Painful Red Eye Management (1).pptx
- 1. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 2. • Red eye-non-specific term to describe an eye that appears red due to illness, injury, or some other condition • Caused by enlarged, dilated blood vessels, leading to the appearance of redness on surface of eye
- 3. Conjunctiva – Conjunctivitis – Dry eye – Pterygium – Subconjunctiva l haemorrhage – Trauma Cornea − Abrasion – Foreign body – Laceration – Corneal ulcer – Keratitis – Contact lens wear Sclera – Episcleritis – Scleritis Iris and ciliary body – Iritis – Iridocyclitis Anterior chamber – Hyphaema – Acute angle closureglaucoma Eyelid – Triachiasis – Entropion – Ectropion Orbit – Orbital cellulitis – Acute dacryocystitis
- 4. SYMPTOMS Pain –corneal ulcer, iritis, acute glaucoma Visual loss Eye discharge Purulent – bacterial conjunctivitis Clear – viral or allergic cause Gritty sensation – common in conjunctivitis Itching – common in allergic eye disease, blepharitis and topical drop hypersensitivity Photophobia -panuveitis
- 5. 1. Vesicles 2. Follicles 3. Ciliary flush 4. Irregular pupil 5. Papillae 6. Foreign body 7. Dilated conjunctival vessels 8. Discharge 9. Corneal ulcer 10. Hypopyon 11. Dendritic ulcer 12. Dilated episcleral vessels 1 2 3 4 5 6 7 9 8 10 11 12
- 7. • Characterize the symptoms: • Duration – hours, days, weeks Acute , Subacute and Chronic • Types of discharge – clear, purulent, etc. • Unilateral or bilateral • Precipitating event – trauma, contact lens usage • Previous episodes of a similar problem • Past medical history – DM, hypertension • Allergic history
- 8. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 9. • Thin, vascular mucous membrane/ epithelium • Conjuntival causes of red eyes: – Bact, viral, chlamydial, allergic conjunctivitis, opthalmia neonatorum (will be presented further by Nafis) – dry eye, pterygium, subconjunctival haemorrhage, injury.
- 10. • Triangular fold of conjunctiva that usually grows from the medial portion of the palpebral fissure towards & invades the cornea • Non-malignant fibrovascular growth • Predisposing factors: – Hot climates – Chronic dryness – Exposure to sun *Prevalent in Southern countries • Mx – surgical removal
- 11. • ‘Extensive bleeding under the conjunctiva’ • Features: red eye, comfortable, no visual disturbance, • Hx of trauma, spontaneously in elderly patient (compromised vascular struc in arteriosclerosis), may occur after coughing, sneezing, heavy lifting objects. • Mx: check BP to exclude HPT (esp if occur repeatedly), usually resolve spontaneously within 2 weeks.
- 12. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 13. Function: •Transmissionof light •Refraction of light •Barrier against infection, foreignbodies 5 layers 1.Epithelium 2.Bowman’smembrane 3.Stromal 4.Desscemet’smembrane 5.Endothelium -extensive sensoryfibre network(V1distribution)
- 14. • Corneal Ulcer (will be presented later) • Corneal abrasion – epithelium defect due to trauma, contact lens – use fluorescein and blue light, defect shine in green. • Corneal foreign body – foreign body in or on cornea. – cause intense irritation and profuse watering. Mx – Topical antibiotic (drop/ointment) – Tropical NSAIDS, cyclopegic – Tight patch
- 15. • Def : Inflammation of the cornea • Type : • Infective – Bacterial – Viral – Protozoal • Non Infective – Autoimmune (eg: RA, SLE) – Non Autoimmune (eg: Marginal keratitis)
- 16. CAUSES - Staphylococcus epidermidis - Staphylococcus aureus - Streptococcus pneumoniae - Coliforms - Pseudomonas - Haemophilis PREDISPOSING FACTOR Keratoconjunctivitis sicca (dry eye) A breach in corneal epithelium (eg following trauma) Prolonged contact lens wear Prolonged use of topical steroids
- 17. SYMPTOMS & SIGNS o severe pain o purulent discharge o ciliary injection o visual loss o hypopyon o white corneal opacity, can be seen with naked eye MANAGEMENT Scrapes taken from base of ulcer for Gram-staining & culture Rx: Dual therapy of intensive topical antibiotics (eg: cefuroxime for Gram +ve bacteria and gentamicin for Gram –ve bacteria) Monotherapy: fluoroquinolones (eg: ciprofloxacin, ofloxacin) Initially by tissue adhessive (cyanoacrylate glue) and subsequent corneal graft– for severe or unresponsive disease where cornea may perforate.
