DOCSLIB.ORG

Ten Eye Problems You'll Meet in the ER, and How to Manage Them

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ten Eye Problems You'll Meet in the ER, and How to Manage Them 9/12/2017 Ten Eye Problems you’ll meet in the ER, and how to Manage Them Scott Kelly, MD, MPH Howerton Eye Clinic Austin, Texas September 16th, 2017 1 9/12/2017 Hyperopia Myopia “Farsightedness” “Nearsightedness” 2 9/12/2017 Pupils • PERRL, not PERRLA! • Accommodative Triad: Accommodation, Convergence, and MIOSIS • CN2- Edinger Westphal Nucleus- CN3 Eye Pain Control Good Idea Bad Idea • Cycloplegics (Atropine, • Proparicaine/ Cyclyopentolate) Tetracaine • Patching if Sharp pain • Ketorolac • Diamox/ IOP lowering • Heavy Narcotics drops (Combigan, Co- opt) if pressure >30 • Steroids (if not HSV Epithelial Keratitis) • Ointment/ Lubrication Patient 1 • 65 yo Man who noticed flashes of light while working in his yard. He saw flashes of light for 4- 5 hours, which has now subsided. He now has a C- shaped floater in his central vision. 3 9/12/2017 Posterior Vitreous Detachment (PVD) • Detachment of Vitreous from Posterior Retina • Has occurred in 66% of 66 year olds • Flashes with large central floater • May cause hemorrhage, retinal detachment • 15% of symptomatic PVD will have a retinal tear Patient 2 • 35 year old white man with 2 day history of pain, redness, photophobia in his right eye. This happened once before in the opposite eye and resolved after 1-2 weeks of pain. Other ROS/ Medical history is negative. Iritis/ Uveitis • Intraocular inflammation • May be Anterior, Posterior, Scleral, Episcleral • Treatment: Steroids, NSAIDs, Cycloplegia • Order lab workup for 2nd episode, or for Scleritis or Panuveitis • Most commonly: Laboratory negative 4 9/12/2017 Lab Workup • Head CT not indicated! • Common Infectious Causes • TB, Syphillis, HSV/ HZV • Common Non Infectious Causes • Sarcoid, RA, Psoriasis, SLE • HLA B-27 5 9/12/2017 Patient 3 • 25 year old carpenter who was scratched in the eye by a piece of plastic. He has severe pain, photophobia, and tearing when opening his eye. His visual acuity is slightly reduced. Corneal Abrasion • Epithelium will heal in 2-3 days regardless of treatment • Comfort: Patch or Bandage Contact lens • Antibiotic drops, cycloplegia, +/- steroids Corneal Ulcer • Corneal ulcer= Supprative material • Bacterial, Fungal, or Viral • Needs Eye MD • Culture first, then Fortified antibiotics, Cycloplegia, +/- Steroid • Pseudomonas, Gram + most severe 6 9/12/2017 Bacterial Keratitis • Contact lens use, Abrasion biggest risk factors • Goal: 1) Treat Infection 2) Heal Epithelium 3) Improve Vision • Consider Fungal infection with plant material • Not typically contagious marginal keratitis • Non-infectious infiltrates from Staph exotoxin secretion from lid margins • Treat lids, not cornea! • Can also be due to Contact Lens intolerance Patient 4 • 18 year old college student with 3 day history of red, swollen eyelid. She feels like there is a knot in her lid that is mobile and painful to the touch. 7 9/12/2017 Chalazion • Blockage of Meibomian Gland • Non-infectious, but can lead of Cellulitis • Treatment: • Reduce inflammation • Treat Blepharitis • Incise/ Curettage • Steroid Injection (Caution) Blepharitis/ Meibomian Gland Dysfunction • “Itching, Burning, Foreign Body Sensation” • Anterior (Lashes) • Seborrhea, Demodex • Posterior (Meibomian Glands) • Systemic inflammation/ Hormone Demodex 8 9/12/2017 Rosacea • Rhinophyma • Telangiectatic vessels, pustules of skin • vascular inflammation of lid margins • spill over inflammation on ocular surface: • Marginal Keratitis • Staph Hypersensitivity • Corneal Perforation Rosacea Treatment Goals • Reduce Eyelid inflammation • Matrix Metalloproteinase 9 (MMP-9) • Doxycycline, Azithromycin, Erythromycin • Clean lids/ lashes • Avenova/ Ocusoft Hypochlor • Warm compresses • Lubricate/ reduce tear osmolarity • Treat Ocular Inflammation (Restasis, Xiidra) 9 9/12/2017 Dry Eye Syndrome • #2 cause of visits to Ophthalmologists • Most DES patients combo of Blepharitis and Aqueous Tear Deficiency (ATD) • Blepharitis causes poor tear film quality and increased evaporation • ATD more common in SLE, RA, Sjogren’s • Tear replacement, increase Tear production, lid hygiene/ improve tear quality • Serum Tears Patient 5 • 25 year old Kindergarten teacher who has a 2 day history of photophobia, redness, pain and discharge in her left eye. She has had runny nose and cough for the last 4 days. Adenoviral (Epidemic) KeratoConjunctivitis • “Pink Eye”; you know real “Pink Eye” when you see it • Adenovirus 8, 19, 37 typically • Very Contagious!!!! • Red conjunctiva with Follicles, rope-like discharge, lids stuck closed • Cough/ runny nose; + Pre-Auricular Node (PAN) 10 9/12/2017 Adenoviral Conjunctivitis • Severe Cases= Conj Pseudomembranes or Corneal Sub-epithelial Infiltrates • Treatment: • Supportive; Cool tears, compress • +/- Steroids • Normal Course: worsening for 5 days, resolves 3 weeks Bacterial Conjunctivitis • Common but self limiting • Over diagnosed • Severe Forms: Chlamydia (chronic) and Gonorrhea (hyperacute/ can perforate) TIP: use a cheaper generic antibiotic • Typically gram +; cultures not necessary (Cipro, Polytrim, Tobramycin) • Ocular symptoms similar to viral but localized instead of brand name Patient 6 • 55 year old Hispanic man with 2 days of right sided scalp and forehead pain. A rash developed yesterday, and he now has difficulty opening his eyelid. 11 9/12/2017 Herpes Zoster Ophthalmicus • Unilateral, respecting midline • Pain from inflamed nerves! • Increased risk of ophthalmic involvement with + Hutchinson’s sign (Nasociliary Nerve V1)- Tip of nose • Eye involvement may lag behind or precede rash Herpes Zoster Ophthalmicus • Treat ideally < 4 days from onset: • Valacyclovir 1 Gram TID 10 days • Oral Prednisone for 10 days • Bacitracin to skin lesions • +/- Capsaicin HZO Ophthalmic Complications • Immune Keratopathy/ Scarring • Neurotrophic Keratopathy • Uveitis • IOP Spike • Retinitis/ Optic Neuritis 12 9/12/2017 Patient 7 • 25 yo Woman who has a 2 day history of a red, painful left eye with photophobia and tearing. Her right eye is normal. She has been under stress recently, and attempted to deal with the stress with a trip to the beach. Herpes Simplex Epithelial Keratitis • Dendritic lesion with club-shaped ends • Represents ACTIVE Virus; typically HSV-1 • Other presentations: • Geographic ulcer • Stromal (Disciform) Keratitis • Uveitis (Iris atrophy and high IOP) HSV Treatment Epithelial Stromal • Valacyclovir 500mg TID • Topical Steroid QID • Acyclovir 400mg 5x/day • Valacyclovir 500mg daily (prophylactic dose) • Trifluridine Drops 9x/day • Cycloplegia • NO STEROIDS until epi healed • Cycloplegia 13 9/12/2017 a) Healing epithelial abrasion b) Herpes keratitis c) Dry eye syndrome d) SLK e) Exposure f) Trichiasis g) Blepharoconjunctivitis h) Foreign body under lid i) Neurotrophic keratopathy j) Corneal abrasion k) Lagophthalmos f) Trichiasis c) Dry eye syndrome d) SLK g) Blepharoconjunctivitis e) Exposure f) Trichiasis k) Lagophthalmos i) Neurotrophic h) Foreign body keratopathy under lid b) Herpes keratitis j) Corneal abrasion a) Healing epithelial abrasion Patient 8 • 30 year old man with a 2 day history of worsening eye pain, eyelid swelling, blurred vision, and pressure-like sensation around his eye. He has had nasal congestion for the last week. 14 9/12/2017 Cellulitis • MUST GET CT ORBITS/ FACE! • Orbital Cellulitis: • Preseptal Cellulitis: • Eyelid/ edema • Eyelid/ edema • Conjunctival Chemosis • No Chemosis/ Proptosis • Proptosis • Abscess possible • Reduced ocular movement/ pain with eye movement • +/- Pupillary Defect Orbital Cellulitis • Frequently