Post on 01-Mar-2018
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The Diferential Diagnosis
oThe Red EyeFKK UMJ
SRI FULINA
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The Red EyeThe most ommon a!se o red
eye is on"!nti#itis
Al$ays he% #is!al a!ity& '!'ilsi(e and reati#ity) E#ert lids toloo% or oreign *ody)
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+on"!nti#a,+ornea
-iral +on"!nti#itis In.ammation o 'al'e*ral
on"!nti#a and *!l*ar
on"!nti#a) Etiology/ -iral/ Adeno#ir!s
ty'e 0 assoiated $ith1haryngitis& e#er& malaise
Transmission is diretontat)
In!*ation 2345 days)
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+on"!nti#a,+ornea
-iral +on"!nti#itis +linial 'resentation
Edema and hy'eremia
o one o *oth eyes) +on"!nti#al in"etion
I'silateral 'al'a*le'rea!ri!lar
lym'hadeno'athy)
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+on"!nti#a,+ornea
-iral +on"!nti#itis Management/
To'ial #asoonstritors 6na'ha(oline7
and steroids 6-e8ol& Flare8&7 S!lonamide dro's 9ighly ontagio!s)
Diferential diagnosis/ a!te!#eitis& a!te gla!oma& ornealdisorders
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+on"!nti#a,+ornea
:aterial +on"!nti#itisThe eye has many deenses to
're#ent *aterial in#asion s!h as
*ateriostati lyso(ymes andimm!noglo*!lins in the tear ;lm&*lin%ing& imm!ne system)
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+on"!nti#a,+ornea
:aterial +on"!nti#itis Etiology/
+ommon 'athogens/ Sta'hyloo!s
a!re!s& 9aemo'hil!s in.!en(ae&Stre'too!s 'ne!moniae and1se!domonas aer!ginosa
Se#ere *aterial on"!nti#itis thatin#ades ornea/ Neisseria gonorrhoeaeand +oryne*ateri!m di'theroides
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+on"!nti#a,+ornea
:aterial +on"!nti#itis Irritation& hy'eremia&
tearing
+o'io!s '!r!lent dishargerom *oth eyes
Mild derease in #is!ala!ity
Diferential diagnosis/a!te !#eitis& a!tegla!oma& ornealdisorders
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+on"!nti#a,+ornea
:aterial +on"!nti#itis Diagnosis/
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+hlamydial,
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+hlamydial,
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+hlamydial,
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+hlamydial,
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+on"!nti#a,+ornea
Allergi +on"!nti#itis Allergen ontat $ith on"!nti#a
res!lts in release o in.ammatory
mediatorsThese In.ammatory mediators
res!lts in sensation o ithing&
#as!lar 'ermea*ility and#asodilation
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+on"!nti#a,+ornea
Allergi +on"!nti#itis +on"!nti#al in"etion Thin& $atery disharge)
'hoto'ho*ia and #is!alloss
Large o**lestone'a'illae
La% 'rea!ri!lar lym'hnodes)
Lids s$ollen and red
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+on"!nti#a,+ornea
Allergi +on"!nti#itis Diferential diagnosis/ a!te !#eitis& a!tegla!oma& orneal disorders
Management/ A#oid ontat $ith allergen& old om'resses&
arti;ial tears To'ial antihistamines& to'ial #asoonstritors or
deongestants s!h as 'henyle'hrine6#asoonstrit and retard release o in.ammatory
mediators7 Mast ell sta*ili(ers 6Alomide and +rolom7 Se#ere ases / to'ial steroids s!h as -e8ol& Flare8
or Alre8
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+on"!nti#a,+ornea
Keratoon"!nti#itis sia Tear film made of 3 layers:
A lipid layer an aqueous layer hydrophilic mucin layer
Any abnormality in any of these layers
leads to an unstable tear film andsymptoms of keratitis sicca. S"ogrenCs disease3 xerostomia
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+on"!nti#a,+ornea
Keratoon"!nti#itis sia Dryness
Redness
Srathy eeling o theeyes) )
@!lar irritation
ucous plaques and dischar!e
Corneal epithelial defects orulceration
Se#ere/
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+on"!nti#a,+ornea
