Name: Red Eye: Painless
Uploaded: 2021-11-22
Duration: 27 min 1 s
Description: Red Eye: Painless. Dr. Motasem Al-latayfeh, MD Consultant Ophthalmologist Hashemite University.

Red Eye: Painless. Dr. Motasem Al-latayfeh, MD Consultant Ophthalmologist Hashemite University. 

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Dr. Motasem Al-latayfeh, MD Consultant Ophthalmologist Hashemite University

It is necessary to perform a systematic exam to determine the involved ocular structure In general, the red eye will be caused by an infection (viral / bacterial) or inflammation (allergic / autoimmune) of a particular structure An acute elevation of intraocular pressure (acute glaucoma) is a rare cause of red eye, but must not be missed. 

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It is necessary to perform a systematic exam to determine the involved ocular structure  In general, the red eye will be caused by an infection (viral / bacterial) or inflammation (allergic / autoimmune) of a particular structure  An acute elevation of intraocular pressure (acute glaucoma) is a rare cause of red eye, but must not be missed

A “ Red Eye ” may be due to an abnormality of a number of ocular structures, including: Adnexa: (i.e. inflamed lids and periorbital region) Lid disorders Lacrimal system inflammatory conditions Orbital disease Globe: Conjunctival / scleral disorders Corneal disease Uveitis Glaucoma. 

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A  “ Red Eye ”  may be due to an abnormality of a number of ocular structures, including:   Adnexa:   (i.e. inflamed lids and periorbital region)  Lid disorders  Lacrimal system inflammatory conditions  Orbital disease  Globe:   Conjunctival / scleral disorders  Corneal disease  Uveitis  Glaucoma

Your objective in assessing a patient with periocular or ocular inflammation is to use the ocular history and physical examination to localize the site of the abnormality and determine its possible etiology Directed Ocular History Characterize the symptoms: Duration – hours, days, weeks Unilateral or bilateral Onset of symptoms – acute vs. chronic Precipitating event – trauma, contact lens usage Previous episodes of a similar problem Treatment to date. 

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Your objective in assessing a patient with periocular or ocular inflammation is to use the ocular history and physical examination to localize the site of the abnormality and determine its possible etiology  Directed Ocular History  Characterize the symptoms:  Duration  –  hours, days, weeks  Unilateral or bilateral  Onset of symptoms  –  acute vs. chronic  Precipitating event  –  trauma, contact lens usage  Previous episodes of a similar problem  Treatment to date

General Danger Symptoms Decreased vision Severe ocular pain Coloured haloes. 

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General Danger Symptoms  Decreased vision  Severe ocular pain  Coloured  haloes

Associated symptoms and symptom complexes Itching, seasonal exacerbation, associated rhinitis = allergy Burning, foreign body sensation, tearing = blepharitis, dry eye, retained foreign body, trichiasis Localized lid tenderness = hordeolum, chalazion Mucopurulent discharge, crusting = bacterial conjunctivitis Mucoid discharge, URTI, history of contacts, initially unilateral then bilateral = viral conjunctivitis Intense pain = corneal ulcer, scleritis, iritis, acute glaucoma Nausea, vomiting, intense ocular pain, halos' in vision = acute glaucoma Intense photophobia = uveitis, keratitis, corneal ulcer. 

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Associated symptoms and symptom complexes  Itching, seasonal exacerbation, associated rhinitis = allergy  Burning, foreign body sensation, tearing = blepharitis, dry eye, retained foreign body, trichiasis  Localized lid tenderness = hordeolum, chalazion  Mucopurulent discharge, crusting = bacterial conjunctivitis  Mucoid discharge, URTI, history of contacts, initially unilateral then bilateral = viral conjunctivitis  Intense pain = corneal ulcer, scleritis, iritis, acute glaucoma  Nausea, vomiting, intense ocular pain, halos' in vision = acute glaucoma  Intense photophobia = uveitis, keratitis, corneal ulcer

Directed Ocular Examination Record the visual acuity for distance, correction If decreased, use pinhole or near vision Examine the pupils for asymmetry (uveitis, acute glaucoma), reactivity, relative afferent pupil defect (RAPD). 

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Directed Ocular Examination Record the visual acuity for distance, correction  If decreased, use pinhole or near vision  Examine the pupils for asymmetry (uveitis, acute glaucoma), reactivity, relative afferent pupil defect (RAPD)

External Ocular Examination Is there redness around (vs. in) the eye Localized lid redness = chalazion, hordeolum Localized periorbital inflammation = dacryoadenitis, dacryocystitis Diffuse periorbital inflammation = orbital cellulitis. 