extension from Paranasal Sinuses • Treatment • Life- Threatening disease! • Admit, ID consult, IV Antibiotics, Drain Abscess • Staph, Strep, H. flu Preseptal Cellulitis • Usually adjacent infection or trauma • Anterior to Orbital Septum • Abscesses common 15 9/12/2017 Patient 9 • 65 year old truck driver that has noticed double vision for the last 2 days. He also is having trouble keeping his right eye open. He denies other symptoms. Cranial Nerve 3 Palsy • CN3 Palsy: “Down and Out” • Often Ptosis (Levator= Superior branch of CN3) • Pupil-sparing: usually Ischemic • Pupil- involving: Aneurysm (Posterior Communicating Artery) until proven otherwise Cranial Nerve 3 Palsy • Diagnosis: Prompt MRI/ MRA! • Ocular Myasthenia Gravis can Masquerade as CN palsy 16 9/12/2017 Patient 10 • A 70 year old woman is complaining of eye pain, redness, haloes around light, headache, nausea and vomiting. • On exam, she has reduced vision, redness, a cloudy cornea, and a fixed pupil. Her IOP reading by tonopen is 55. High Pressure Angle Phaco- Neo- Inflammatory Closure morphic vascular • Small stature • Elderly • Uncontrolled • Viral Uveitis Diabetes (or Vein • Hyperopia • No history of Occlusion) • Trabeculitis or Iris Cataract Chaffing extraction • Treatment: • Lower IOP with Timolol, Brimonidine, Dorzolamide. • Acetazolamide 500mg • Prednisolone Acetate 1% • +/- Zofran • +/- IV Mannitol 17 9/12/2017 Primary Open Angle Glaucoma • #2 cause of blindness in the world (ACG and POAG) • 2% of US population above 40 yo • Risks: • Classic: Age, Race, FHx, Corneal Thickness, IOP • New: Myopia, Vascular compromise • Most IOP elevations NOT PAINFUL Bonus: Patient 11 • 60 year old construction worker who was diagnosed with Diabetes Mellitus Type II 5 years ago. Since then, he has been “controlling his Diabetes with his diet, because he doesn’t feel bad”. He doesn’t check his blood sugar, and his last Hemoglobin A1c was 10. • He is complaining today of black spiderwebs in his vision of his right eye. He says that his vision has been
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • Eyelid and Orbital Infections
    27 Eyelid and Orbital Infections Ayub Hakim Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel 1. Introduction The major infections of the ocular adnexal and orbital tissues are preseptal cellulitis and orbital cellulitis. They occur more frequently in children than in adults. In Schramm's series of 303 cases of orbital cellulitis, 68% of the patients were younger than 9 years old and only 17% were older than 15 years old. Orbital cellulitis is less common, but more serious than preseptal. Both conditions happen more commonly in the winter months when the incidence of paranasal sinus infections is increased. There are specific causes for each of these types of cellulitis, and each may be associated with serious complications, including vision loss, intracranial infection and death. Studies of orbital cellulitis and its complication report mortality in 1- 2% and vision loss in 3-11%. In contrast, mortality and vision loss are extremely rare in preseptal cellulitis. 1.1 Definitions Preseptal and orbital cellulites are the most common causes of acute orbital inflammation. Preseptal cellulitis is an infection of the soft tissue of the eyelids and periocular region that is localized anterior to the orbital septum outside the bony orbit. Orbital cellulitis ( 3.5 per 100,00 ) is an infection of the soft tissues of the orbit that is localized posterior to the orbital septum and involves the fat and muscles contained within the bony orbit. Both types are normally distinguished clinically by anatomic location. 1.2 Pathophysiology The soft tissues of the eyelids, adnexa and orbit are sterile. Infection usually originates from adjacent non-sterile sites but may also expand hematogenously from distant infected sites when septicemia occurs.
