1. The Red Blind Eye

2. THE RED EYE Periorbital / Orbital cellulitis Conjunctivitis
Iritis/ Keratitis/ Corneal ulcer
Glaucoma
cavernous sinus thrombosis
thyroid eye disease
alcoholism

3. Periorbital / Orbital Cellulitis
ORBITAL CELLULITIS PRESEPTAL CELLULITIS
Location orbit eyelids
Proptosis present absent
Eye movements decreased normal
Visual acuity decreased late normal
Orbital pain present absent

4. Periorbital / Orbital Cellulitis (management)
Exclude herpetic involvement - flouresin
CT orbit
swab eye
Peri-orbital: PO Flucloxacillin (PO Cephalexin)
Orbital: IV Cefotaxime + Flucloxacillin
(gentamicin if contact lens wearer)
topical chloramphenicol

5. Glaucoma (primary closed angle)
Acute severe unilateral pain
visual disturbance - fog, halo
mid dilated non reactive pupil
shallow ant chamber
corneal haze
IOP > 40mmHg

6. Glaucoma (management)
More common - female, FHx glaucoma, old
beta agonists, mydriatics
acetazolamide 500mg IV stat, 250mg PO tds
timoptolol 0.5% drops bd
Lie flat
Topical steroids
pilocarpine 2% every 15min x 2 mannitol 1g/kg IV
Mannitol
Corneal Indentation
urgent peripheral iridectomy
Lie flat – lens falls away from the iris decreasing pupillary block
Pilocarpine may not be effectively immediately due ischaemic paralysis of the iris so start 1 hr after initial treatment
Mannitol is an osmotic agent which may decrease vitreous volume
Corneal indentation : a flat soft object is pushed gently on the anaesthetised cornea in an attempt to move the vitreous to the peripheries and open the angle

7. ACUTE NON TRAUMATIC BLINDNESS
Acute glaucoma
Central retinal artery occlusion
Central retinal vein occlusion
Retinal detachment
Optic neuritis
lens dislocation
vitreous haemorrhage
optic n. / chiasma compression
toxic / metabolic neuropathies
post chiasmal - infarct, infection

8. Retinal detachment Immediate or delayed (months) partial field defect
flashes and floaters
pad eye , bed rest
laser coagulation

9. Central retinal artery occlusion
Very sudden
Painless
unilateral usually
fundoscopy
pale disc
retinal white oedema
cherry red macula
paucity of arterial vasculature

10. Central retinal artery occlusion (management)
At risk - AF, Carotid/Cardiac embolus, giant cell arteritis, vasculitis(lupus), sickle cell disease
90min before irreversible injury
digital massage
hypoventilate ( increase pCO2)
decrease IOP - acetazolamide, tioptolol, mannitol, diuretics
anterior chamber paracentesis
retrobulbar anaesthesia (thrombolysis)

11. Central retinal vein occlusion
Onset over minutes
painless
fundoscopy
dilated tortuous veins
diffuse retinal haemorrhage
asprin 300mg
monitor neovascularisation