DCR) Presentation:
Darcyocystorhinostomy (DCR) Trichiasis Abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva.
Cause: marginal entropion by infection, inflammation, autoimmune conditions, congenital defects
foreign body sensation
Management: removal or destruction of the affected eyelashes with forceps, specialized laser, or surgery Orbital cellulitis is an inflammation of eye tissues posterior to the orbital septum. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. When it affects the rear of the eye, it is known as retro-orbital cellulitis Orbital Cellulitis Orbital cellulitis is an inflammation of eye tissues posterior to the orbital septum. It most commonly refers to an acute spread
of infection into the eye socket from
either the adjacent sinuses or
through the blood.
* 11% of cases of orbital cellulitis
result in visual loss *Ciliary flush is an injection of the deep counjunectival and episcleral vessels surrounding the cornea.
* It seen most easily in daylight and appears
as violaceous ring in which individual vessels are indiscernible to the unaided eye.
* Ciliary flush is a danger sign often seen in the eyes with corneal inflammation, iridocyclitis, or acute glaucoma.
* Usually, ciliary flush is not present in conjunictivitis Conjunctival hyperemia is an engorgment of the larger and more superficial bulbar conjunictival vessels. A nonspesific sign, it may be seen in almost any of the condition causing a red eye. It may indicated by direct illumination with a pen light, or they may be seen with a direct ophthalmoscope out line against the red fundus reflex. Several type of cornea opacities may occur:
*Keratic precipitates, or cellular deposits on the corneal endothelium, usually too small to be visible but occasionally forming large clumps these precipitates can result from iritis or from chronic iridocyclitis.
*A diffuse haze obscuring the pupil and iris marking, characteristic of corneal edema and frequently seen in acute glaucoma
*Localized opacities due to keratitis or ulcer Disruption of the corneal epithelium occurs in corneal inflammations and trauma. It can be detected in two was:
*Position yourself so that you can observe the reflection from the cornea of a single light source as the patient moves the eye into various positions. Epithelial disruptions cause distortion and irregularity of the reflection
*Apply fluorescien to the eye. Diseased epithelium or areas denuded of the epithelium stain a bright green. IOP not affected by common cause red eye other than iridocyclitis and glaucoma. if IOP suspected top be increase it should be measured In a red eye, a shallow anterior chamber should always suggest the possibility of acute angle glaucoma. ACD can be estimated through side illumination with a pen light (compare with unaffected eye) *The pupil in an eye with iridocyclitis is typically is somewhat smaller than that of other eye, due to reflex spam of the iris sphincter muscle.
* The pupil is also distorted occasionally by posterior synenchiae, which is an inflammatory adhesion between the lens and the iris.
* In acute glaucoma, the pupil usually fixed middilated and slightly irregular.
* Conjunictivitis does not affect the pupil. Type of discharge may be an important clue to the cause of a patient's conjunictivitis:
purulent (creamy-white) or mucopurulent (yellowish) ---> suggest bacterial causes.
serous (white, clear, or yellow-tinged) ---> suggest viral causes.
scant, white, stringy ---> suggest allergic conjunictivitis, dry eyes. It is a frequent sign of viral
conjunictivitis. usually, such
enlargement does not occur in
acute bacterial conjunictivitis. * URT infection and fever --> adenovirus type 3 & 7
* Erythema multiforme ---> allergic response to medication * It is an engorgement of the larger and more
* Superficial bulbar conjunictival vessels.
it is non specific sign . *sudden proptosis suggest serious orbital or cavernous sinus disease.
*the common cause for chronic proptosis. pathogenesis chalazion thank you Dacryocystitis * Patients commonly complain of pain when moving the eye, sudden loss of vision, bulging of the eye or eyes that are infected and limited eye movement. Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy
*Antibiotic: commonly caused by Staphylococcus and Streptococcus species
*Surgical Intervention : drainage of the sinuses and abscess. Blepharitis is an inflammation of the eyelids, causing red, irritated, itchy eyelids, and the formation of dandruff-like scales on the eyelashes
*The word "blepharitis" is derived from the Greek word blepharos, which means "eyelid," classification:
Gritty, burning sensation
Crusting, flaking of skin on the lids
Redness in eyelid margins
*Eyelid margin hygiene is the basis of *treatment
- Application of warm compresses
- Washing the eyelid margin mechanically
- An antibiotic ointment is applied to the eyelid margin
erythromycin or sulfacetamide ointments..
- Tear substitute.