    [Show full text]
  • Special Considerations in Cataract Surgery: Five Cornea Challenges
    Clinical Update EXTRA CONTENT AVAILABLE CATARACT Special Considerations in Cataract Surgery: Five Cornea Challenges by linda roach, contributing writer interviewing preston h. blomquist, md, rosa a. braga-mele, md, kimberly a. drenser, md, phd, herbert e. kaufman, md, marguerite mcdonald, md, and roger f. steinert, md s the most common surgical choices, said Marguerite McDonald, IOL Selection procedure in ophthalmol- MD, of Lynbrook, N.Y. The device en- ogy, replacement of a cloudy ables the surgeon to directly measure 1 crystalline lens with an the eye’s aphakic refractive power in intraocular lens (IOL) usu- the operating room. Aally presents the ophthalmologist with Using intraoperative aberrometry is familiar sets of surgical routines. But becoming more commonplace, as “it what about those cases that involve may help in achieving more accuracy comorbidities or other complicating with IOL power selection,” Dr. Mc- factors? Donald said. Several experts shared their per- Tips on IOL selection. The chosen spectives on approaching out-of-the- IOL should be shaped to neutralize After an off-center LASIK procedure ordinary cataract surgeries in ways spherical aberrations, said Rosa A. such as this, the irregularity of the that offer the best chance at optimiz- Braga-Mele, MD, at the University of corneal topography indicates that a ing patient outcomes. This month, Toronto. “In anybody who has had multifocal IOL should be avoided. here’s a look at five challenges involv- myopic LASIK or PRK, I think it’s very ing the cornea. important to use a negatively aspheric prior to cataract surgery. 2) A dysfunc- IOL, because these patients have more tional, unstable tear film will affect the Challenge: Prior Refractive Surgery positively aberrant corneas.
    [Show full text]
  • Diagnosing, Treating, and Managing Scleritis in 2020 an Expert Panel Recommendation Panel Members Melissa Toyos, Md Stephen D
    DIAGNOSING, TREATING, AND MANAGING SCLERITIS IN 2020 AN EXPERT PANEL RECOMMENDATION PANEL MEMBERS MELISSA TOYOS, MD STEPHEN D. ANESI, MD, FACS n Partner and Director of Research n Massachusetts Eye Research & Surgery Institution n Toyos Clinic n Waltham, MA n Nashville, TN DAVID S. CHU, MD n Medical Director, Metropolitan Eye Research THOMAS A. ALBINI, MD & Surgery Institute n Professor of Clinical Ophthalmology n Associate Professor of Clinical Ophthalmology n University of Miami Health n Rutgers University n Bascom Palmer Eye Institute n Newark, NJ n Miami, FL ROBERT C. WANG, MD n Texas Retina Associates n Dallas, TX Corresponding Author: Melissa Toyos, MD; Toyos Clinic, Nashville, TN; [email protected]. This work was supported by an unrestricted medical writing grant from Mallinckrodt Pharmaceuticals and is based on a virtual roundtable discussion hosted by Evolve Medical Education LLC. Although uncommon, scleritis is a dangerous immune-me- DIAGNOSING SCLERITIS diated disease that can potentially threaten the structural Melissa Toyos, MD: What percentage of patients in integrity of the eye and may be indicative of potentially your practice have scleritis? life-threatening systemic vasculitis.1,2 Data on the genetic factors of scleritis is lacking, but it is thought that genes affect- Stephen D. Anesi, MD, FACS: Scleritis accounts for 10% ing systemic autoimmune diseases impact scleritis as well.2 to 15% of the patients I see in my practice. Differentiating between episcleritis and scleritis and posterior and anterior scleritis can be challenging for physicians. An David S. Chu, MD: I agree; 10% to 15% sounds right to accurate diagnosis is critical to properly treat the disease and me as well.
