common causes - ktph red eye - gp cme 2017.pdf · common causes •allergies •infections...
TRANSCRIPT
Common Causes
• Allergies • Infections
– Ocular – Cornea, uveitis, endophthalmitis – Orbital – Orbital cellulitis
• Inflammation – Uveitis – Scleritis / episcleritis
• Glaucomas • Trauma
– Foreign bodies – Chemical injuries
History
• PAINFUL vs PAINLESS • Onset • Laterality • Contact history • Contact lens user • Trauma / recent surgery • Other symptoms
– Itch, pain, headache, nausea – Photophobia – BOV
• Medical history – Immunocompromised, thyroid
Examination
Eye Features
Visual acuity • Good • Poor
Cornea • Clear vs hazy • Foreign body • Infiltrates • Scar • Stain with fluorescein
Conjunctiva • Sectoral • Circumciliary • Diffuse • Subconj hemorrhage ± chemosis
Anterior chamber • Shallow? • Hypopyon • Hyphema
Examination
Eye Features
Pupils • Reactive • Fixed, mid-dilated • Irregular • Peaked • RAPD
Lens • Red reflex • White cataract
Orbit • Preseptal / orbital cellulitis • Proptosis • Lagophthalmos
Other features • Discharge • Associated symptoms
What we will be covering
• Corneal / conjunctival disorders
• Glaucoma
• Uveitis / inflammatory causes
• Retina
• Orbit and ocular adnexa
Dry eyes • Symptoms
– On-off • BOV • Tearing • Redness
– Discomfort – FB sensation – “Tiredness”
• Treatment – Lubricants
• Drops • Ointments
Viral Conjunctivitis
• Common organisms – Adenovirus
• Symptoms – Tearing + discharge
– Itch
– Redness
– Laterality
– Glare / photophobia
– Contact history
– Chronology
Viral Conjunctivitis - 2
• Clinical features
– Uniform conjunctival injection
– URTI symptoms
• Management
– Symptomatic
– Hand and contact hygiene
– Reassurance
Bacterial Conjunctivitis
• Severe and sight threatening • Neisseria, Chlamydia
• Clinical features – Copious, purulent discharge
– Conjunctival injection and chemosis
• Management – Copious irrigation
– Systemic antibiotics
– Systemic screening + partners
Ophthalmia Neonatorum
• Ophthalmic emergency!! • 2 weeks from birth • Vertical transmission • Organisms
– Neisseria + Chlamydia – Others: S Pneumoniae, Hemophilus – Viral
• Management – Antibiotics – Treat parents
Allergic Conjunctivitis
• Acute allergies
• Seasonal allergic conjunctivitis
• Perennial allergic conjunctivitis
• Vernal keratoconjunctivitis
• Atopic keratoconjunctivitis
• Giant papillary conjunctivitis
Acute Allergies
• Usually can pinpoint allergen
• Self-limiting
• Clinical features
– Lid edema / erythema
– Unilateral / bilateral
– Discharge
– No papillae
– No corneal involvement
Vernal KC
• Allergic disease of the conjunctiva
• A/w asthma, eczema, allergic rhinitis
• Boys > Girls
• Younger
• Clinical features
– Papillae on tarsal plate
– Limbal follicles
– Shield ulcers
Treatment
• Removal of allergen!!
• Systemic – Antihistamines
– Steroids
– Management of other associated conditions
• Ocular – Lubricants +++++
– Steroids
– Mast cell stabilisers / Anti-histamines
– Steroid-sparing agents
Blepharoconjunctivitis
• Anterior – Crusting
– Lid margin changes
– Madarosis / trichiasis
– Cicatricial changes
– Preseptal
• Posterior – Orifice plugging
– Erythema, discharge
– Corneal changes
Contact Lens
• Serious / urgent
– CL-related ulcer
• Serious / not urgent
– Contact lens overwear
• Not serious
– Scar
• Old corneal ulcer
– Dry eyes
Contact Lens Overwear
• Symptoms – Eye pain, redness – Glare / photophobia – Tearing
• Clinical features – PEES ++, SEIs, SPKs – Corneal vascularisation
• Treatment – CL holiday – Lubricants – Antibiotics
CL-related Ulcer
• Pseudomonas Aeruginosa
• Clinical features
– Localised injection
– White lesion on the cornea
• Management
– CL holiday
– Topical Fortified antibiotics
Viral Infective Keratitis
• HSV vs VZV
• Clinical features – Dendritic ulcer or geographic ulcer
– Terminal bulbs
– Stromal keratitis
– Uveitis
– Episcleritis / Scleritis
– Retinal complications
• Management – Topical antivirals
– ± topical steroids
– ± oral antivirals
Fungal Infective Keratitis
• Filamentous vs Yeasts
• Predisposing factors – Trauma (vegetative)
– Immunosuppression
• Clinical features – Gray-white ulcer with feathery edges
– Satellite lesions
– Ring infiltrate
• Treatment – Anti-fungals
Parasitic
• Acanthamoeba
• History – Contact lens user
– Contact with brackish, dirty water, eg, rivers, lakes
– Trauma
• Clinical features – Pain out of proportion to clinical signs
– Early
– Late
Subconjunctival hemorrhage
• Benign, self-limiting • Etiology
– Spontaneous – Trauma – Valsalva – Blood thinners – Systemic disorders
• Management – Reassurance, – Exclude other traumatic injuries – Lubricants
Foreign Body
• Subtarsal vs Corneal • Subtarsal
– Usually non-specific event – Management
• Removal • Ensure no infection • Antiobiotic and lubricant cover
• Corneal – Hammering, grinding, drilling – Management
• Can attempt removal • Refer to A&E
Chemical Injury
• Ocular emergency
• Acid vs Alkali injury
• Management – Acute
• Copious irrigation
• Reduce inflammation
• Promote healing
• Prevent infection
• Reduce pain
– Chronic • Complications
Corneal Abrasion / Recurrent Corneal Erosion
• Stain with Fluorescein
• Pain on waking up
• Poor attachment of epithelium to underlying basement membrane
• Management
– Lubricants
• Drops and ointments
– Antibiotics