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Differential diagnosis of

red eye
RED EYE

▪ dilation of blood vessels in response to


inflammation or infection

Conjunctival (superficial) Ciliary (deeper)


CAUSES OF RED EYE

▪ EYELIDS/ORBIT/ ▪ CONJUNCTIVA/ ▪ CORNEA ▪ ANTERIOR


LACRIMAL SCLERA ▪ Foreign body
CHAMBER
SYSTEM ▪ Subconjunctival ▪ Keratitis ▪ Uveitis (iritis,
iridocyclitis)
▪ Hordeolum/chalazion hemorrhage ▪ Abrasion, Laceration
▪ ▪ Conjunctivitis ▪ Acute angle-closure
Blepharitis ▪ Ulcer glaucoma
▪ Dacryocystitis ▪ Dry eyes
▪ Preseptal/orbital/ ▪ Pterygium
cellulitis ▪ Episcleritis/ scleritis

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Eyelids

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BLEPHARITIS

▪ Inflammation of the eyelids


▪ Signs:
▪ Gritty, burning sensation in eyes
▪ Mattering of eyes upon
awakening
▪ Redness & swelling of lid margins
▪ Scaly, flaky debris on lid margins
▪ Mild conjunctival injection

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ANTERIOR BLEPHARITIS

▪ Primarily: S. aureus
▪ Apocrine glands Zeiss and
Moll affected
▪ Infection of lid margin, lash
bases, associated glands
▪ Stasis of secretions
eventually get infected.

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POSTERIOR BLEPHARITIS

▪ Meibomian gland
dysfunction
▪ Abnormal lipid composition
& abnormal secretion
▪ Enlargement, irregularity,
inspissation, plugging of
meibomian orifices

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MANAGEMENT OF BLEPHARITIS

▪ Lid hygiene ▪ Steroid eyedrops/


▪ Warm compresses ointments:
▫ to control eye & eyelid
▪ Antibiotics
inflammation
▫ reduce lid margin
bacteria. ▪ Eye make-up
▫ prior to bedtime to ▫ discontinued while
avoid blurry vision inflammation is
present

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EXTERNAL HORDEOLUM

▪ aka stye
▪ Inflammation of ciliary
follicles or accessory glands
of the anterior lid margin
▪ Signs:
▪ Painful, tender red mass near
the lid margin of one eyelid,
often w/ pustule
▪ Mild conjunctival injection
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MANAGEMENT OF HORDEOLUM

▪ Warm compresses
▪ Topical antibiotic ointment
▪ Oral antibiotic
▪ Incision and drainage

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CHALAZION

▪ Sterile chronic
granulomatous
inflammatory lesion of
the meibomian gland
caused by retained
sebaceous secretions
▪ Hard & nontender

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MANAGEMENT OF CHALAZION

▪ Surgical excision
▪ Incision and curettage

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DACRYOCYSTITIS

▪ Inflammation of lacrimal sac


▪ Obstruction of nasolacrimal
passage
▪ Unilateral edema & erythema
w/ distention of the lacrimal
sac
▪ Children: H. influenzae
▪ Adults: S. aureus or B-
hemolytic streptococci

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MANAGEMENT OF DACRYOCYSTITIS

▪ Warm compress
▪ Oral antibiotics (Co-
amoxiclav)
▪ Do not irrigate
▪ I and D
▪ Dacryocystorhinostomy
(chronic)
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Orbit

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PRESEPTAL CELLULITIS

▪ Infection of subcutaneous tissues anterior to orbital septum


▪ Causes
▫ Skin trauma - laceration, insect bites (S. aureus or S.
pyogenes)
▫ Spread of local infection - acute hordeolum or dacryocystitis.
▫ Remote infection – URTI middle ear by hematogenous spread
▪ Signs - Unilateral, tender & red periorbital edema

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MANAGEMENT OF PRESEPTAL CELLULITIS

▪ Oral antibiotics

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ORBITAL CELLULITIS

▪ Life-threatening infection of soft tissues behind the


orbital septum, mainly in children
▪ MCC: S. pneumoniae, S. aureus, S. pyogenes and
H. influenzae.
▪ Presentation - rapid onset of severe malaise,
fever, pain & visual impairment

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ORBITAL CELLULITIS

▪ Signs
▪ Unilateral, tender, warm &
red periorbital edema
▪ Proptosis, lid swelling
▪ Painful ophthalmoplegia
▪ Optic nerve dysfunction

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Conjunctiva

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CONJUNCTIVITIS

▪ Inflammation or swelling of the


conjunctiva
▪ Common pathogens: S.
Pneumoniae, H. Influenzae, S.
aureus, N. meningitidis,
adenovirus strains, HSV
▪ Sexually transmitted causes:
C. Trachomatis, N.
gonorrhoeae
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CONJUNCTIVITIS