    [Show full text]
  • Changes in Ocular Rigidityin Endocrine Exophthalmos
    Br J Ophthalmol: first published as 10.1136/bjo.42.11.680 on 1 November 1958. Downloaded from Brit. J. Ophthal. (1958) 42, 680. CHANGES IN OCULAR RIGIDITY IN ENDOCRINE EXOPHTHALMOS* BY R. WEEKERS AND G. LAVERGNE From the Ophthalmological Clinic, Lie'ge University Two types of endocrine exophthalmos are frequently distinguished, being referred to thyrotoxic or hyperthyroid exophthalmos, and thyrotropic, ophthahnoplegic, or oedematous exophthalmos. (a) Hyperthyroid or Thyrotoxic Exophthalmos.-This accompanies Graves's disease and is, therefore, much more frequently seen in females than in males. In the majority of cases the exophthalmos is quite unobtrusive or there is merely an appearance of exophthalmos due to retraction of the upper lid. It is associated with a decreased frequency of blinking and a fixed stare. The majority of authors agree that these symptoms should be attributed to an increase in tone of the sym- pathetic system. The importance of the pituitary thyrotropic hormone in thiscopyright. clinical picture is not clear. Hyperthyroid exophthalmos is not complicated either by chemosis or by diplopia, but heterophoria and lack of convergence are often seen. (b) Thyrotropic, Ophthalmoplegic, or Oedematous Exophthalmos.-This may occur either in a subject suffering from verified and treated hyperthyroidism, when the signs of thyrotoxicosis are about to disappear, or in an apparently normal subject free from any thyroid symptom or history of symptoms. The second type http://bjo.bmj.com/ is more frequently seen in males than in females. Thyrotropic exophthalmos is often very marked'and may even lead to irreducible lagophthalmos; it is invariably associated with a disturbance of ocular movements, particularly with elevation of the gaze.
    [Show full text]
  • Preseptal and Orbital Cellulitis
    Journal of Microbiology and Infectious Diseases / 2014; 4 (3): 123-127 JMID doi: 10.5799/ahinjs.02.2014.03.0154 REVIEW ARTICLE Preseptal and orbital cellulitis Emine Akçay, Gamze Dereli Can, Nurullah Çağıl Yıldırım Beyazıt Univ. Medical Faculty Atatürk Training and Research Hospital Dept. of Ophthalmology, Ankara, Turkey ABSTRACT Preseptal cellulitis (PC) is defined as an inflammation of the eyelid and surrounding skin, whereas orbital cellulitis (OC) is an inflammation of the posterior septum of the eyelid affecting the orbit and its contents. Periorbital tissues may become infected as a result of trauma (including insect bites) or primary bacteremia. Orbital cellulitis generally occurs as a complication of sinusitis. The most commonly isolated organisms are Staphylococcus aureus, Streptococcus pneu- moniae, S. epidermidis, Haempphilus influenzae, Moraxella catarrhalis and S. pyogenes. The method for the diagnosis of OS and PS is computed tomography. Using effective antibiotics is a mainstay for the treatment of PC and OC. There is an agreement that surgical drainage should be performed in cases of complete ophthalmoplegia or significant visual impairment or large abscesses formation. This infections are also at a greater risk of acute visual loss, cavernous sinus thrombosis, meningitis, cerebritis, endo- phthalmitis, and brain abscess in children. Early diagnosis and appropriate treatment are crucial to control the infection. Diagnosis, treatment, management and complications of PC and OC are summarized in this manuscript. J Microbiol Infect Dis 2014; 4(3): 123-127 Key words: infection, cellulitis, orbita, preseptal, diagnosis, treatment Preseptal ve Orbital Sellülit ÖZET Preseptal selülit (PS) göz kapağı ve çevresindeki dokunun iltihabi reaksiyonu iken orbital selülit (OS) orbitayı ve onun içeriğini etkileyen septum arkası dokuların iltihabıdır.
