MBBS MRCS MRCGP pgcertMed ED pgdIP DIABETES AND ENDOCRINOLOGY pgdIP ent Opthalmology for GPVTS The red eye 1 Where is the eye red Sectorial All over Cirumcorneal ID: 1009785
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1. Dr Asoka Wijayawickrama MBBS, MRCS, MRCGP, pgcertMed ED, pgdIP DIABETES AND ENDOCRINOLOGY , pgdIP entOpthalmology for GPVTS
2. The red eye 1) Where is the eye red ? Sectorial ? All over? Cirumcorneal ?
3. Sectorial
4. Sectorial
5. Circumcorneal redness
6. All over
7. vision
8. Is the cornea clear
9. Pupil reactions/ relative afferent pupillary defect
10. LIDS ? Smooth ? discharge
11. Pain/ photophobia ?
12. Fluroscein staining
13. Fluroscein staining
14. conditionsconditionhistoryExam featuresAcute glaucomaUnilateral pain, headache,lights surrounded by haloes , nausea/ vomitReduced VA, tender hard eye, ciliary injection fixed mid dilated pupilCorneal ulcer/ contact lens red eyePhotophobia, blurred vision,pain may start with FB sensationSevere conjunctival injection, discharge, ulceration on fluresceinAnterior uveitis Pain, photophobia , epiphora, hx spondyloarthritis Ciliary injection, constricted/ distorted pupil VA may be normalscleritisSevere painReduced v/a abnormal pupil reaction
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17. URGENT EYEUrgent referral penetrating eye injury/ high velocity FBChemical injuriesNeonatal conjunctivitisAny red eye within 6 weeks of eye surgery.‘ golden rule unsure unilateral painful red eye : refer’
18. Loss of vision ? Painless ? Painful ? Duration ?
19. Vascular
20. Central retinal artery occlusion
21. RETINAL DETACMENT
22. RETINAL DETACHMENTPAINLESS LOSS OF VISION CURTAIN COMING ACROSS THE VISUAL FIELDREDUCED VISUAL ACUITY
23. OTHER CAUSES
24. VITREOUS HAEMORRAGE BLACK SPOTS , PERSISTENT FLOATERS, BLURRED/ HAZY VISION, ‘ RED HUE’, SCTOMA/ COMPLETE LOSS ‘ PRE WARNING SYMPTOMS FLOATERS/ ANTS IN VISUAL FIELDS THEN CLEARS .RISK FACTORS : DIABETIC , OCULAR TRAUMA TO THE EYE, VITREOUS DETACHMENT GCA
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27. Preseptal vs orbital cellulitis
28. Painful white eye ? Opthalmic sight threatening : trauma, posterior uveitis ( low level ache reduced VA) , posterior scleritis (severe pain unexplained v/a) optic neuritisNon sight threatening : eye strain, dry eye syndromeNon opthalmic sight threatening : GCA, IOP, ShinglesNon opthalmic non sight threatening : sinusitis , migraine , trigeminal neuralgia
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30. Blepharitis Anterior and posterior More common middle age and older adultsSymptoms : gritty / burning / scratchy often worse than signs suggest.Lid hygeine twice daily warm compress 10-15 mins / massage posterior lid cleaning anterior.Ineffective after two weeks topical chloramphenicol for six weeks > oxytetracycline bd for 4 weeks> oxytetracycline / doxycycline for 8 weeks Prevention : ongoing lid hygeine, avoid eye make up and contact lenses treat dry eyes / associated rosacea/ dermatitis refer for persistent chalazia
31. Dry eye syndromeSoreness, gritty, burning feeling of FB sensation in the eye Worse in dusty environments ,air condition excess reading/ use of computer improved by blinking .Important to treat as can lead to corneal ulcer.Regular breaks have computer screen lower than eye level .Drops , hypromellose / viscotears Xailin night Secondary sjorgens
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33. glaucomaChronic open angle , rubeiotic , closed angle .Majority of people asymptomatic 50% undiagnosed IOP > 21mmhg with damage to the optic nerve head, ocular hypertension optic nerve intact . peripheral vision loss first then slowly progress Dull persistent throbbing headache.
34. glaucomaRisk factors : 1st degree relative with raised IOP, diabetes, afro caribean, retinal detachment, secondary to uveitis, diabetes .Rx drop s laser rx surgery.PGA : latanoprost, betablockers : timolol, carbonic anhydrase inhibitors brizolamide Surgery AA Glaucoma prophylactic other eye BECAREFUL : oral and neb salbutamol, TCAs, paroxetine/ citalopram, anticholinergic , topiramate, sulphazalazine.
35. Rubeotic glaucoma
36. Diabetic retinopathy
37. Diabetic retinopathyNo retinopathy screen 12-15monthsBackground 12month and encourage risk factor control .Preproliferative and proliferative .Macular oedema changes on the macular reduction in central vision missing parts of text when reading .
38. Conjunctivitis
39. VIRAL CONJUNCTIVITIS
40. Allergic conjunctivitis
41. Allergic conjunctivitis Seasonal vs perennial Bilateral conjunctival redness itching is main symptom associated with atopyTopical antihisamines ( azalaztine)Mast cell stabilisers not for acute management e.g nedocromil/ cromoglycate .
42. Chalazion /Stye
43. Chalazion/styeChalazion :sterile inflammatory granuloma caused by obstruction of sebaceous gland Risk factors : blepharitis, seborrhoeic dermatitis, rosacea, pregnancy , diabetesWarm compression 10-15minutes 5* a dayConsider referral not resolving, recurrent astigmatism.Stye localised infection of eye lid margin.
44. Macular degeneration
45. Macular degenerationLoss of central vision missing out bits of textDry vs wetMost common cause of blindness > 65Drusen lipid deposits in retina.Wet immature blood vessels leakMost important risk smokerDry cut smoking diet high carotinoids vitamin c and eWet antivascular endothelial growth factor .