Red Eye Differential Diagnosis

7/25/2019 Red Eye Differential Diagnosis

1/70

The Diferential Diagnosis

oThe Red EyeFKK UMJ

SRI FULINA


2/70

The Red EyeThe most ommon a!se o red

eye is on"!nti#itis

Al$ays he% #is!al a!ity& '!'ilsi(e and reati#ity) E#ert lids toloo% or oreign *ody)


3/70

+on"!nti#a,+ornea

-iral +on"!nti#itis In.ammation o 'al'e*ral

on"!nti#a and *!l*ar

on"!nti#a) Etiology/ -iral/ Adeno#ir!s

ty'e 0 assoiated $ith1haryngitis& e#er& malaise

Transmission is diretontat)

In!*ation 2345 days)


4/70

+on"!nti#a,+ornea

-iral +on"!nti#itis +linial 'resentation

Edema and hy'eremia

o one o *oth eyes) +on"!nti#al in"etion

I'silateral 'al'a*le'rea!ri!lar

lym'hadeno'athy)


5/70

+on"!nti#a,+ornea

-iral +on"!nti#itis Management/

To'ial #asoonstritors 6na'ha(oline7

and steroids 6-e8ol& Flare8&7 S!lonamide dro's 9ighly ontagio!s)

Diferential diagnosis/ a!te!#eitis& a!te gla!oma& ornealdisorders


6/70

+on"!nti#a,+ornea

:aterial +on"!nti#itisThe eye has many deenses to

're#ent *aterial in#asion s!h as

*ateriostati lyso(ymes andimm!noglo*!lins in the tear ;lm&*lin%ing& imm!ne system)


7/70

+on"!nti#a,+ornea

:aterial +on"!nti#itis Etiology/

+ommon 'athogens/ Sta'hyloo!s

a!re!s& 9aemo'hil!s in.!en(ae&Stre'too!s 'ne!moniae and1se!domonas aer!ginosa

Se#ere *aterial on"!nti#itis thatin#ades ornea/ Neisseria gonorrhoeaeand +oryne*ateri!m di'theroides


8/70

+on"!nti#a,+ornea

:aterial +on"!nti#itis Irritation& hy'eremia&

tearing

+o'io!s '!r!lent dishargerom *oth eyes

Mild derease in #is!ala!ity

Diferential diagnosis/a!te !#eitis& a!tegla!oma& ornealdisorders


9/70

+on"!nti#a,+ornea

:aterial +on"!nti#itis Diagnosis/


10/70

+hlamydial,


11/70

+hlamydial,


12/70

+hlamydial,


13/70

+hlamydial,


14/70

+on"!nti#a,+ornea

Allergi +on"!nti#itis Allergen ontat $ith on"!nti#a

res!lts in release o in.ammatory

mediatorsThese In.ammatory mediators

res!lts in sensation o ithing&

#as!lar 'ermea*ility and#asodilation


15/70

+on"!nti#a,+ornea

Allergi +on"!nti#itis +on"!nti#al in"etion Thin& $atery disharge)

'hoto'ho*ia and #is!alloss

Large o**lestone'a'illae

La% 'rea!ri!lar lym'hnodes)

Lids s$ollen and red


16/70

+on"!nti#a,+ornea

Allergi +on"!nti#itis Diferential diagnosis/ a!te !#eitis& a!tegla!oma& orneal disorders

Management/ A#oid ontat $ith allergen& old om'resses&

arti;ial tears To'ial antihistamines& to'ial #asoonstritors or

deongestants s!h as 'henyle'hrine6#asoonstrit and retard release o in.ammatory

mediators7 Mast ell sta*ili(ers 6Alomide and +rolom7 Se#ere ases / to'ial steroids s!h as -e8ol& Flare8

or Alre8


17/70

+on"!nti#a,+ornea

Keratoon"!nti#itis sia Tear film made of 3 layers:

A lipid layer an aqueous layer hydrophilic mucin layer

Any abnormality in any of these layers

leads to an unstable tear film andsymptoms of keratitis sicca. S"ogrenCs disease3 xerostomia


18/70

+on"!nti#a,+ornea

Keratoon"!nti#itis sia Dryness

Redness

Srathy eeling o theeyes) )

