Presented by: Awatif K. Al-Mutairi Hind K. Bin-Drees Sarah N. Al-Gubaisi Supervised by: Dr....
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Transcript of Presented by: Awatif K. Al-Mutairi Hind K. Bin-Drees Sarah N. Al-Gubaisi Supervised by: Dr....
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