acute unilateral red eye
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Acute unilateral red eye. Dr. Anthony Hall MD, FRA NZ CO. 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. Eyelid. - PowerPoint PPT PresentationTRANSCRIPT
Acute unilateral red eye
Dr. Anthony Hall MD, FRANZCO
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
Eyelid
Acute lid problems
Chalazion Preseptal cellulitis
Chalazion Obstructed and
infected and inflamed meibomian gland
Unilateral, unifocal lid swelling
Chalazion – initial treatment Topical antibiotics
+ oral if associated cellulitis
Hot compresses If fails then surgery
Chalazion – surgical treatment LA Lid everted Chalazion incised
form tarsal surface
Preseptal cellulitis Acutely unwell Swollen, tender red
eyelid No orbital signs
No proptosis, visual loss, movement problems
Orbital vs preseptal cellulitis The orbital septum
divides the eyelid from the orbit
Conjunctiva
Conjunctivitis Viral
Watery discharge URTI
Allergic Itch Stringy discharge Atopic patient
Usually bilateral!!
Viral conjunctivitis URTI Acute pain, redness,
and watery discharge Normal pupil Normal VA Normal cornea
Management
Allergic conjunctivitis Atopy Sub-acute irritation,
itch, redness, and stringy discharge
Normal pupil Normal VA Normal cornea
Subconjunctival haemorrhage
Cornea
Keratitis Suspect if
Corneal fluorescein stain (dendritic)
Focal corneal swelling
Past history HSV/VZV
Contact lens wear Post trauma
Keratitis management HSV
Topical aciclovir till epithelium healed
Keratitis management Bacterial
Intensive topical antibiotics
Corneal foreign body/ulcer Suspect if
History of grinding etc
Fluorescein staining Corneal/subtarsal
foreign body Always evert eyelid
Management of corneal FB Topical LA Remove fb with 23 G
needle Oc Chloro and pad 24
hrs
Corneal ulcer Without Fluorescein: Underlying cornea is
clear - iris details are seen
Fluorescein with or without cobalt blue filter
Anterior chamber
Trauma Hyphaema or corneal
abrasion may follow trauma
In this setting beware of Keratitis Perforation
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)
Iritis - symptoms
pain redness photophobia epiphora
Iritis - signs ciliary flush small irregular pupil AC cells and flare keratic precipitates hypopyon iris nodules spill over vitritis
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
B 27 related diseases
Ankylosing spondylitis Psoriatic arthritis Reiters syndrome (reactive arthritis) Inflammatory bowel disease associated
arthropathy
Sarcoidosis Multisystem
granulomatous disease 90% lung 90% lymph node 25-50% joint
involvement 25% skin 25% eye
Syphilis Primary
4-6 weeks of ulcer Secondary
2-4 months Skin rash and
lymphadenopathy Eye and CNS
involvement Latent/tertiary
CVS and CNS
Viral Suspect if
History of simplex or zoster
Chronic course Iris changes High pressure Keratitis (old or
new)
Investigation of AAU
Most important Clinical
HistoryFamily history
Examination
Less important HLA B 27 Sarcoidosis
CXRACE
Syphilis serology
Principles of management of Iritis Determine the underlying cause Control the inflammation Detect and control ocular complications of
the inflammation the treatment
How to control the inflammation
Adequate high potency topical steroids Sub conjunctival steroids Oral steroids
Aggressive dilation
Regular and close review
Acute angle closure glaucoma Unusual Severe pain Profound visual loss Cloudy cornea Fixed mid position
pupil
Treatment iridotomy
Orbital disease
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
Pre septal Orbital
Treatment
Pre septal Antibiotics
Orbital Image Drain sinus disease Antibiotics Drain orbital disease
Key steps in the diagnosis of the unilateral red eye History Ocular
Previous episodesCL wearTrauma
SystemicAuto-immune diseaseRecent URTI
Examination VA Cornea Pupil Conjunctiva
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