- 18. • Herpes simplex keratitis – Causes: Type 1 or Type 2 Herpes Simplex Virus – Most are asymptomatic – Accompanied by: • Fever • Vesicular lid lesion • Follicular conjunctivitis • Pre-auricular lymphadenopathy • Pathognomonic: dendritic ulcer on cornea • Dendritic ulcer may heal without scar, but may progress to stromal keratitis, a/w inflammatory infiltration, oedema and ultimately loss of corneal transparency and permanent scarring if severe – corneal graft • Rx: topical antivirus (trifluridine)– heal within 2 weeks.
- 20. Herpes zoster ophthalmicus (ophthalmic shingles) Cause : Varicella zoster virus Area affected: ophthalmic division of CN V Accompanied by: prodromal period with systemically unwell, vesicles, lid swelling, iritis, 2° glaucoma. Rx: - oral antiviral (eg: aciclovir, famciclovir) to reduce post-infective neuralgia - topical antiviral and steroids and antibacterials to cover secondary infection for the ocular disease.
- 21. • Acanthamoeba keratitis • Commonly due to used of contact lenses and exposure to contaminated water or soil. • Presentation: painful keratitis, redness of the eye and photophobia. • Rx: topical chlorhexidine, polyhexamethylene biguanide (PHMB) and propamidine.
- 22. Whitefibrousouterprotectivecoat of eye Continouswith corneaant and the dura of opticnerveposteriorly RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 23. • Episcleritis • Etiology – Mostly idiopathic, rest collagen vascular dz, infections(herpes zoster,herpes simplex,syphillis),IBD • Rx – Self-limited – Tropical steroid if painful • Scleritis • Etiology – 50%systemic • collagen vasculardz • Granulomatous • Metabolic • Infectious • chemical/physicalagents – 50%idiopathic • Rx – Systemic NSAID/steroid – Treat underlying etiology
- 24. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 25. • Anterior chamber’s causes of red eyes:- – Hyphaema • is blood in the front (anterior) chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea. – Acute Congestive Glaucoma • (will be presented by Joo Qing)
- 26. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 27. • Irritation of cornea due to aberrant eyelashes grow inward with a normal eyelid position. • May result from chronic inflammatory lid diseases(blepharitis), Steven-johnson syn, trauma,burn etc • Rx: - topical lubricant -epilation with forceps - electrolysis for isolated lashes - cryotherapy - laser ablation -surgery in cases resistant to other treatment.
- 28. • Eversion of the lid leads to disruption of tears flow. • Types:- – Congenital – Involutionary (senile) ectropion • Affects lower lid of elderly(weak orbicularis oculi) • Results in epiphora – Cicatrical ectropion • Caused by scarring or contracture of skin and underlying tissue, pulling eyelid away from the globe • Defect may be local (trauma) or general (burns or dermatitis) – Paralytic ectropion • Caused by facial nerve palsy – Mechanical ectropion • Caused by lid edema, herniated fat or tumour on or near the lid margin which mechanically evert the lid.
