the red eye - yorkgpvts.co.uk · questions • one eye or both • painful / itchy / scratchy •...
Post on 27-Jul-2018
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equipment
• Snellen chart• Pinhole• Daylight• Fluorescein• Illuminated magnifier (auriscope head)• Paper clip• Proxymetacaine minims
What do you do?
• Ask a few questions• Have a look• Ask more if necessary• Find your eye things• Look again.
questions
• One eye or both• Painful / itchy / scratchy• Trauma• How long• Contact lenses• Stuck together• History of same or same in others/family• Associated URTI• Any treatment
1st look
– How old– One or both– Acuity affected– Pattern of redness in daylight– Pupil-reactive? shape? – Cornea- bright or cloudy– Look for foreign body
2nd look
• Fluorescein-stains corneal injury(abrasion, fb, herpes. All unilateral)
• Local anaesthetic-is pain relieved?• Magnifier-lumps on palpebral conjunctiva and good
look at cornea• Evert lid if fb suspected (wipe)• Feel for pre auric lmyph nodes
viral
– Watery– Unilateral then bilateral– Often with urti and preauric nodes– May be trivial to severe– May need referral if painful– May last weeks– sometimes epidemic
bacterial
– Usually bilateral– Sticky in am– Not usually painful– Self limiting, lasts days.– Treat with chloro, or fucidin in children
allergic
– Itchy– Seasonal or perennial– Hay fever– Chronic severe types may need steroids esp in
children/teenagers– sensitised to drops or preservatives
Corneal causes
• Abrasion• Foreign body• Corneal ulcer
• Contact lenses, herpetic
• Other rarer causes• Look for cloudy cornea• Any corneal cause needs slit lamp exam to confirm
herpetic
– Simplex usually corneal except as primary infection and commonly recurrent
– Zoster causes immune mediated intra ocular inflammation 2-any weeks after infection
– Signs of uveitis– Corneal denervation– Raised iop common
blepharitis
• Itching• burning• mild pain• fb sensation• tearing or dry• crusting• recurrent and variable
uveitis
– Usually unilateral or asymmetric– Painful, unrelieved by local– Circumcorneal injection– Recurrent– May be systemic associations
• HLA B27. Sarcoid etc– Needs referral
• Only indication in 1care for steroids if recurrent before slit lamp examination
scleritis
– Immune mediated- complex deposition– Needs systemic Ix and Rx– Painful and usually bilateral– Try nsaids, then steroids then others
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