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External Ocular Examination  Is there redness  around  (vs. in) the eye  Localized lid redness = chalazion, hordeolum  Localized periorbital inflammation = dacryoadenitis, dacryocystitis  Diffuse periorbital inflammation = orbital cellulitis

Slit Lamp Examination Lid margin – blepharitis? Conjunctiva – diffuse or sectoral redness? Limbal injection (corneal or iris involvement)? Conjunctivial follicles (viral conjunctivitis) Cornea – clear or opaque? Epithelial defect with fluorescein? Abrasion vs. ulcer Anterior chamber – cells & flare? Narrow with ACG? Iris Lens. 

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Slit Lamp Examination  Lid margin  –  blepharitis?  Conjunctiva  –  diffuse or sectoral redness?     Limbal injection (corneal or iris involvement)?  Conjunctivial follicles (viral conjunctivitis)  Cornea  –  clear or opaque?    Epithelial defect with fluorescein?    Abrasion vs. ulcer  Anterior chamber  –  cells & flare?    Narrow with ACG?  Iris  Lens

Clinical Features : Palpebral or diffuse redness Purulent discharge Papillae Edema of eyelids. 

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Clinical Features : Palpebral or diffuse redness Purulent discharge  Papillae Edema of eyelids

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Common pathogens : Staphylococcus coagulase or non-coagulase positive, Streptococcus Hemophilus influenzae, Pseudomonas sp .. 

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Common pathogens :   Staphylococcus coagulase   or  non-coagulase positive, Streptococcus    Hemophilus   influenzae,  Pseudomonas sp .

Treatment: culture warm compresses clean lids of discharge Topical antibiotic drops qid for 5-7 days and ointment hs for 7-10 days. 

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Treatment: culture warm compresses  clean lids of discharge Topical antibiotic drops qid for 5-7 days and ointment hs for 7-10 days

Very serious infection caused by gonococcus May rapidly perforate the cornea URGENT REFERRAL for intensive IV & topical treatment. 

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Very serious infection caused by  gonococcus   May rapidly perforate the cornea  URGENT REFERRAL for intensive IV & topical treatment

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Symptoms – itching, burning, redness;palpebral patient often has a viral URI and / or history of contact with others affected. 

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Symptoms  –   itching,  burning,  redness;palpebral  patient often has a viral URI and / or history of contact with others affected

Signs – mucoid / watery discharge, conjunctival follicles, preauricular lymph node palpable pseudomembrane subepithelial infiltrates. 

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Signs  –   mucoid / watery discharge,  conjunctival follicles,  preauricular lymph node palpable pseudomembrane  subepithelial infiltrates

Highly contagious, epidemics occur Adenovirus commonest cause Initially one eye, with second eye affected a few days later Rx artificial tears & cold compresses topical steroids sometimes used in severe cases Gets worse for 4-7 days, then resolves over next 2-3 weeks (contagious for 10-12 days). 

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Highly contagious, epidemics occur  Adenovirus commonest cause  Initially one eye, with second eye affected a few days later   Rx artificial tears & cold compresses  topical steroids sometimes used in severe cases  Gets worse for 4-7 days, then resolves over next 2-3 weeks (contagious for 10-12 days)

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Adult chlamydial Keratoconjunctivitis: Adult chlamydial keratoconjunctivitis is a sexually transmitted disease caused by the obligate intracellular bacterium Chlamydia trachomatis serotypes D to K. Patients with chlamydial conjunctivitis are generally young At least 50% have a concomitant genital infection. Transmission is by autoinoculation from genital secretions although eye-to-eye spread may occur rarely.. 

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Adult chlamydial Keratoconjunctivitis: Adult chlamydial keratoconjunctivitis is a sexually transmitted disease caused by the obligate intracellular bacterium  Chlamydia trachomatis  serotypes D to K.  Patients with chlamydial conjunctivitis are generally young  At least 50% have a concomitant genital infection.  Transmission is by autoinoculation from genital secretions although eye-to-eye  spread may occur rarely.

Presention is with a subacute onset of unilateral or bilateral, mucopurulent discharge. Unlike adenoviral infection, the conjunctivitis may persist for 3-12 months if untreated> Signs include: edematous conjunctiva, mucopurulent discharge, papillary then follicular reaction , non-tender lymphadenopathy. Corneal involvement is uncommon Long-standing cases are characterized by conjunctival scarring. 

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Presention is with a subacute onset of unilateral or bilateral,   mucopurulent  discharge.  Unlike adenoviral infection, the conjunctivitis may persist for 3-12 months if untreated> Signs include: edematous conjunctiva, mucopurulent discharge, papillary then follicular reaction , non-tender lymphadenopathy. Corneal involvement is uncommon Long-standing cases are characterized by conjunctival scarring

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Treatment: Topical therapy is with tetracycline ointment four times daily for 6 weeks. Systemic therapy can be with one of the following: Doxycycline either 300 mg weekly for 3 weeks or 100 mg daily for l-2 weeks. Tetracycline 250mg four times daily for 6 weeks. Erythromycin 250mg four times daily for 6 weeks if tetracycline is inappropriate.. 

