Acute unilateral red eye
description
Transcript of Acute unilateral red eye
![Page 1: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/1.jpg)
Acute unilateral red eye
Dr. Anthony Hall MD, FRANZCO
![Page 2: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/2.jpg)
differential diagnosis of the unilateral red eye Eyelid Conjunctiva
Conjunctivitis Cornea
Corneal foreign body/ulcer Infectious keratitis
Sclera Anterior chamber
Iritis Angle closure glaucoma
Orbit
![Page 3: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/3.jpg)
Eyelid
![Page 4: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/4.jpg)
Acute lid problems
Chalazion Preseptal cellulitis
![Page 5: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/5.jpg)
Chalazion Obstructed and
infected and inflamed meibomian gland
Unilateral, unifocal lid swelling
![Page 6: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/6.jpg)
Chalazion – initial treatment Topical antibiotics
+ oral if associated cellulitis
Hot compresses If fails then surgery
![Page 7: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/7.jpg)
Chalazion – surgical treatment LA Lid everted Chalazion incised
form tarsal surface
![Page 8: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/8.jpg)
Preseptal cellulitis Acutely unwell Swollen, tender red
eyelid No orbital signs
No proptosis, visual loss, movement problems
![Page 9: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/9.jpg)
Orbital vs preseptal cellulitis The orbital septum
divides the eyelid from the orbit
![Page 10: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/10.jpg)
Conjunctiva
![Page 11: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/11.jpg)
Conjunctivitis Viral
Watery discharge URTI
Allergic Itch Stringy discharge Atopic patient
Usually bilateral!!
![Page 12: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/12.jpg)
Viral conjunctivitis URTI Acute pain, redness,
and watery discharge Normal pupil Normal VA Normal cornea
Management
![Page 13: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/13.jpg)
Allergic conjunctivitis Atopy Sub-acute irritation,
itch, redness, and stringy discharge
Normal pupil Normal VA Normal cornea
![Page 14: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/14.jpg)
Subconjunctival haemorrhage
![Page 15: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/15.jpg)
Cornea
![Page 16: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/16.jpg)
Keratitis Suspect if
Corneal fluorescein stain (dendritic)
Focal corneal swelling
Past history HSV/VZV
Contact lens wear Post trauma
![Page 17: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/17.jpg)
Keratitis management HSV
Topical aciclovir till epithelium healed
![Page 18: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/18.jpg)
Keratitis management Bacterial
Intensive topical antibiotics
![Page 19: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/19.jpg)
Corneal foreign body/ulcer Suspect if
History of grinding etc
Fluorescein staining Corneal/subtarsal
foreign body Always evert eyelid
![Page 20: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/20.jpg)
Management of corneal FB Topical LA Remove fb with 23 G
needle Oc Chloro and pad 24
hrs
![Page 21: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/21.jpg)
Corneal ulcer Without Fluorescein: Underlying cornea is
clear - iris details are seen
![Page 22: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/22.jpg)
Fluorescein with or without cobalt blue filter
![Page 23: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/23.jpg)
Anterior chamber
![Page 24: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/24.jpg)
Trauma Hyphaema or corneal
abrasion may follow trauma
In this setting beware of Keratitis Perforation
![Page 25: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/25.jpg)
Iritis(acute anterior uveitis) Inflammation confined primarily to the iris
and anterior chamber Resolving totally within three months (not associated with other significant
anterior or posterior segment pathology)
![Page 26: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/26.jpg)
Iritis - symptoms
pain redness photophobia epiphora
![Page 27: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/27.jpg)
Iritis - signs ciliary flush small irregular pupil AC cells and flare keratic precipitates hypopyon iris nodules spill over vitritis
![Page 28: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/28.jpg)
![Page 29: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/29.jpg)
Id io pa th ic O th e rs(sa rco id , in fe c tion s , tra u m a e tc)
H L A B 27 -ve
N o d is e a se
A n kylo sin g spo n d ylit is R e ite r's syn d ro m e P so ria tic a rth rit is In fla m m ato ry b o w e l d ise a se
B 2 7 re la te d d ise a se
H L A B 2 7 + ve
Irit is
Iritis - aetiology
![Page 30: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/30.jpg)
B 27 related diseases
Ankylosing spondylitis Psoriatic arthritis Reiters syndrome (reactive arthritis) Inflammatory bowel disease associated
arthropathy
![Page 31: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/31.jpg)
Sarcoidosis Multisystem
granulomatous disease 90% lung 90% lymph node 25-50% joint
involvement 25% skin 25% eye
![Page 32: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/32.jpg)
Syphilis Primary
4-6 weeks of ulcer Secondary
2-4 months Skin rash and
lymphadenopathy Eye and CNS
involvement Latent/tertiary
CVS and CNS
![Page 33: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/33.jpg)
Viral Suspect if
History of simplex or zoster
Chronic course Iris changes High pressure Keratitis (old or
new)
![Page 34: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/34.jpg)
Investigation of AAU
Most important Clinical
HistoryFamily history
Examination
Less important HLA B 27 Sarcoidosis
CXRACE
Syphilis serology
![Page 35: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/35.jpg)
Principles of management of Iritis Determine the underlying cause Control the inflammation Detect and control ocular complications of
the inflammation the treatment
![Page 36: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/36.jpg)
How to control the inflammation
Adequate high potency topical steroids Sub conjunctival steroids Oral steroids
Aggressive dilation
Regular and close review
![Page 37: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/37.jpg)
Acute angle closure glaucoma Unusual Severe pain Profound visual loss Cloudy cornea Fixed mid position
pupil
Treatment iridotomy
![Page 38: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/38.jpg)
![Page 39: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/39.jpg)
![Page 40: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/40.jpg)
![Page 41: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/41.jpg)
![Page 42: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/42.jpg)
Orbital disease
![Page 43: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/43.jpg)
Orbital cellulitis Pre septal
Acute lid swelling No chemosis, visual
loss or eye movement disorder
Secondary to trauma, chalazia, lacrimal sac disease
Orbital Lid swelling Chemosis, visual loss,
eye movement abnormalities
Secondary to sinus disease
![Page 44: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/44.jpg)
Pre septal Orbital
![Page 45: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/45.jpg)
Treatment
Pre septal Antibiotics
Orbital Image Drain sinus disease Antibiotics Drain orbital disease
![Page 46: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/46.jpg)
Key steps in the diagnosis of the unilateral red eye History Ocular
Previous episodesCL wearTrauma
SystemicAuto-immune diseaseRecent URTI
Examination VA Cornea Pupil Conjunctiva
![Page 47: Acute unilateral red eye](https://reader036.fdocuments.us/reader036/viewer/2022062222/568165bf550346895dd8c191/html5/thumbnails/47.jpg)
R e laxg o to pub
N o rm a l V AC le a r co rn ea (n o s ta in )N o rm a l re a c tive p u p il
W o rry !
D e c re a sed V AC o rn ea l s ta in o r c lo u d in e ssS m all o r n o n re a ctive p u p il
A cu te u n ila te ra l red e yeT yp e tit le h e re