Term
| Sign of Ocular Inflammation: Etiologies |
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Definition
• Conjunctivitis
• CornealAbrasion
• Foreign Body
• Allergies
• Subconjunctival Hemorrhage • Keratitis
• Iritis
• Glaucoma (Acute angle)
• Chemical Exposure
• Scleritis |
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Term
| Focused History: Red Eye - questions to ask |
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Definition
• Unilateral or Bilateral?
• Isthereeyepain?Lengthoftime?Typeofpain? • Istheeyeitchy?
• Istheredischargefromtheeye?
• Anyvisionchanges?
• Anyrecenteyetrauma?
• Anyrecenteyesurgery?
• Previous episodes of red eye?
• Any systemic illnesses which could contribute?
• Any allergies which could contribute? |
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Term
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Definition
| eye with inflamed or irritated conjunctiva |
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Term
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Definition
| diffuse reddness. not seeing any structures in the conjunctiva, all blood- diffuse subconjunctival hemorrhage. upper eyelid is swollen. eyelashes w/o evidence of trauma- not in misdirection, no tear or problems w eyelid margin. corneal light reflux- clear cornea. pupil black and round. iris is diffuse and homogeneous in color. there may be clear or bloody discharge, hard to tell |
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Term
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Definition
allergic conjunctivitis
-esp seen in spring and fall w allergies. redness of the conjunctiva. almost always bilateral. the eyelids have a reddness to the lower and upper eyelid. in more severe presentations can be swollen shut. not as defusely red, mainly on nasal aspect |
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Term
| Management: Allergic Conjunctivitis |
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Definition
- Topical treatment:
• Histamine H1 receptor antagonist
• Mast cell stabilizer
• Histamine H1 receptor antagonist + mast cell stabilizer
• Non-steroidal anti-inflammatory
- Often systemic co-treatment is needed and helps
- Co-management with internist, pediatrician, primary care provider |
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Term
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Definition
| viral conjunctivitis. impt to assess face. typically caused by adenovirus. highly contageous. common cold in the eye. unilateral but a few days to a week later can spread to the other eye as well. nasal and temporal redness and increased tearlake. use slit lamp to look at cornea and evaluate for mild cloudiness (SEI- subepithelial infiltrates- viral particles deposit in endothelium of cornea). lower eyelid mildly swollen- distinguish from allergeis and foreign body |
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Term
| Management: Viral Conjunctivitis |
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Definition
-Adenovirus: highly contagious
• Often starts in one eye and then presents in the fellow eye
• Recommend no work/school in the initial presentation
• Recommend hand washing, no sharing of towels, avoidance of food preparation and interacting with others
• Lubricant eye drops (artificial tears) and avoiding antibiotic and steroid eye drops initially
• Resolution typically within 1-3 weeks |
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Term
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Definition
Bacterial Conjunctivitis
-rarer, most of the cornea looks clear, can see corneal light reflex, mucus in left eye, thick yellowy mucus- impt to culture from each eye individually. culture in case doesn't respond to 1st line of antibiotic to get sensitivities |
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Term
| Management: Bacterial Conjunctivitis |
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Definition
• Culture from conjunctival fornix is important
• Careful evaluation of the cornea
• In adults: Staphylococcus aureus infection is common
• In children: Streptococcus pneumoniae and Haemophilus influenzae and are more common
• Topical treatment based on sensitivities to antibiotics in severe cases, immune compromise, contact lens wearers, in neonates
• Typically: Ofloxacin 0.3%:1 drop qid for 1 week |
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Term
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Definition
Subconjunctival Hemorrhage
-localized, well circumcised area of inferior temporal quadrant of conjunctiva on left, maybe from foregin body, valsalca maneuver, surgery. likely will resolve w/i 10-14 days or sooner
-on right- more diffuse and deeper red. from a foreign body, trauma, surgery. may take up to 2-3 weeks to resolve |
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Term
| Management: Subconjunctival Hemorrhage |
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Definition
• Resolution without eye drops or ointment
• Reassurance given to patient and family re: decreasing/resolving hemorrhage in 1-2 weeks
• Typically noted after eye surgery, after valsalva manuevers
• Important to evaluate for conjunctival FB
• Important to evaluate to any prior episodes
• Important to ask patient about systemic illnesses |
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Term
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Definition
Foreign Body (Corneal)
-red eye secondary to corneal FB. slit lamp photograph. diffuse reddness and injection of conjunctiva. metallic foreign body in superficial layer of cornea- epithelium. diffuse inflammatory reaction. likely just from FB bc pubil is round and reactive, no distortion, iris is flat and all normal crypts. no distruption of integrity and health of iris |
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Term
Management:
Red Eye Secondary to Corneal FB |
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Definition
• Remove Corneal Foreign Body at slit lamp w a burr- numb eye, examine for rust ring after removal
• Start topical antibiotic (Moxifloxacin 0.5%)
• Evaluate visual acuity, intraocular pressure
• Perform dilated retinal exam
• Redness of conjunctiva should resolve with removal of corneal FB |
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Term
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Definition
Keratitis
-infection of the cornea causing a red eye. very white circular well circumscribed opacity on the cornea w stuck on appearance. can see most of iris, haziness of cornea around opacity (not healthy), diffusely red conjunctiva, conjunctiva appears to be swollen - chemosis, |
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Term
Management:
Red Eye Secondary to Keratitis |
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Definition
• Complete evaluation at the slit lamp
• Measurement of depth of corneal opacity
• Assessment of visual acuity, intraocular pressure
• Culture of corneal opacity may be needed for treatment
• Start topical antibiotics (Moxifloxacin0.5%)
• Resolution/improvement/decrease of conjunctival redness should occur with resolution of corneal opacity |
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Term
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Definition
Scleritis: Nodular and Diffuse
-sclera is the white layer under the conjunctiva. can have a blue hue. can be nodular (on left)(could have autoimmune illness like rheumatoid arthritis). on right- diffuse scleritis, blood vessels stop right next to cornea at the limbus- white line of the limbus, solidly deep red (scleritis) |
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Term
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Definition
• Evaluation of conjunctival tissue movement with Q-tip
• Assessment of episcleritis versus scleritis
• Episcleritis: self-limiting and resolves within 2 weeks
• For scleritis:
- evaluation of presence or absence of nodules
• Assessment of visual acuity, intraocular pressure, cornea, anterior chamber, iris
• Evaluation for the presence/absence of systemic disease, ie: autoimmune disease, RA, SLE
• If needed:
- co-management with rheumatologists for immunosuppressant treatment |
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Term
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Definition
acute glaucoma
-ocular emergency, rarer, on PE redness of eye- corkscrew type blood vessels that go all the way to the limbus + middilated pupil- wont' react well to light/frozen + cloudy cornea- haziness w corneal light reflex, not perfect view of iris |
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Term
Management:
Red Eye Secondary to Acute Glaucoma |
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Definition
• Ocular emergency
• Assessmentofintraocularpressure,visual acuity is critical
• Assessmentofcornea,anteriorchamber, iris/pupil
• Topical treatment needed as well as systemic treatment (depending on the level of intraocular pressure)
- Treat with precaution/awareness of patient’s allergies and medical history |
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