    [Show full text]
  • Orbital Cellulitis Management Guideline – for Adults & Paeds
    ORBITAL CELLULITIS MANAGEMENT GUIDELINE – FOR ADULTS & PAEDS Authors: Stephen Ball, Arthur Okonkwo, Steven Powell, Sean Carrie Orbital cellulitis management guideline – For Adults & Paeds Is it limited to Preseptal Cellulitis? i.e. Eyelid only & eye not involved Oral Co-amoxiclav (clindamycin if penicillin allergic) Consider treating as an outpatient with review in eye casualty in 24-48 hours No Indication for admission – any of: Clinical suspicion of post-septal cellulitis Baseline Investigations Pyrexia FBC, CRP, lactate (& blood culture if Immunocompromised pyrexia) Had 36-48 hours of oral antibiotics Endonasal swab <12 months old unable to assess eye due to swelling Yes Medical management Discharge ADULTS – iv Tazocin (allergy; Iv clindamycin & iv ciprofloxacin) Discharge once swelling PAEDS – iv co-amoxiclav (allergy; iv cefuroxime & has resolved and metronidazole if mild allergy - other allergy discuss with micro) pyrexia settled with IMMUNOCOMPROMISED - discuss all with microbiology/ID oral antibiotics; Consider nasal Otrivine & nasal steroids -co-amoxiclav 4 hourly eye & neuro-observations -clindamycin if Urgent Ophthalmology assessment & daily review penicillin allergic Urgent Otolaryngology assessment & daily review Yes Indication for imaging CNS involvement NO - Discuss Unable to examine eye/open eyelids with Eye signs – any of: proptosis, restriction/pain microbiology/ID on eye movement, chemosis, RAPD, reduced visual acuity/colour vision/visual field, optic nerve swelling No Failure to improve or continued pyrexia after 36-48 hours IV antibiotics Improvement in 36-48 hours Contrast enhanced CT Orbit, Sinuses and Brain Continue medical management, rescan if failure to improve after 36-48 Orbital Collection No Orbital Collection Outpatient Treatment hours Admission Surgical management Medical Management Approach depends on local skill set o Evacuation of orbital pus Imaging o Drainage of paranasal sinus pus Discuss any intracranial complication with both neurosurgery & Microbiology Surgical Management .
    [Show full text]
  • Eye Disease 1 Eye Disease
    Eye disease 1 Eye disease Eye disease Classification and external resources [1] MeSH D005128 This is a partial list of human eye diseases and disorders. The World Health Organisation publishes a classification of known diseases and injuries called the International Statistical Classification of Diseases and Related Health Problems or ICD-10. This list uses that classification. H00-H59 Diseases of the eye and adnexa H00-H06 Disorders of eyelid, lacrimal system and orbit • (H00.0) Hordeolum ("stye" or "sty") — a bacterial infection of sebaceous glands of eyelashes • (H00.1) Chalazion — a cyst in the eyelid (usually upper eyelid) • (H01.0) Blepharitis — inflammation of eyelids and eyelashes; characterized by white flaky skin near the eyelashes • (H02.0) Entropion and trichiasis • (H02.1) Ectropion • (H02.2) Lagophthalmos • (H02.3) Blepharochalasis • (H02.4) Ptosis • (H02.6) Xanthelasma of eyelid • (H03.0*) Parasitic infestation of eyelid in diseases classified elsewhere • Dermatitis of eyelid due to Demodex species ( B88.0+ ) • Parasitic infestation of eyelid in: • leishmaniasis ( B55.-+ ) • loiasis ( B74.3+ ) • onchocerciasis ( B73+ ) • phthiriasis ( B85.3+ ) • (H03.1*) Involvement of eyelid in other infectious diseases classified elsewhere • Involvement of eyelid in: • herpesviral (herpes simplex) infection ( B00.5+ ) • leprosy ( A30.-+ ) • molluscum contagiosum ( B08.1+ ) • tuberculosis ( A18.4+ ) • yaws ( A66.-+ ) • zoster ( B02.3+ ) • (H03.8*) Involvement of eyelid in other diseases classified elsewhere • Involvement of eyelid in impetigo
    [Show full text]
  • CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
    CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g.
