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Red eye (high risk) by thann
- 1. RED EYE (HIGH RISK) EXTERN AKECHANOK WATCHARAPUNJAMART
- 2. RED EYE (HIGH RISK) •Infectious Keratitis/ Corneal Ulcer •Anterior Uveitis •Acute angle closure glaucoma
- 4. Infectious Keratitis/ Corneal Ulcer • Infection • Bacterial: Adnexal infection, lid malposition, dry eye, CL • Pseudomonas aeruginosa • Staphylococcus aureus • Streptococci. • Viral: HSV, HZO • Fungal: Candida,Fusarium,Aspergillus,Penicillium • Protozoan: Acanthamoeba in CL wearer • Mechanical or trauma • Chemical: Alkali injuries are worse than acid
- 5. Clinical features • Blurred vision • Ocular pain • Photophobia • Epiphora • Purulent discharge • Eye lid swelling • Ciliary injection • corneal infiltration, ulcer • Hypopyon
- 6. รูปแสดงกระจกตาติดเชื้อเห็นเป็นวงเล็กสีขาว (Focal corneal ulcer) (ขอบคุณ ภาพถ่ายผู้ป่วย จากคลินิกกระจกตา รพ.ธรรมศาสตร์ เฉลิมพระเกียรติ)
- 7. Investigation • Corneal scraping • May not be required for a small infiltrate,particularly without an epithelial defect and away from the visual axis. • Conjunctival swabs • Particularly in severe case, may be culture when corneal scape is negative • Contact lens cases • Bottles of solution and lens for culture • Gram strain,Giemsa stain ,KOH ,Culture • Sensitivity reports REFERENCE:
- 8. Treatment • Fortify broad spectrum antibiotic • Antifungus : Amphotericin B eye drop,Natamycin eye drop • Acyclovir eye ointment • Cycloplegic drug ( 1% Atropine eye drop)
- 10. Anatomical Classification • Uveitis : an inflammation of uveal tract • Anterior uveitis • Iritis : inflammation primarily involves the iris • Iridocyclitis : in which both iris and pars plicata of the ciliary body • Intermediate : Inflammation predominantly involving the pars plana,the peripheral retina and the vitreous • Posterior uveitis : involves the fundus posterior to the vitreous base • Retinitis : Primary focus in the retina • Choroiditis : Primary focus in the choroid • Vasculitis : which may involve veins, arteries or both • Panuveitis • Endophthalmitis : implies inflammation, often pururent, involving all intraocular tissue except the sclera • Pandophthalmitis : involves the entire globe,often orbital extension
- 11. Definition : Acute : Sudden onset and limited duration Chronic : Persistent inflammation,Prompt relapse (in less than 3 months) Recurrent : repeat episodes separated by period of inactive without treatment lasting at least 3 months
- 12. Anterior uveitis • Most common form of uveitis (75%) • Acute anterior uveitis is the most common form of anterior uveitis ,accounting for three-quarters of cases
- 13. Main symptoms • Sudden onset of unilateral pain • Photophobia • Redness • Decrease vision • Lacrimation
- 14. Signs • Ciliary injection (circumcorneal flush) • Fine white keratic precipitaes (KP) • Aqueous flare and cell in anterior chamber • Iris nodules (Koeppe & Busacca nodule ) • Iris atrophy • Rubeosis iridis • Miosis • Posterior synechiae
- 16. Causes • Autoimmune - Juvenile rheumatoid arthritis - Ankylosing spondylitis - Reiter’s syndrome • Infections - Syphilis - TB - Herpes Zoster • Malignancy - Leukemia - Lymphoma - Retinoblastoma • Other - Traumatic uveitis - Retinal detachment - Ideopathic
- 17. Type of Anterior Uveitis 1. Suppurative 2. Non supurative 2.1 Granulomatous uveitis - chronic, posterior uveitis - infection Toxoplasma, TB - injury : sympathetic ophthalmia 2.2 Non granulomatous uveitis - more common - Anterior uveitis - Hypersensitvity phenomenon —» Steroid
- 18. Differentiation of Granulomatous & nongranulomatous uveitis Feature Granulomatous Nongranulomatous Onset Course Pain Photophobia Blurred vision Anterior segment Injection Iris nodule (Koeppe,Busacca nodules KP Fundus Recurrence Insidious Long None or minimal Slight Marked + +++ Mutton fat Nodular lesion Sometimes Acute Short Marked Marked Marked,moderate +++ + Small fine Diffuse involvement Common
- 19. Complication • Anterior, posterior synechiae • Rubeosis iridis • Band keratopathy • Cataract • Secondary glaucoma • Retinal detachment • Cystoid macular edema • Hypotony – phthisis bulbi
- 20. Aim of Treatment 1. Relief of pain 2. Improve vision 3. Prevent complication
- 21. Treatment 1. Medical therapy - specific Rx. - Non specific Rx. 1.1 Corticosteroid - Topical -Systemic 1.2 Cycloplegic 1.3 Cytotoxic agent
- 22. Treatment 2. Surgical therapy 2.1 Cataract —» cataract extraction 2.2 Glaucoma —» Trabeculectomy 2.3 Vitreous opacification —» Parplana vitrectomy 2.4 Retinal detachment —» Laser, SBP ( sclera bucking procedure)
- 23. Acute angle closure glaucoma
- 24. What is glaucoma? • A disease of progressive optic neuropathy with loss of retinal neurons and their axons (nerve fiber layer) resulting in blindness if left untreated. Robert N. Weinreb, MD1; Tin Aung, MD, PhD2,3; Felipe A. Medeiros, MD, PhD1 JAMA. 2014;311(18):1901-1911. doi:10.1001/jama.2014.3192.
- 25. Clinical picture of glaucoma 1. High intraocular pressure 2. Optic disc change cupping & degeneration 3. Visual field defect
- 30. How to maintain Intraocular pressure ?
- 31. Normal
- 32. c - Iris outflow a - Conventional outflow-90% b - Uveoscleral outflow Aqueous outflow
- 36. Sign - ciliary injection - corneal edema - shallow anterior chamber - semidilated pupil - increase IOP Corneal oedema Ciliary hyperaemia Dilated pupil
- 37. Management 1. Medical treatment 1.1 Osmotic treatment - 20% Mannitol intravenous drip ( 250 ml) - 50% glycerine (1-2 ml/kg.) 1.2 Carbonic anhydrase inhibitor - Acetazolamide (Diamox) oral - Topical : Brinzolamide : Dorsolamide
- 38. Management 1.3 Cholinergic agent - 2% Pilocarpine ed. —» Miotic —» decrease papillary block 1.4 B-Blocker - 0.5% Timolol maleate ed. 1.5 Selective Sympathominetic - Alphagan ed. (Brimonidine) 1.6 Prestaglandin deviation - Lagtonoprost - Travanoprost - Bimatoprost
- 39. 2. Surgical treatment - Laser iridotomy - Peripheral iridectomy - Trabeculectomy
- 40. THANKS YOU