Diploma In Family Health Care Professor Noshad Ahmed Shaikh Vice Chancellor Liaquat University of Medical and Health Sciences/Jamshoro.

Dr Isam Al-Qurainy 3

Dr Isam Al-Qurainy 4

Dr Isam Al-Qurainy 5

The Red Eye Differential Diagnosis Sameen Afzal Junejo MCPS; DOMS; FCPS Professor of Ophthalmology LUMHS/Jamshoro

Causes Of Red Eye • 1) • 2) Conjunctivitis.

Corneal Abrasions and Ulcer.

• 3) • 4) • 6) Acute Angle Closure Glaucoma.

Uveitis.

• 5) Episcleritis and Scleritis.

Sub-Conjunctival Haemorrhage.

7

Conjunctivitis Papillae Follicles Purulent discharge Redness Chemosis

Acute Bacterial Conjunctivitis

Acute Viral Conjunctivitis

Corneal Abrasion • Surface epithelium sloughed off. • Stains with fluorescein • Usually due to trauma • Pain, FB sensation, tearing, red eye

Corneal Ulcer

• Infection – Bacterial: – Viral:

HSV, HZO

– Fungal: – Protozoan:

Acanthamoeba

in CL wearer • Mechanical or trauma • Chemical: Alkali injuries are worse than acid

Corneal ulcer stained green with fluorescein dye .

Purulent Corneal Ulcer with Hypopyon Excessive Steroid Usage

Acute Angle-closure Glaucoma • Symptoms – Pain, headache, nausea-vomiting – Redness, photophobia, Ciliary hyperaemia – Reduced vision Corneal oedema – Haloes around lights – Raised IOP Dilated pupil

Acute Angle Closure Glaucoma

Uveitis

Anterior: acute recurrent and chronic Intermediate: Ciliary Body Posterior: vitritis, retinal vasculitis, retinitis, choroiditis Pan uveitis: anterior and posterior

Anterior uveitis (Iritis) • Photophobia, red eye, decreased vision, pain • Idiopathic. Commonest • Associated to systemic disease – Seronegative arthropathies:AS, Psoriatic arthritis, Reiter’s Disease – Autoimmune: Sarcoidosis, Behcets – Infection: Shingles, Toxoplasmosis, TB, Syphillis, HIV

Ciliary flush Fibrin KPs Small Pupil

Keratic Precipitates ( KPs)

Circum Corneal Conjunctival Congestion In Uveitis A.C Glaucoma

Episcleritis • Superficial • Idiopathic, collagen vascular disorder (RA) • Asymptomatic, mild pain • Self-limiting or topical treatment(NSAIDs, Steroids)

Scleritis • Idiopathic • Collagen vascular disease (RA, SLE, Wegener Granulomatosis, PAN) • Zoster • Sarcoidosis • Dull, deep pain wakes patient at night • Systemic treatment with NSAID or Steroids.

Scleritis 25

Red Eye In Scleritis Conjunctivitis Dr Isam Al-Qurainy 26

Subconjunctival Haemorrhage • Diffuse or localised area • of blood under conjunctiva. Asymptomatic • Idiopathic, trauma, cough, sneezing, aspirin, HT • Resolves within 10-14 days • Treatment of Cause.

Differential Diagnosis Of Red Eye • Stress Upon 4 Vital Structures: • 1- Conjunctiva • 2- Cornea • 3- Pupil • 4- Intraocular Pressure (IOP) 28

Differential Diagnosis Of “Red Eye” • • Conjunctivitis Conjunctiva Cornea Pupil IOP Diffuse cong Normal Normal Normal • Uveitis Cir.Corn.Cong

KPs Small Normal • Ac.Cong

Glaucoma Cir.Corn.Cong Hazy Dilated Raised Fixed • Sub.Conjunctival

Bright Red Normal Normal Normal Haemorrhage 29

Dr Isam Al-Qurainy 30

• Your Eyes Are For Ever • Take Care Of Them 31

32