- RED EYE:
- Conjunctivitis
- When to refer for Ophthalmological evaluation
- if any of the following develops: visual loss, moderate
or severe pain, severe purulent discharge, corneal involvement, conjunctival scarring, lack of response to therapy, recurrent episodes of
conjunctivitis, or history of herpes simplex virus eye disease.
- the following patients should be considered for referral: con-tact lens wearers, patients requiring steroids, and those with photophobia.
- if there
is no improvement after 1 week.
- Allergic
- Treatment
- Avoid offending agent
- Saline solution or artificial tears to physically dilute and remove the allergens
- One of the following agent
- Topical Antihistamines
- Superior to Mast cell inhibitors in providing short term benefits
- Be careful about long term use due to rebound hyperemia
- Azelastine 0.05%: 1 drop 2 ×/d
- Emedastine 0.05%: 1 drop 4 ×/d
- Topical Mast cell inhibitors
- Cromolyn sodium 4%: 1-2 drops every 4-6 h
- Lodoxamide 0.1%: 1-2 drops 4 ×/d
- Nedocromil 2%: 1-2 drops 2 ×/d
- NSAIDs
- Vasoconstrictor / Antihistamines
- Avoid long term use due to rebound hyperemia
- Naphazoline/pheniramine: 1-2 drops up to 4 ×/d
- Combination Drops (LOE: A)
- Ketotifen 0.025%: 1 drop 2-3 ×/d (antihistamines plus mast cell stabilizers)
- Olopatadine 0.1%: 1 drop 2 ×/d (antihistamines plus mast cell stabilizers)
- Viral
- 65% are due to Adenovirus
- High transmission rate; extreme caution is needed
- Avoid the use of antibacterial drops
- Treatment (LOE: C)
- Cold compress
- Artificial Tear
- Anti-histamines
- Herpes Conjunctivities
- 1st and 2nd brach of Trigeminal Nerves are involved
- Hutchison sign (correlates with corneal involvement)
- Opthal evaluation may be needed if eye involvement is suspected
- Treatment
- Oral antiviral and
- Topical Steroids
- Bacterial
- Causes
- S aureus,
- S epidermidis,
- H influenzae,
- S pneumoniae,
- S viridans,
- Moraxella spp
- Treatment
- Aminoglycosides
- Gentamicin B
- Ointment: 4 ×/d for 1 wk
- Solution: 1-2 drops 4 ×/d for 1 wk
- Tobramycin ointment: 3 ×/d for 1 wk A
- Besifloxacin: 1 drop 3 ×/d for 1 wk A
- Ciprofloxacin
- ointment: 3 ×/d for 1 wk A
- Solution: 1-2 drops 4 ×/d for 1 wk
- Gatifloxacin: 3 ×/d for 1 week B
- Levofloxacin: 1-2 drops 4 ×/d for 1 wk B
- Moxifloxacin: 3 ×/d for 1 wk A
- Ofloxacin: 1-2 drops 4 ×/d for 1 wk A
- Azithromycin: 2 ×/d for 2 d; then 1 drop A daily for 5 d
- Erythromycin: 4 ×/d for 1 wk B
- Sulfacetamide
- ointment: 4 ×/d and at B bedtime for 1 wk
- Solution: 1-2 drops every 2-3 h for 1 wk
- Trimethoprim/polymyxin B: 1 or 2 drops A
- Scleritis
- Uveitis
- DDx:
- Sarcoidosis
- Spondyloarthopathies
- Behcet's
- SLE
- SS
- Systemic Vasculitis
- Relpasing Polychondritis
- Glaucoma
ConjunctivitisA Systematic Review of Diagnosis and Treatment JAMA 2013 Diagnosis and Management of Red Eye AAFP 2010 The Red Eye NEJM 2000
- EYE LID DISEASE
- Anatomy: Eye lid anatomy - Mercer only
- Infection and Inflammation of Eye lid:
- Hordoleum (Acute inflammation)
- Chalazion (Chronic; Often seen in patient with blepharitis, or in rosacea)
- Granumomatous chronic inflammation
- Abx not indicated
- Blepharitis
- DRY EYES
- 3 layers of lipid: Aqueous, Mucus, Lipid
- Pathophysiology: Disorder of any component of the lacrimal functional unit (lacrimal gland, eye lid, ocular surface)
- Decreased tear formation (or Aqueous deficient): Lacrimal Gland Dysfunction (around 10%)
- Sjogren Syndrome
- Non-Sjogren Syndrome
- Increased tear evaporation (or Hyperevaporative)
- Meiobian glend dysfunction (as seen in posterior blepharitis): Lipid layer of tear is not formed
- Lid: Decreased lid closure increasing the ocular surface
- Ocular surface : Contact lens etc
- Mixed ( Later two >80% cases)
- Sx and Signs
- Conjunctival injection, Excessive tearing, Blepharitis, Entropion and ectropion, Reduced blink rate, Visual impairmente
- EVALUATION (2015 Paper)
- Topics Coming Soon
- Blocked tear duct
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