Keratoon"!nti#itis sia Diagnosis/ slit lam' e8am sho$s
s!*tle a*normalities o tear ;lm
sta*ility& red!ed tears& Shirmertest
Management/
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+on"!nti#a,+ornea
Keratoon"!nti#itis sia +om'liations/
Se#ere and hroni may lead to
%eratini(ation o the o!lar s!rae orloss o the orneal e'itheli!m
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1ing!e!la :enign yello$ olored thi%ening o
the on"!nti#a
I it e8tends onto the ornea it is%no$n as a 'terygi!m
+an *e a!sed *y hroni s!n
e8'os!re& re'eated tra!ma&dry,$indy onditions
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1ing!e!la ello$ or $hite
nod!le on
on"!nti#a nearornea
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1ing!e!la Management/
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1terygi!m +on"!nti#a *egins to gro$ onto
ornea
Etiology is U- s!nlight and dryonditions
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1terygi!m :l!rred #ision
Eye irritation
Ithing& *!rning
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1terygi!m +om'liations/
*lo%age o #ision
Management/ Eye dro's to moisten eyes and
derease in.ammation)
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Daryoystitis Nasolarimal system o*str!tion
res!lting in a larimal sainetion
Etiology/ A!te/
S) a!re!s& :3hemolyti stre')+hroni/ S) e'idermidis& andida
+hroni/ m!osal degeneration& d!tile
stenosis& stagnant tears& *aterialo#ergro$th
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Daryoystitis 1ain
Redness o tear3sa
S$elling 1!r!lent material
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Daryoystitis Diagnostis/
+T
Management Ke.e8& A!gmentin $ith to'ial
anti*ioti dro's) arm om'resses Might need s!rgial remo#al o
o*str!tion 1atient Ed!ation/
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:le'haritis +an *e assoiated $ith a *aterial
inetion s!h as S) a!re!s or a hroni
s%in ondition T$o orms/
Anterior/ afets o!tside lids $here eyelashesattah) +a!sed *y *ateria or se*orrhei)
1osterior/ Inner eyelid 6mei*omian glands7)Leads to gland 'l!gging and +hala(ionormation)
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:le'haritis S A!re!s/
Ithing& larimation&tearing& *!rning&'hoto'ho*ia
Se*orrhei/ lid margin erythema&
dry .a%es& oilyseretions on lidmargins& assoiateddandr!f
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:le'haritis Diagnostis/
+om'liations/thi%ened lid
margins& dilated and #isi*lea'illaries& eyelash loss& Etro'ionand Entro'ion& orneal erosions
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:le'haritis
Management Anterior/
%ee' sal'& eyelids and *ro$s lean)
Remo#e sales $ith *a*y sham'oo) 1osterior/
E8'ression o mei*omian gland on
reg!lar *asis) I orneal in.ammationneed oral anti*ioti)
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9ordeol!m "ocali#ed infection or inflammation of
the eyelid mar!in involvin!: $air follicles of the eyelashes eibomian !lands
D!e to *lo%age and inetion o
se*aeo!s glands Etiology
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9ordeol!m 1ain!l& erythemato!s&
and loali(ed)
+an lead to edema olid
+an lead to+on"!nti#al inetion)
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9ordeol!m Diagnostis/
Management/To'ial anti*ioti,ointment s!h as
%acitracin ophthalmic ointment
Severe mi!ht need oral tetracycline or
Cloxacillin
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+hala(ion Loali(ed sterile s$elling o !''er
or lo$er eyelid that orms $hen
mei*omian gland *eomes*lo%ed)
:le'haritis and ane rosaea oten
'rior to +hala(ion)
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+hala(ion 9ard non3tender s$elling
o !''er or lo$er eyelid
1ainless +on"!nti#a red and
ele#ated May distort #ision
&nvert the eyelid to visuali#ethe palpebral conjunctivaand note internal chala#ia.