@!lar irritation

ucous plaques and dischar!e

Corneal epithelial defects orulceration

Se#ere/


19/70

+on"!nti#a,+ornea

Keratoon"!nti#itis sia Diagnosis/ slit lam' e8am sho$s

s!*tle a*normalities o tear ;lm

sta*ility& red!ed tears& Shirmertest

Management/


20/70

+on"!nti#a,+ornea

Keratoon"!nti#itis sia +om'liations/

Se#ere and hroni may lead to

%eratini(ation o the o!lar s!rae orloss o the orneal e'itheli!m


21/70

1ing!e!la :enign yello$ olored thi%ening o

the on"!nti#a

I it e8tends onto the ornea it is%no$n as a 'terygi!m

+an *e a!sed *y hroni s!n

e8'os!re& re'eated tra!ma&dry,$indy onditions


22/70

1ing!e!la ello$ or $hite

nod!le on

on"!nti#a nearornea


23/70

1ing!e!la Management/


24/70

1terygi!m +on"!nti#a *egins to gro$ onto

ornea

Etiology is U- s!nlight and dryonditions


25/70

1terygi!m :l!rred #ision

Eye irritation

Ithing& *!rning


26/70

1terygi!m +om'liations/

*lo%age o #ision

Management/ Eye dro's to moisten eyes and

derease in.ammation)


27/70

Daryoystitis Nasolarimal system o*str!tion

res!lting in a larimal sainetion

Etiology/ A!te/

S) a!re!s& :3hemolyti stre')+hroni/ S) e'idermidis& andida

+hroni/ m!osal degeneration& d!tile

stenosis& stagnant tears& *aterialo#ergro$th


28/70

Daryoystitis 1ain

Redness o tear3sa

S$elling 1!r!lent material


29/70

Daryoystitis Diagnostis/

+T

Management Ke.e8& A!gmentin $ith to'ial

anti*ioti dro's) arm om'resses Might need s!rgial remo#al o

o*str!tion 1atient Ed!ation/


30/70

:le'haritis +an *e assoiated $ith a *aterial

inetion s!h as S) a!re!s or a hroni

s%in ondition T$o orms/

Anterior/ afets o!tside lids $here eyelashesattah) +a!sed *y *ateria or se*orrhei)

1osterior/ Inner eyelid 6mei*omian glands7)Leads to gland 'l!gging and +hala(ionormation)


31/70

:le'haritis S A!re!s/

Ithing& larimation&tearing& *!rning&'hoto'ho*ia

Se*orrhei/ lid margin erythema&

dry .a%es& oilyseretions on lidmargins& assoiateddandr!f


32/70

:le'haritis Diagnostis/

+om'liations/thi%ened lid

margins& dilated and #isi*lea'illaries& eyelash loss& Etro'ionand Entro'ion& orneal erosions


33/70

:le'haritis

Management Anterior/

%ee' sal'& eyelids and *ro$s lean)

Remo#e sales $ith *a*y sham'oo) 1osterior/

E8'ression o mei*omian gland on

reg!lar *asis) I orneal in.ammationneed oral anti*ioti)


34/70

9ordeol!m "ocali#ed infection or inflammation of

the eyelid mar!in involvin!: $air follicles of the eyelashes eibomian !lands

D!e to *lo%age and inetion o

se*aeo!s glands Etiology


35/70

9ordeol!m 1ain!l& erythemato!s&

and loali(ed)

+an lead to edema olid

+an lead to+on"!nti#al inetion)


36/70

9ordeol!m Diagnostis/

Management/To'ial anti*ioti,ointment s!h as

%acitracin ophthalmic ointment

Severe mi!ht need oral tetracycline or

Cloxacillin


37/70

+hala(ion Loali(ed sterile s$elling o !''er

or lo$er eyelid that orms $hen

mei*omian gland *eomes*lo%ed)

:le'haritis and ane rosaea oten

'rior to +hala(ion)


38/70

+hala(ion 9ard non3tender s$elling

o !''er or lo$er eyelid

1ainless +on"!nti#a red and

ele#ated May distort #ision

&nvert the eyelid to visuali#ethe palpebral conjunctivaand note internal chala#ia.


