Presented by:Awatif K. Al-MutairiHind K. Bin-Drees

Sarah N. Al-Gubaisi

Supervised by:Dr. Al-Johara Al- Quaiz

Red Eye

Iron deficiencyAnaemia

acne

RED EYEOutlines:• What is red eye?• Red eye in PHC.• DDx.• How to deal with pt. with red eye?

A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6.

Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60.

25 year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6.

19 -year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9.

Back groundCardinal sign of ocular inflammation.Most cases can managed effectively by

the PC provider.Account ≈ 2% of GP consultation (at least

1 case/week).In KSA, trachoma prevalence was 22.2% in

1984, while in 1994, it was 10.7%.Conjunctivitis in KSA is very common but

least researched.

Pathophysiology Due to dilatation of BVs in the eye. BV either ciliary OR conj. Injection

Ant. cil. a. superficial a.(cornea,iris, ↑↑redness

cili.body) ↔ ê topical VC

DDx

Blepharitiseither staphylococcal or seborreic, FB sensation, burning, matting of the lashes, Worse in the morning.

CellulitisPreseptal:

tender, swollen, red lid,,, ??? insect bites, minor trauma, and

sinus disease.

Orbital: tender, swollen, and red eyelid.

DacrocystitisPain, redness, and swelling over lacrimal

sac

Tearing and discharge from the sac.

The vision is unchanged

Antibiotics, if not improve >>> refer

Conjunctivitis Viral:

– Watery discharge, redness, discomfort , photophobia.

– Bilateral– lymphoid follicles– Enlarged tender preauricular

nodes.

Conjunctivitis (Cont.)Bacterial:

– acute redness(pink eye), grittiness, burning

– mucupurulent discharge– crusted eyelids on waking

Conjunctivitis (Cont.)Chlamydia (trachoma):

– red, mildly irritated eye, mucopurulent discharge.

– lids stuck together on awakening.– Unilateral, preauricular node, papillae

Conjunctivitis (Cont.)

• allergic rhinoconjunc.:

– red , itchy, watery eyes,

– sneezing , watery nasal discharge

Conjunctivitis (Cont.)

• Vernal keratoconjunctivitis– itching, lacrimation, burning , FB

sensation, photophobia.– Hx of atopy,– Giant Papillae, Tranta's Dots.

Keratoconj. Siccasandy sensation, dryness, burning

peak in the afternoon

Rx: eye lubricants

Corneal abrasion/ulcer

Pain (a.m), ↓ ↓ VA, photophopiaFB, bacterial, fungal(contact lenses),herpis(dendritic keratitis)

Scleritisglobe is tender, sclera swollen, ↓ ↓ VA

Deep scleral injection

If sever, deep violet discoloration

Iritis + Uveitis Pain, perilimbal flush, ↓ ↓ VA,

photophopia, small pupil.minor trauma, chronic inflammatory

conditions UC.??? acute glaucoma, cataract.

Acute angle closure

glaucomared, hard eye, mid dilated pupil,cloudy corneaunilateral

Medicationsalt solution, alcohol, ground cowries,

human sputum, bird and lizard faeces, urine, …etc.)

corneal ulcers ,scars or eye

perforations

How to approach the patient

At first: is this emergency case?

Neonates should always be referred to an ophthalmologist.

Management

Rule out serious ophthalmic conditions

YESNO

Refer URGENTLY

corneal abrasion

Conjunctivitiscellulitis Hordeolum Blepharitis

Management (cont.)

corneal abrasion

Conjunctivitiscellulites Hordeolum Blepharitis

Lid hygieneAbcs

(fusidic acid Tetracycli)

HOT COMPRESSNO Abcs

??(stye)

periorb. Abcs

Orbital refer

Superficial deep

LAAbcsErythromNSAID

refer

Management (cont.)

Conjunctivitis

Watery discharge Preauric.LN

( Viral conj).

Preaur.LN .hx sex .Contact

(chlamydia)

Mucopurul. stick lid

( a.m)( bact. Conj ).

Severe itching

(allergic)

lid vesicle(HSV, HZ)

REFER

Adeno.Cold comp.Herpis

< refer>

Cold comp.Antihist.

Abcs(Fucithalmic)

1wk.

Not improve

A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6.

Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60.

25 year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6.

19 -year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9.

conclusion

Refrences • Farina A.2005.red eye evaluation.e-medicine.• Yorston d., Zondervan m.2005. Red eye: the role of primary

care.community Eye Health Journal Vol 18 No.53 2005 p78• Allan V. Diagnosis and Treatment of Red Eye.Primary Care Case

Reviews: Volume 4)1( March 2001 pp 23-31• Leibowitz H. The red eye. N Engl J Med. 2000. 3;343)5(:345-51.• Jacobs DH. Evaluation of the Red Eye. UpToDate 2003.• Tabbara KF, al-Omar OM. Trachoma in Saudi Arabia.

Ophthalmic Epidemiol. 1997 Sep;4)3(:127-40• www.sunmed.org/redeye/htm • http://www.eyeweb.org/the_red_eye.htm