ophtha report
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ophtha report.pptxTRANSCRIPT
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The Red Eye
Reganit, Chelsea Marie A.
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Conjunctivitis• Inflammation of the conjunctiva
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Viral Conjunctivitis
• Inflammation of palpebral conjunctiva and bulbar conjunctiva
• Acute • Adenovirus type 3• direct contact• Incubation 5-12 days
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Viral Conjunctivitis
• Clinical presentation– Edema and hyperemia of
one of both eyes. – Conjunctival injection– Ipsilateral palpable
preauricular lymphadenopathy.
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Viral Conjunctivitis
• Management:– Topical vasoconstrictors (naphazoline) and steroids
(Vexol, Flarex,)– Sulfonamide drops
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Bacterial Conjunctivitis
• Etiology– Hyperacute: Neisseia gonorrhea– Acute catarrhal: S. pneumonia, Staphylococcus
– Subacute: Hemophylus influenza– Chronic: Moraxella, pseudomonas, gram negative
species
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Bacterial Conjunctivitis
• Irritation• Hyperemia• tearing • Copious purulent discharge from
both eyes • Mild decrease in visual acuity
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Bacterial Conjunctivitis
• Diagnosis: – Gram stain: presence of polymorphonuclear cells and
predominant organism
• Complications:– secondary keratitis, corneal ulcer
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Bacterial Conjunctivitis
• Management– Broad spectrum topical antibiotics
• Polytrim (polymixin B sulfate and trimethoprim sulfate)• Gentamicin 0.3%• Tobramycin 0.3%
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Chlamydial/GonococcalConjunctivitis
• Eye infection greater than 3 weeks
• Mucopurulent discharge • Conjunctival injection• palpable preauricular node • Conjunctival papillae • Chemosis
Conjunctival papillae
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Chlamydial/GonococcalConjunctivitis
• Diagnosis– Fluorescent antibody stain, enzyme immunoassay
tests – Giemsa stain: Intracytoplasmic inclusion bodies in
epithelial cells, polymorphonuclear leukocytes and lymphocytes
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Chlamydial/GonococcalConjunctivitis
• Management: – Oral
• Tetracycline • Azithromycin• Amoxicillin and erythromycin or Doxycycline
– Topical: erythromycin, tetracycline or sulfacetamide – Gonococcal: ceftriaxone 1g IM, and then 1gm IV 12-24
hours later– Topical Fluoroquinolone
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Allergic Conjunctivitis
• Usually allergy to air born allergen• Mediated by IgE• May occur with hay fever, asthma or rhinitis
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Allergic Conjunctivitis
• Conjunctival injection• Thin, watery discharge • photophobia and visual loss • Large cobblestone papillae• Lids swollen and red
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Allergic Conjunctivitis
• Management– Avoid contact with allergen, cold compresses, artificial tears – Topical antihistamines, topical vasoconstrictors or
decongestants such as phenylephrine (vasoconstrict and retard release of inflammatory mediators)
– Mast cell stabilizers (Alomide and Crolom) – Severe cases : topical steroids such as Vexol, Flarex or Alrex
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Blepharitis
• Can be associated with a bacterial infection such as S. aureus or a chronic skin condition
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Blepharitis
• Two forms– Anterior
• affects outside lids where eyelashes attach• Caused by bacteria or seborrheic
– Posterior• meibomian glands• Leads to gland plugging and Chalazion formation
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Blepharitis
• S Aureus:– Itching, lacrimation,
tearing, burning, photophobia
• Seborrheic: – lid margin erythema,
dry flakes, oily secretions on lid margins, associated dandruff
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Blepharitis
• Complications– thickened lid margins– dilated and visible capillaries– eyelash loss– Ectropion and Entropion– corneal erosions
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Blepharitis
• Management– Lid hygiene– Antibiotic ointment to lid margins after cleaning
ie. Bacitracin, erythromycin– Lubrication to relieve foreign body sensation
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Subconjunctival Haemorrhage
• Bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space
• Idiopathic, trauma, cough, sneezing, aspirin, hypertension
• If traumatic must do thorough exam
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Subconjunctival Hemorrhage
• No therapy• Reassurance that the condition is not serious
and will resolve in 1-3 weeks• Hematologic coagulation studies are not
indicated unless there are associated retinal hemorrhages or many recurrences
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Corneal & Conjunctival Foreign Body
• pain, tearing, photophobia and foreign body sensation• Foreign body may be flushed out or can be removed with
a g25 needle• Treatment with antibiotics is necesssary• Flip lid if no FB seen and linear abrasion
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Chemical Injury
• True ocular emergency• Requires immediate irrigation with nearest
source of water• Management dependent on acid or alkaline
offending substance
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Chemical Burns
• Management – Immediate irrigation – Topical antibiotics– Cycloplegia– Removal of particulate matter
• Goal is to reepithelialize the cornea
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Contact Lens Wear Associated Red Eye
• Prolonged contact lens wear or poorly fitting lenses may cause a red eye.
• Severe pain.• Tearing.• If opacity is noted or corneal infection is
suspected,treat as if infected.• Bacterial, parasite, fungus are possible
pathogens.
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Bacterial Keratitis
• Red, painful eye• Watery - purulent discharge• May have corneal opacity• May have decreased vision
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Bacterial Keratitis
• Diagnosis – Confirmation with scrapings and cultures– Gram stain
• Management– Initial broad spectrum treatment with antibiotics
eg. Flouroquinolone and Bacitracin, Cefazolin and Amikacin
– Modify treatment based on culture results