1. Acute Red Eye and Ocular Pain

2. What is Red Eye?
-One of the most common complaints in ophthalmology. - It means redness of the exposed white of the eye; the exposed conjuctiva and underlying sclera. - Associated symptoms will help establish the diagnosis.

3. Red eye: causes and symptoms
Major Causes Trauma Infection Acute Glaucoma Other inflammations Associated symptoms Discharge Pain Photophobia Blurred vision

4. Trauma
Subconjuctival hemorrhage: Bright red, y? beacause the blood is well oxygenated so remains bright . Maybe associated with HTN or blood clotting disorders including anti-coagulatant therapy so check INR + Hx
Corneal foreign body & abrasions: Extreme pain, watering. Ciliary or Limbal flush is a reflex vasodialtion of limbal episcleral vessels often in the meridian of the lesion aiding in its detection.
Chemical Injury: Alkali is worse than acid burn, y?
Because alkali diffuse more , while acid coagulate forming a layer that prevent its diffusion .
Ttx by irrigation immediately.

5. Subconjuctival Hemorrhage : Trauma

6. Trauma : Foreign Body

7. Trauma : Alkali Burn

8. Infection
Conjuctivitis: Discharge, visual blur due to discharge cleared on blinking. Bacterial gives purulent discharge giving sticky eyelids. Viral gives watery discharge. Blepharitis and entropion: 2ry infection. Corneal infection: Affects visual axis, sight threatening esp. acanthamoeaba keratitis. Hx of lens. Mucopurulent discharge.

9. Infection
Intraocular infection (endophthalmitis): post-op, painful red eye, reduced vision. Emergency. Infection of the orbit: orbital cellulitis, swollen, erythematous lids, chemotic conjuctiva, red, reduced eye movements, proptosis. Emergency because the vision may be rapidly lost due to Optic Nerve Damage. Ttx IV antibiotics and admission

10. Acute Glaucoma
Acute angle closure glaucoma. Generalized red eye, corneal clouding, reduced vision and severe pain. Urgent.

11. Other forms of inflammation
Seasonal allergic conjuctivitis: Spring & summer, allergens. Chomotic, itchy, watery, sneezing,Hx of atopy. Vision unaffected. Dry eyes: MILD redness, irritation and tired eyes. Episcleritis: No discharge. Vision unaffected. Scleritis: Pain deep and boring, associated with collagen vascular diseases. Medications: Topical. Prostglandin analogues used in treatment of Glaucoma. Others: Pterygia & pinguecula.

12. Case :D
28 year old male presents with painful, red eye. Blurred vision increasing over last 2 days. Wears contact lenses. Vision is 6/60 in right eye, there is central opacity on the cornea. A small hypopyon is present. Diagnosis? Bacterial keratitis Approach & Ttx? Fortified broad spectrum Antibiotic ( vancomycin and tobramycin )

13. OCULAR PAIN Pain: Itching & discomfort Deep severe pain Eye strain
Headache

14. Ocular Pain
Discomfort Blepharitis Dry eyes Conjuctivitis Allergy Dysthyroid eye disease Pain on eye movements Optic Neuritis

15. Ocular Pain
Pain around eye Giant cell arteritis Migraine Orbital cellulitis Causes of headache Severe Pain Keratitis Corneal abr./ul./FB Uveitis Angle Closure Glaucoma Endophthalmitis Scleritis Myositis of extraocular muscles

16. Case :3
A 75 year old female presents with nausea and vomiting. Rt eye is painful and red. Reduced vision. She is longsighted. No history of medical problems. Cornea is cloudy , the pupil is dilated and oval on the affected side. Diagnosis? Acute angle closure glaucoma Confirm by..? Tonometer , goniometer Ttx? All effort to decrease IOP by oral acetazolamide and b-blocker and pilocarpine urgently . But the main step is to do bilateral iridotomy .

17. Chemical burn (injury)
Most chemical substances that come in contact with the conjunctiva or cornea cause little harm.
The chief danger comes from alkali-containing compounds found in household cleaning fluids, fertilizers and pesticides. They erode and opacify the cornea.
Acid-containing compounds (battery fluid, chemistry labs) are somewhat less dangerous.
There are no antidotes to these chemicals. The best you can do is to dilute them immediately with plain water.
The resultant reaction of the tissue causes the damage.

18. Chemical burn (injury) cont.
Treatment should be instituted immediately, even before testing vision.
Emergency treatment:
1-copious irrigation of the eyes, preferably with saline or ringer lactate.
Don’t use acidic solutions to neutralize alkalis or vice versa.
Pull down the lower eyelid and evert the upper eyelid to irrigate the fornices
2-irrigation should be continued until neutral PH is reached.
The volume of irrigation fluid required to reach neutral PH varies with the chemical and the duration of the chemical exposure

19. Chemical burn (injury) cont.
For mild to moderate burns (during and after irrigation):
cycloplegic
topical antibiotic
oral pain medication
if increase IOP use drugs to reduce it (acetazolamide, methazolamide add b blocker if additional IOP control is required)
frequent use of preservative free artificial tear

20. Chemical burn (injury) cont.
For severe burns (Treatment after irrigation):
Admission to the hospital Lysis of conjunctival adhesion
Debride necrotic tissue
Topical antibiotic
Topical steroid
Consider a pressure patch
Antiglaucoma medication if the IOP is increased or cant be determined
Frequent use of preservative free artificial tear
Other consideration:
Therapeutic contact lenses, collagen, amniotic membrane transplant
IV ascorbate and citrate for alkali burns
If any melting of the cornea occurs, collagenase inhibitors may be used
If the melting progresses an emergency patch graft or corneal transplat may be necessary.

21. Chemical burn (injury)
A hazy cornea following an alkali burn