OPHTHALMOLOGY (ABC)

RED EYE
The red eye is one of the most common ophthalmic problems CAUSES OF RED EYE 1. Conjunctivitis 2. Episcleritis & scleritis 3. Corneal ulceration 4. Uveitis 5. Acute closed angle glaucoma 6. Subconjunctival hemorrhage 7. Inflamed pterygium & pingueculum Red eye may be associated with Pain Itching Discomfort Discharge Visual loss

CONJUNCTIVITIS
Most common cause of uncomfortable red eye Causes: Viral Bacterial Allergy Chlamydia

BACTERIAL CONJUNCTIVITIS
Symptoms Discomfort, red eye Purulent discharge ( difficult to open in the morning because of the stickiness of eye lashes because of the discharge) Exam Clear vision Red eye No eye cornea staining after putting the flurescein Management Topical drops antibiotics ( chloramphenicol) Ointment ( chloramphenicol) at night to prevent the stickiness of eye lashes in the morning Advice Good hygiene ( no sharing face towels)

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OPHTHALMOLOGY (ABC)

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OPHTHALMOLOGY (ABC)

VIRAL CONJUNCTIVITIS
Epidemic of red eye Common with URTI Usually caused by adenovirus Symptoms Bilateral eye redness + uncomfortable Watery discharge Begins in one eye then goes to the next eye History of presence of cold & cough Photophobia Exam Presence of follicles ( white lymphoid aggregation) on the conjunctiva Management Lasts longer than bacterial conjunctivitis, for many weeks Self limiting condition Antibiotics eye drops FOR Symptomatic relieve Prevent secondary bacterial infection Highly contagious strict hygiene for BOTH the doctor & the patient Chronic infection needs steroids eye drops1

CHLAMYDIAL CONJUNCTIVITIS (Chlamydia trachomatis)

Major cause of blindness Symptoms Young patients Bilateral conjunctivitis Mucopurulent discharge May be associated with venereal disease Exam Bilateral diffuse conjunctival injection Presence of follicles under the eyelids Keratitis Management Difficult to diagnose clinically, should do culture

Steroids must be prescribed with ophthalmologist supervision, because the risk of glaucoma & cataract

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OPHTHALMOLOGY (ABC)

Tetracycline2 for one month Poor compliance recurrence

Complications Severe scarring of the conjunctiva underlying the tarsal plate that may also cause: Entropion, damage to the cornea

CONJUNCTIVITIS IN INFANTS
EXTREMLY IMPORTANT, because it may causes Blindness Immature eye deafness Severe corneal disease In an infant less than 1 month old ( ophthalmia neonatorum) is a notifiable disease Venereal diseases in parents should be excluded.

ALLERGIC CONJUNCTIVITIS
Symptoms History (+) family history History of contact with chemicals or eye drops Acute Vs. chronic EXAM Red eye Large papillae due to edema in the conjunctiva that covers the eyelids (cobblestone appearance) Management Mainly ITCHING Binocular red eye Clear discharge

Topical Antihistamines Vasoconstrictor eye drops Steroids can be used ( risk of glaucoma and cataract)

Tetracycline affects the growth of bone & teeth in children ( contraindicated), also not used in pregnancy

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OPHTHALMOLOGY (ABC)

EPISCLERITIS & SCLERITIS

Localized area of redness & inflammation Causes : Rheumatoid arthritis ( mainly), idiopathic Symptoms : red, sore eye

IRITIS, IRIDOCYCLITIS (ANTERIOR UVEITIS) & PANUVEITIS

DEFINITIONS Uvea: iris + ciliary body + choroids Iritis: inflammation of the iris Cyclitis: inflammation of the ciliary body Iridocyclitis ( anterior uveitis): both iritis + cyclitis Risk people to develop anterior uveitis Who have HLA B27 ( Autoimmune) Ankylosing spondylitis adults Seronegative RA children Infectious Syphilis, TB, sarcoidosis, herpes zoster ophthalmaticus Causes of Panuveitis SLE polyarthritis nodosa, toxoplasmosis, wegner's granulomatosis Symptoms Pain Exam Increases during reading due to contracting the ciliary muscle Photophobia due to inflammation and ciliary spasm Impaired vision & accomodation Inflammatory cells in the ant. Chamber ( hypopyon) The eye is red around the cornea, circumcorneal redness Small pupil spasm of the sphincter Inflammatory cells deposits behind the cornea ( keratic precipitates)

Management Treat underlying disease 5

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OPHTHALMOLOGY (ABC)

Steroids for inflammation Ciliary body paralysis to decrease the pain Dilatation of the pupil prevents adhesions between the iris and the lens ( posterior synechia) glaucoma3 Complications Glaucoma Cataract Edema of the macula

SUBCONJUNCTIVAL HEMORRHAGE
Symptoms Red eye with/ without visual disturbance History of Trauma, foreign body, ocular injury, strain, child birth, HTN Exam Localized / diffused area of subconjunctival blood No discharge Management Role out HTN The patient should be assured and told that the redness may take several weeks to fade Coagulation profile should be checked & platelets

Open angle glaucoma may developed, because inflamed cells may block the trabecular meshwork

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