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PINGUECULA

▪ Area of nasal/temporal
bulbar conjunctiva that
contains epithelial
hyperplasia
▪ Irritative phenomenon due
to UV light, drying, & windy
environments
▪ Tx: topical vasoconstrictors

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PTERYGIUM

▪ “winged growth”
▪ Benign fibrovascular
proliferation of nasal, rarely
temporal bulbar
conjunctiva extending into
peripheral cornea
▪ Tx: Surgery, Excision w/
ancillary procedure

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SUBCONJUNCTIVAL HEMORRHAGE

▪ Diffuse or localised area of


blood under conjunctiva
▪ Idiopathic, trauma, cough,
sneezing, aspirin
▪ Asymptomatic
▪ Vision unchanged
▪ Tx: Reassurance,
Resolves within 10-14 days

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Cornea

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KERATOCONJUNCTIVITIS SICCA

▪ Dry eye
▪ Poor quality
▫ Meibomian gland
disease, Acne rosacea
▫ Lid related
▫ Vitamin A deficiency
▪ Poor quantity
▫ Lacrimal disease
▫ CN VII palsy

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KERATOCONJUNCTIVITIS SICCA

▪ Dx: Schirmers testing


w/ or w/o anesthesia
▪ Tear break-up time

▪ Tx: aqueous tear


replacement, punctual
occlusion
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MICROBIAL KERATITIS

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MICROBIAL KERATITIS

▪ S/Sx:
▫ Pain & FB sensation d/t
mechanical effects of lids
▫ Increased tearing d/t reflex
hyperlacrimation
▫ Photophobia d/t stimulation of
nerve endings
▫ Blurred vision d/t corneal haze
▫ Redness d/t circumcorneal
vessels congestion

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MICROBIAL KERATITIS

▪ Dx: Corneal scraping


▪ Tx: Topical antibiotics,
mainstay
▪ keratectomy
▪ corneal transplantation

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CORNEAL ABRASION / FOREIGN BODY

▪ Surface epithelium
sloughed off
▪ Tx: Patching, Topical
Antibiotics,
Cycloplegics

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CORNEAL ULCER

▪ Infection
▫ Bacterial: Adnexal infection, lid
malposition, dry eye, CL
▫ Viral: HSV, HZO
▫ Protozoan: Acanthamoeba in
CL
▪ Mechanical or trauma
▪ Chemical: Alkali injuries are
worse than acid

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Sclera & Episclera

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EPISCLERITIS

▪ Inflammatory condition ▪ S/Sx: Rapid onset of


affecting the episcleral redness, dull ache, &
tissue tenderness
▪ Eye redness confined in ▪ Tx: Topical
interpalpebral area, Vasoconstrictors, Mild
blanch w/ 10% Corticosteroids, Chilled
phenylephrine artificial tears Q4–6 hrs

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EPISCLERITIS

▪ Simple: intermittent bouts ▪ Nodular: prolonged


of moderate-to-severe attacks of inflammation
inflammation, recur at 1- that are more painful
to 3-month intervals

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SCLERITIS

▪ severe ocular inflammation w/ cellular


infiltration, destruction of collagen,
vascular remodeling of sclera
▪ Redness is gradual, bluish-red tinge,
fails to blanch w/ 10% phenylephrine
▪ Pain, severe & boring, wakes at night
▪ Tx: Systemic NSAIDs or Prednisolone

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Anterior chamber

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UVEITIS

▪ Inflammation of 1 or all
parts of the uveal tract
▪ Idiopathic
▪ Systemic
▪ Infectious
▪ Hallmark: Cells and Flare

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UVEITIS

▪ S/Sx:
▪ Deep, dull pain of eye & orbit
▪ Photophobia, Tearing
▪ Difficulty in reading
▪ Ciliary flush
▪ Sterile hypopyon (severe)
▪ Keratic precipitates
▪ Posterior synechiae
▪ Granulomatous nodules

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UVEITIS

▪ Tx: Steroids,
▪ Immunosuppresive
agents
▪ Complications:
blindness, cataract,
secondary glaucoma

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ACUTE IRITIS

▪ Pain, aching eye,


photophobia
▪ Anterior chamber
cloudy from white cells
▪ Tx: Mydriatic drops,
Analgesia, Steroid Eye
Drops
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ACUTE GLAUCOMA

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ACUTE GLAUCOMA

▪ Symptoms: ▪ Signs:
▫ ocular pain, h/a ▫ Elevated IOP
▫ unilateral BOV ▫ "ciliary flush"
▫ "iridescent" vision ▫ fixed, mid-dilated pupil
▫ n/v ▫ edematous cornea
▫ shallow anterior
chamber

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ACUTE GLAUCOMA

▪ Dx:
▪ Applanation tonometry –
eye pressure
▪ gonioscope lens – angle
structure
▪ Visual field exam – extent
of damage to nerve

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ACUTE GLAUCOMA

▪ Tx: Acetazolamide or
hyperosmotic oral
solutions, laser
iridotomy

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Thank you.

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