Middle of the eye

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Middle of the eye !!!
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Eye symptoms

• Sore eye
• Red eye
• Watering
• Alteration in appearance
• Impaired Vision
• Double vision
• Asymptomatic

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• Red eye
• Referral criteria from primary care for
  red eye
• Few other conditions

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• Acute Conjunctivitis
• Commonest cause
• Bacterial,Viral, Allergic
• Usually bacterial in origin
• Mucopurulent discharge, gritty discomfort
• Usually self limiting condition

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• Acute Conjunctivitis
• Viral-onset slower
• Watery discharge,maybe sticky
• Allergic- itchy
• In allergic, avoid commencement of steroid drops
  in primary care

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When to refer a case of conjunctivitis to
Ophthalmologist ?

• Neonatal conjunctivitis
• Chronic conjunctivitis
• Does not respond to initial treatment
• Corneal damage associated with conjunctivitis
• Conjunctivitis with blurring of vision or pain as
  opposed to discomfort
• Sicca ( i.e. dry eye syndrome)

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• Corneal abrasion
• Caused by trauma to surface of the eye
• Symptoms- scratchy pain, lacrimation,photophobia,
• foreign body sensation
• Thorough examination of the conjunctiva by
  eversion of eyelids
• Most heal by 36 hours, prophylactic abx ointment
• Eye pads not helpful

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• Episcleritis
• Relatively common, benign and self-limiting
• 30 associated with general medical
  conditions-gout,collagen diseases
• Localised response and lack of palpebral
  conjunctiva involvement
• Oral and topical nsaids as treatment normally
  works

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• Corneal Ulcer
• Corneal ulcer is secondary to infective cause
• Referred same day to Ophthalmologist
• Pain, redness, reduced visual acuity, discharge
  maybe present,
• photophobia
• Signscircumcorneal injection, pupil small
• fluorescein stain
• Does the patient wear contact lenses?

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• Acute iritis
• Must always be considered in painful red eye
• Causes-idiopathic, auto-immune, Infection,
  malignancy
• Acute- pain, redness, photophobia, lacrimation
• o/e ciliary injection, hyperaemia initially
  later aqueous flare, miosis,posterior synechia

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• Acute Glaucoma
• Primary closed angle glaucoma-latent,
  subacute,acute
• Loss of vision in affected eye, severe periocular
  pain and congestion, nausea and vomiting
• o/e stony hard eye,semi-dilated non-reactive
  pupil, hazy cornea

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• Acute Glaucoma ( comparison wih iritis and
  conjunctivitis)

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Causes Of Red Eye

• Acute Conjunctivitis
• Corneal trauma
• Corneal ulceration
• Episcleritis
• Scleritis
• Acute Iritis
• Eye injuries
• Acute glaucoma
• Acute subconjunctival haemorrhage

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Referral for ophthalmology opinion

• Impaired visual acuity
• Abnormal pupillary reactions
• Corneal ulceration
• History of possible penetrating injury
• Cloudy fundus

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• Keratoconus
• Uncommon, degenerative disease inherited as AR or
  AD
• Usually associated with syndromes
• Presents in second decade
• Cornea- irregular in shape, astigmatism, thinning
  and bulge, progressive
• Good prognosis if corneal transplant done early

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• Thank you, and now we have some more
• over to Ray