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+hala(ion Diagnostis/ :io'sy or re!rrent&
#iral or *aterial !lt!res
Diferentials/ on"!nti#itis&9ordeol!m& mei*omian glandarinoma
Management/ arm om'resses tid In"etion or ortiosteroid or I,D S!rgial remo#al
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Entro'ion Etiology/ older
'o'!lation& e8tensi#e
sarring oon"!nti#a& inetion
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Entro'ion Redness
Light sensiti#ity
Dryness Inreased larimation
Foreign *ody sensation
Srathing o ornea Eye irritation
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Entro'ion Diagnostis/
Management/ Arti;ial tears
S!rgial tightening o m!sles
:oto8 in"etions to *!ild !' asia
+ool om'resses E'ilation o the eyelashes
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Etro'ion Etiology/ @lder
'o'!lation& th
ner#e 'alsy& an*e ongenital)@*i!laris o!li
m!slerela8ation
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Etro'ion E8essi#e larimation
Droo'ing o eyelid
Redness Light sensiti#ity
Dryness
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Etro'ion Diagnostis/
Management/
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+orneal A*rasion Irreg!larity o the ornea
Res!lts rom tra!ma or oreign
*ody&
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+orneal A*rasion 1ain,
Redness,1hoto'ho*ia
E8essi#e tearing Foreign *ody sensation
:l!rred #ision
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+orneal A*rasion Diagnostis/
Fl!oresein staining/ello$ .!oresene o e8'osed *asement
mem*rane !nderlying e'itheli!m
Management/ Remo#e oreign *ody$ith otton ti''ed a''liator) Anti*iotio'hthalmi ointment& eye 'ath $ith'ress!re& @ral 'ain mediation)
+om'liations
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U#eitis Intrao!lar in.ammation o iris& iliary
*ody and horoid
Anterior !#eitis/ o!lar in.ammation limitedto iris or iris and iliary *ody 6irodoylitis7 Intermediate !#eitis/ in.ammation o
str!t!res "!st 'osterior to the lens
1osterior !#eitis/ in.ammation o the horoid& retina or near o'ti ner#e and ma!la
Etiology/ Imm!ne& inetion& idio'athi)
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U#eitis Anterior !#eitis/
Dee' eye 'ain 1hoto'ho*ia +on"!nti#a
#essel dilation +iliary .!sh Small
'!'il,irreg!lar +ornea lear or
slightly lo!dy
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S!*on"!nti#al
9emorrhage :leeding o the on"!nti#al or
e'isleral *lood #essels into the
s!*on"!nti#al s'ae) Ris% ators inl!de *l!nt tra!ma&
r!**ing eyes& #igoro!s o!ghing&
*leeding disorder
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S!*on"!nti#al
9emorrhage Eye red $ith mild
irritation
-ision not afeted I tra!ma rule out
ruptured !lobe or
retrobulbar hemorrha!e
Management/
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Angle +los!re
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E8am'le 4
A 55 year old emale omes to yo!om'laining o 'haryngitis& e#er
and eye tearing) She has notied a$atery disharge and red eye)There is 'rea!ri!larlym'hadeno'athy
hat is thisH hat is the etiologyH hat is the managementH
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E8am'le 5
A 40 year old emale 'resents $ith *ilateral'!r!lent disharge rom her eyes) Shenotied this yesterday to right eye and no$
*oth eyes) She $o%e !' $ith her eyessti%ing together)
hat is thisH hat is the etiologyH hat are management o'tionsH I she is se8!ally ati#e& $hat other ;ndings
$o!ld 'oint to hlamydial on"!nti#itisH
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E8am'le 0
This 'atient has a history o S"ogrenCssyndrome) :esides 8erostomia& yo!diagnose this *ased on the a''earane o
her eyes) She om'lains o o!larirritation)
hat is thisH hat are histology ;ndings assoiated
$ith thisH 9o$ is this diagnosedH hat is the managementH
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E8am'le
A 'atient omes to yo! *ea!seher h!s*and notied a yello$
nod!le on her eye) hat is thisH
hat are ris%s or thisH
hat is the management o thisH hat an this ad#ane toH
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E8am'le 2
A o!r year old has a *!m' *y hereye) Mom is onerned sine it is
lea%ing yello$ st!f) hat is thisH
hat is the etiology o this in the
a!te ormH hat is the management o thisH
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E8am'le
This 'atient has a stye) hat isthe medial term or thisH
hat is the management o thisH hat might yo! all this i the area
$as not 'ain!l or tenderH
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E8am'le
A year old male'atient re'orts
e8essi#e tearing) 9ethin%s he might ha#eallergies) hat do
@U thin% he hasH
hat is themanagement or thisH
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E8am'le
A 55 year old male re'orts s!ddenonset o 'ain& 'hoto'ho*ia ande8essi#e tearing to his right eye) 9ethin%s he has a 'iee o sand in hiseye) It started $hile on the *eah)
hat is yo!r diferential diagnosisH
9o$ an yo! on;rm yo!r diagnosisH hat is the management or thisH
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E8am'le 4=
A 'atient de#elo's a!te o!lar'ain and *l!rred #ision) 9is I@1 is
G=mm9
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Staey Singer3Leshins%y R1A+