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Treatment: Topical therapy is with  tetracycline ointment four  times daily for 6 weeks. Systemic therapy can be with one of the following: Doxycycline either 300 mg weekly for 3 weeks or 100 mg daily for l-2 weeks. Tetracycline 250mg four times daily for 6 weeks. Erythromycin 250mg four times daily for 6 weeks if tetracycline is inappropriate.

Chlamydial infection is the most common cause of neonatal conjunctivitis. It may be associated with systemic chlamydial infection which may result in otitis, rhinitis and pneumonitis. Because the infection is transmitted from the mother during delivery it is important that both parents are examined for evidence of genital infection.. 

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Chlamydial infection is the most common cause of neonatal  conjunctivitis.  It may be associated with systemic chlamydial infection which may result in otitis, rhinitis and pneumonitis.  Because the infection is transmitted from the mother during delivery it is important that both parents are examined for evidence of genital infection.

Presentation is usually between 5 and 19 days after birth. Signs include Papillary conjunctivitis with a mucopurulent discharge . Treatment is with topical tetracycline and oral erythromycin 25mg/kg body weight twice daily for 14 days.. 

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Presentation is usually between 5 and 19 days after birth. Signs include Papillary conjunctivitis with a mucopurulent discharge . Treatment is with topical tetracycline and oral erythromycin 25mg/kg body weight twice daily for 14 days.

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Symptoms – itching, Redness: perilimbal , bulbar or palpebral seasonal, atopic history, rhinitis. 

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Symptoms  –  itching, Redness: perilimbal , bulbar or palpebral seasonal,  atopic history,  rhinitis

Signs – chemosis, papillary reaction, Mucus Limbal thickening with white deposits. 

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Signs  –   chemosis,  papillary reaction,  Mucus Limbal thickening with white deposits

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Treatment – cool compresses, artificial tears, topical antihistamines/vasoconstrictors systemic antihistamines, topical mast cell stabilizers. 

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Treatment  –   cool compresses,  artificial tears,  topical antihistamines/vasoconstrictors  systemic antihistamines,  topical mast cell stabilizers

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Pingueculum Change in conjunctiva due to wind, sun exposure, increased vascularity confined to conjunctival tissue respond to irritants in environment (eg. smoke, fumes) by becoming red, inflamed, and obvious Treatment: lubricant and/or vasoconstrictor. 

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Pingueculum Change in conjunctiva due to wind, sun exposure, increased vascularity   confined to conjunctival tissue  respond to irritants in environment (eg. smoke, fumes) by becoming red, inflamed, and obvious  Treatment:  lubricant and/or vasoconstrictor

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Pterygium : Blood vessel extension onto cornea Treatment a. frequent use of artificial tears b. sungoggles/sunglasses for outdoor wear (with ultraviolet filter) c. topical ophthalmic solutions with vasoconstrictors up to tid prn to alleviate redness d. refer for possible removal if actively growing pterygium or severe inflammation. 

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Pterygium : Blood vessel extension onto cornea Treatment a. frequent use of artificial tears b. sungoggles/sunglasses for outdoor wear (with ultraviolet filter) c. topical ophthalmic solutions with vasoconstrictors up to tid prn to alleviate redness d. refer for possible removal if actively growing pterygium or severe inflammation

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Subconjunctival Haemorrhage : blood beneath conjunctiva No pain, normal vision Traumatic or spontaneous Traumatic cases should be referred to rule out other ocular injury Spontaneous may follow coughing, sneezing or straining Spontaneous will resolve in about 10 days – but should check CBC, INR/PTT & BP if recurrent episodes . no treatment except time and reassurance. 

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Subconjunctival Haemorrhage  : blood beneath conjunctiva  No pain, normal vision  Traumatic or spontaneous  Traumatic cases should be referred to rule out other ocular injury  Spontaneous may follow coughing, sneezing or straining  Spontaneous will resolve in about 10 days  –  but should check CBC, INR/PTT & BP if recurrent episodes  . no treatment except time and reassurance

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Red Eye: Painless 

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 Subconjunctival Haemorrhage  : blood beneath conjunctiva  No pain, normal vision  Traumatic or spontaneous  Traumatic cases should be referred to rule out other ocular injury  Spontaneous may follow coughing, sneezing or straining  Spontaneous will resolve in about 10 days  –  but should check CBC, INR/PTT & BP if recurrent episodes  . no treatment except time and reassurance 