1. RED EYE

2. Chronic unilateral conjunctivitis
Case # /F 정 O 연
C.C : Ocular discomfort (OD) for 3개월
“ 눈이 빨개요“
“ 찐득한 눈꼽이 붙어 있어요”
“ 안약을 넣어도 호전이 없어요”
“ 보이는 것은 괜찮아요”
PHx.
DM/HTN(-/-)
Ocular op/trauma (-/-)
안약 – ocuflox, ocumetholone qid 1개월
Chronic unilateral conjunctivitis

3. Chronic unilateral follicular conjunctivitis
VA OD 1.0 OS 0.8 Conjunctiva : OD Cornea: OD clear OS clear AC OD deep & cell (-) OS deep & cell (-) Pupil OD: round & nl. Sized LR (+/+) OS: round & nl. Sized Lens OD: clear OS: clear
injection c follicles in inferior bulbar conjunctiva
Chronic unilateral follicular conjunctivitis

4. Chronic unilateral follicular conjunctivitis
Moraxella
Molluscum contagiosum
Lyme disease
Toxic
Chlamydia infection

5. Molluscum contagiosum
Moraxella - Angular blepharoconjunctivitis : Lid lateral margin ulceration
Molluscum contagiosum
- Young children, lid margin umblicated lesion
3. Lyme disease- rare
Toxic follicular conjunctivitis
- Brimonidine, Pilocarpine, Apraclonidine
: Glaucoma reagent
- Inferonasal, cornea epithelial defect

7. 5. Chlamydia conjunctivitis
Trachoma
- most common blindness, within 2yrs
- superior bulbar conjunctiva scarring
Inclusion conjunctivitis
- sexual transmitted disease
- nontender preauricular lymph node
- Inferior conjunctiva follicle

8. Imp) Chlamydia inclusion conjunctivitis(OD) 환자에게 물어보아야 할 것은
질환 전파 경로
Preauricular LN 촉진

9. Chlamydia inclusion conjunctivitis(OD) 치료 전신질환이므로 경구용 항생제 사용
Doxycycline 계열 적어도 3주 이상 사용
배우자 같이 치료

10. Case #2. 19261647 65/F 오 O 희 C.C 눈이 건조해요 (OU) for 1yrs
eyedrop) Duratears
Optagent
Hyalein mini
PHx.
DM/HTN(-/+)
Ocular op/trauma (-/-)
Schirmer 0/0(OU)
BCVA OD 0.63
OS 0.125

11. Lid Meibomitis OS) notching in lower lid Conjunctiva OD medial conjunctiva symblepharon, concretion OS medial conjunctiva symblepharon, concretion Cornea: OD filament OS SPE

12. Chronic cicatrizing conjunctivitis, Symblepharon, Severe dry eye
Sjogren’s syndrome – 입마름, Anti Ro/La (+/+)
Cicatrical pemphigoid
–conjunctival biopsy, BM에 면역복합물 침착
Stevens-Johnson syndrome
: skin lesion, definite history, keratinized lid

13. Secreted mucin: MUC5AC
Membraneous mucin
: MUC1, MUC4, MUC16

14. Imp) Ocular cicatrical pemphigoid Plan) Rhematology consult Restasis BID 1% PDL pulse therapy hyalein mini (0.3%) q2hr Monocin 1T Blephasol BID apply

15. After 2 month
각막미란 그대로
-> T-lens apply
Serum

16. Case # /M 김 O 준
C/C Ocular pain for 3months (OD) first attck
- aggravated for 1months
P/Hx DM (-) HBP (-)
Ocular trauma/ op (-/ -)
No improvement after consevative Tx. at local clinic
IOP elevation Hx. (+) during local clinic Tx.

17. Conj :severely injected c chemosis
VA : OD 1.0
OS 0.8 (1.0 x –0.75Dc Ax 120)
Conj :severely injected c chemosis
engorged conjunctival & episcleral vessels
Cornea :clear
AC : deep & cell(rare)
IOP : 20 mmHg
Lens : mild cortical opacity
Not blanched after
O-2PE dropping OD

18. Imp) scleritis(OD)
Plan)
1. 1.O-FML x4, O-BMDP x2, O-LTP(xhs)
2.MFN 3T #3
C-CP 50mg #2 for 15 days
TBT 2T #2

19. EPISCLERITIS AND SCLERITIS
Simple
Nodular
2. Anterior scleritis
Non-necrotizing diffuse
Non-necrotizing nodular
Necrotizing with inflammation
Necrotizing without inflammation
( scleromalacia perforans )
3. Posterior scleritis

20. Applied anatomy of vascular coats
Normal
Episcleritis
Scleritis
Radial superficial episcleral
vessels
Maximal congestion
of episcleral vessels
Maximal congestion of
deep vascular plexus
Deep vascular plexus
adjacent to sclera
Slight congestion of
episcleral vessels

21. 10% phenylephrine test

22. Case #4. 19243390 39/F 배 O 희 C.C Red eye(OD) for 1yr, 아침에 눈 뜰 때 아파요
eyedrop) Cravit
Tearin-Free
Duratears
PHx.
DM/HTN(-/-)
Ocular op/trauma (-/+)
아이 손가락에 찔린 경험
YAG epithelioplasty

23. VA OD 0. 32 (0. 8 x -1. 75Ds = -1. 0Dc Ax75) OS 0. 32 (0. 8 x -1
VA OD 0.32 (0.8 x -1.75Ds = -1.0Dc Ax75) OS 0.32 (0.8 x -1.75Ds = -0.5Dc Ax95) Conjunctiva : OD mod. injected OS not injected Cornea: OD Corneal erosions c previous YAG scar OS clear AC OD deep & cell (-) OS deep & cell (-) Pupil OD: round & nl. Sized LR (+/+) OS: round & nl. Sized Lens OD: mild cortical opacity OS: mild cortical opacity

24. Recurrent Corneal Erosion
Episodic recurrence
Corneal erosion incomplete healing, loose
Most erosion occur during the evening or early morning
Abrupt tearing or ripping sensation followed by sharp pain, markedly FB sensation, lid swelling
Anxiety  more quickly & abnormal blinking, rapid eye movement  more frequent erosions

25. Ragged, edematous,
dirupted gray epithelium

26. Ant. stromal puncture Epithelial reinforcement, corneal micropucnture
- improve epithelial adhesion by forming tiny scarring attachments
- entire erosive area and 1 to 2 mm of normal margins outside the visible limits of the erosive area
- treatment within the pupillary space should be avoided if possible
- single procedure is effective approximately 80%

27. Conventional straight needle
3 months later
Conventional straight needle

28. 시술 후 지속적인 5% Nacl
- 적어도 6개월 이상 사용
- 자기 전에는 반드시
- 과도한 인공누액 사용은 삼가