39/70

+hala(ion Diagnostis/ :io'sy or re!rrent&

#iral or *aterial !lt!res

Diferentials/ on"!nti#itis&9ordeol!m& mei*omian glandarinoma

Management/ arm om'resses tid In"etion or ortiosteroid or I,D S!rgial remo#al


40/70

Entro'ion Etiology/ older

'o'!lation& e8tensi#e

sarring oon"!nti#a& inetion


41/70

Entro'ion Redness

Light sensiti#ity

Dryness Inreased larimation

Foreign *ody sensation

Srathing o ornea Eye irritation


42/70

Entro'ion Diagnostis/

Management/ Arti;ial tears

S!rgial tightening o m!sles

:oto8 in"etions to *!ild !' asia

+ool om'resses E'ilation o the eyelashes


43/70

Etro'ion Etiology/ @lder

'o'!lation& th

ner#e 'alsy& an*e ongenital)@*i!laris o!li

m!slerela8ation


44/70

Etro'ion E8essi#e larimation

Droo'ing o eyelid

Redness Light sensiti#ity

Dryness


45/70

Etro'ion Diagnostis/

Management/


46/70

+orneal A*rasion Irreg!larity o the ornea

Res!lts rom tra!ma or oreign

*ody&


47/70

+orneal A*rasion 1ain,

Redness,1hoto'ho*ia

E8essi#e tearing Foreign *ody sensation

:l!rred #ision


48/70

+orneal A*rasion Diagnostis/

Fl!oresein staining/ello$ .!oresene o e8'osed *asement

mem*rane !nderlying e'itheli!m

Management/ Remo#e oreign *ody$ith otton ti''ed a''liator) Anti*iotio'hthalmi ointment& eye 'ath $ith'ress!re& @ral 'ain mediation)

+om'liations


49/70

U#eitis Intrao!lar in.ammation o iris& iliary

*ody and horoid

Anterior !#eitis/ o!lar in.ammation limitedto iris or iris and iliary *ody 6irodoylitis7 Intermediate !#eitis/ in.ammation o

str!t!res "!st 'osterior to the lens

1osterior !#eitis/ in.ammation o the horoid& retina or near o'ti ner#e and ma!la

Etiology/ Imm!ne& inetion& idio'athi)


50/70

U#eitis Anterior !#eitis/

Dee' eye 'ain 1hoto'ho*ia +on"!nti#a

#essel dilation +iliary .!sh Small

'!'il,irreg!lar +ornea lear or

slightly lo!dy


51/70


52/70

S!*on"!nti#al

9emorrhage :leeding o the on"!nti#al or

e'isleral *lood #essels into the

s!*on"!nti#al s'ae) Ris% ators inl!de *l!nt tra!ma&

r!**ing eyes& #igoro!s o!ghing&

*leeding disorder


53/70

S!*on"!nti#al

9emorrhage Eye red $ith mild

irritation

-ision not afeted I tra!ma rule out

ruptured !lobe or

retrobulbar hemorrha!e

Management/


54/70


55/70


56/70


57/70


58/70

Angle +los!re


59/70


60/70

E8am'le 4

A 55 year old emale omes to yo!om'laining o 'haryngitis& e#er

and eye tearing) She has notied a$atery disharge and red eye)There is 'rea!ri!larlym'hadeno'athy

hat is thisH hat is the etiologyH hat is the managementH


61/70

E8am'le 5

A 40 year old emale 'resents $ith *ilateral'!r!lent disharge rom her eyes) Shenotied this yesterday to right eye and no$

*oth eyes) She $o%e !' $ith her eyessti%ing together)

hat is thisH hat is the etiologyH hat are management o'tionsH I she is se8!ally ati#e& $hat other ;ndings

$o!ld 'oint to hlamydial on"!nti#itisH


62/70

E8am'le 0

This 'atient has a history o S"ogrenCssyndrome) :esides 8erostomia& yo!diagnose this *ased on the a''earane o

her eyes) She om'lains o o!larirritation)

hat is thisH hat are histology ;ndings assoiated

$ith thisH 9o$ is this diagnosedH hat is the managementH


63/70

E8am'le

A 'atient omes to yo! *ea!seher h!s*and notied a yello$

nod!le on her eye) hat is thisH

hat are ris%s or thisH

hat is the management o thisH hat an this ad#ane toH


64/70

E8am'le 2

A o!r year old has a *!m' *y hereye) Mom is onerned sine it is

lea%ing yello$ st!f) hat is thisH

hat is the etiology o this in the

a!te ormH hat is the management o thisH


65/70

E8am'le

This 'atient has a stye) hat isthe medial term or thisH

hat is the management o thisH hat might yo! all this i the area

$as not 'ain!l or tenderH


66/70

E8am'le

A year old male'atient re'orts

e8essi#e tearing) 9ethin%s he might ha#eallergies) hat do

@U thin% he hasH

hat is themanagement or thisH


67/70

E8am'le

A 55 year old male re'orts s!ddenonset o 'ain& 'hoto'ho*ia ande8essi#e tearing to his right eye) 9ethin%s he has a 'iee o sand in hiseye) It started $hile on the *eah)

hat is yo!r diferential diagnosisH

9o$ an yo! on;rm yo!r diagnosisH hat is the management or thisH


68/70


69/70

E8am'le 4=

A 'atient de#elo's a!te o!lar'ain and *l!rred #ision) 9is I@1 is

G=mm9


70/70

Staey Singer3Leshins%y R1A+

Documents

Red Eye Differential Diagnosis