    [Show full text]
  • Canine Red Eye Elizabeth Barfield Laminack, DVM; Kathern Myrna, DVM, MS; and Phillip Anthony Moore, DVM, Diplomate ACVO
    PEER REVIEWED Clinical Approach to the CANINE RED EYE Elizabeth Barfield Laminack, DVM; Kathern Myrna, DVM, MS; and Phillip Anthony Moore, DVM, Diplomate ACVO he acute red eye is a common clinical challenge for tion of the deep episcleral vessels, and is characterized general practitioners. Redness is the hallmark of by straight and immobile episcleral vessels, which run Tocular inflammation; it is a nonspecific sign related 90° to the limbus. Episcleral injection is an external to a number of underlying diseases and degree of redness sign of intraocular disease, such as anterior uveitis and may not reflect the severity of the ocular problem. glaucoma (Figures 3 and 4). Occasionally, episcleral Proper evaluation of the red eye depends on effective injection may occur in diseases of the sclera, such as and efficient diagnosis of the underlying ocular disease in episcleritis or scleritis.1 order to save the eye’s vision and the eye itself.1,2 • Corneal Neovascularization » Superficial: Long, branching corneal vessels; may be SOURCE OF REDNESS seen with superficial ulcerative (Figure 5) or nonul- The conjunctiva has small, fine, tortuous and movable vessels cerative keratitis (Figure 6) that help distinguish conjunctival inflammation from deeper » Focal deep: Straight, nonbranching corneal vessels; inflammation (see Ocular Redness algorithm, page 16). indicates a deep corneal keratitis • Conjunctival hyperemia presents with redness and » 360° deep: Corneal vessels in a 360° pattern around congestion of the conjunctival blood vessels, making the limbus; should arouse concern that glaucoma or them appear more prominent, and is associated with uveitis (Figure 4) is present1,2 extraocular disease, such as conjunctivitis (Figure 1).
    [Show full text]
  • Update on Surgical Management of Corneal Ulceration and Perforation
    Romanian Journal of Ophthalmology, Volume 63, Issue 2, April-June 2019. pp:166-173 GENERAL ARTICLE Update on surgical management of corneal ulceration and perforation Stamate Alina-Cristina* **, Tătaru Călin Petru* ***, Zemba Mihail* **** *Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania **Arena Med Clinic, Bucharest, Romania ***Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania ****Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania Correspondence to: Stamate Alina-Cristina, MD, Arena Med Clinic, Bucharest, 68 Basarabia Boulevard, Ap. 1, District 2, Bucharest, Romania, Mobile phone: +40737 027 067, E-mail: [email protected] Accepted: May 28th, 2019 Abstract Corneal ulcerations are a medical emergency, and in recalcitrant cases, leading to perforation, a surgical ophthalmological emergency. The urgency of the treatment is dictated by the necessity of preventing complications that can lead to serious ocular morbidities. Medical treatment represents the first therapeutic approach and is a defining step in the further management of a patient with corneal ulceration. Multiple surgical strategies are available, but the option depends on the etiology and parameters of the ulceration: size, depth, and location. Keywords: corneal ulceration, corneal perforation, tissue adhesives, cross-linking, amniotic membrane, conjunctival flap, keratoplasty Introduction reepithelialization by using preservative-free lubricants,
    [Show full text]
  • Eleventh Edition
    SUPPLEMENT TO April 15, 2009 A JOBSON PUBLICATION www.revoptom.com Eleventh Edition Joseph W. Sowka, O.D., FAAO, Dipl. Andrew S. Gurwood, O.D., FAAO, Dipl. Alan G. Kabat, O.D., FAAO Supported by an unrestricted grant from Alcon, Inc. 001_ro0409_handbook 4/2/09 9:42 AM Page 4 TABLE OF CONTENTS Eyelids & Adnexa Conjunctiva & Sclera Cornea Uvea & Glaucoma Viitreous & Retiina Neuro-Ophthalmic Disease Oculosystemic Disease EYELIDS & ADNEXA VITREOUS & RETINA Blow-Out Fracture................................................ 6 Asteroid Hyalosis ................................................33 Acquired Ptosis ................................................... 7 Retinal Arterial Macroaneurysm............................34 Acquired Entropion ............................................. 9 Retinal Emboli.....................................................36 Verruca & Papilloma............................................11 Hypertensive Retinopathy.....................................37 Idiopathic Juxtafoveal Retinal Telangiectasia...........39 CONJUNCTIVA & SCLERA Ocular Ischemic Syndrome...................................40 Scleral Melt ........................................................13 Retinal Artery Occlusion ......................................42 Giant Papillary Conjunctivitis................................14 Conjunctival Lymphoma .......................................15 NEURO-OPHTHALMIC DISEASE Blue Sclera .........................................................17 Dorsal Midbrain Syndrome ..................................45
    [Show full text]