- 30. • Irritation of eye and cornea due to inturning, usually of the lower lid. • Types:- – Orbicularis oculi muscle spasm – Involutionary (senile) entropion • Affects mainly lower lid • Constant rubbing of lashes in longstanding cases results in ulceration and pannus formation. – Cicatrical entropion • Both eyelids can be affected • Caused by severe scarring of palpebral conjunctiva, which pulls the lid margin towards the globe – Congenital entropion • Caused by improper development of retractor aponeurosis insertion into inferior border of tarsal plate. • Sign: inturning of entire lower eyelid and lashes with absence of lower lid crease.
- 32. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 33. • Inflammation of orbital contents posterior to orbital septum • Can cause blindness & may spread to cause brain abscess. • Often arises from adjacent ethmoid sinus.(facial,toothinfection/trauma) • Cause: Haemophilus infuenzae • Symptoms & signs: painfull eye periorbital inflammation and swelling reduced eye movement conjunctival injection possible visual loss systemic illness and fever • Rx: intravenous broad spectrum antibiotics
- 34. Panophthalmitis Purulent inflammation of all layers of the eye Acute dacryoadenitis Inflammation of the lacrimal gland
- 36. • Discontinuation in normal epithelial surface of cornea a/w necrosis of surrounding corneal tissue. • Etiology: – primary event due to bacterial, rarely viral ,fungal or protozoan infections(acanthamoeba). – secondary event that has compromised the eye – eg: corneal exposure, abrasion, foreign body, contact lens – associated with conjuctivitis, blepharitis, keratitis, vit A deficency. • Symptoms : - red eye - pain (main feature) worsened by movement of eyelids persists until healing occur. (not if herpes zoster opthalmicus) - photophobia - watery or mucopurulent discharge • Signs: - normal or reduced VA(central ulcer) - generalized or localized conjunctival injection - hazziness of the cornea - hypopyon. • Fluorescein MUST be used to see the ulcer RedEye CornealUlcer Acute Conjunctivitis Acute Iridocyclitis Acute Congestive Glaucoma
- 37. • Investigation: – usually diagnosed through clinical appearance). – swabs and culture to identify causative organism. • Management: (urgent referral) Drops & ointment of broad spectrum antibiotics. Topical antiviral – for herpetic corneal infection Cycloplegic drops – relieve pain resulting from spasm of ciliary muscle and prevent adhesion of the iris to the lens. Topical steroids – reduce local inflammatory damage Complications - Decreased vision - Corneal perforation - Iritis - Endophtalmitis
- 38. - Inflammation of the conjunctiva - ACUTE vs CHRONIC - Aetiology: INFECTIOUS NON-INFECTIOUS -Bacteria - Viral -Chlamydia - Neonatal -Allergic (acutevs chronic) - Toxic(due to irritantse.g smoke,dust) - due to otherdisease (Steven-Johnson syndrome) RedEye CornealUlcer Acute Conjunctivitis Acute Iridocyclitis Acute Congestive Glaucoma
- 39. • Aetiology: – Staphylococcus, Streptococcus, Pneumococcus, Haemophil us • Patient presents with: – red eye, purulent discharge yellow crusts, ocular irritation (gritty, burning & pain sensation). – History of contact with infected person. Usually unilateral bilateral. • Findings: – Chemosis, papillae, round & reactive pupil, normal vision. Fluorescein drops no staining of the cornea
- 40. • Investigations: – not routinely done(diagnosed from the typical S&S). • Management: – usually self-limiting. Fails to resolve conjunctival swabs for C&S. • General measures: – wipe off all discharge & not sharing towel (prevent spread of infection) • Specific: – 1)Antibiotic drops hasten resolution (used day time, broad spectrum e.g chloramphenicol, gentamicin) – 2)Antibiotic ointment (used at night, during sleep).
- 42. • Aetiology: – Adenovirus (commonest, highly contagious epidemic), Coxsackie, Herpes Simplex. – Systemic infection – influenza virus, Epstein-Barr virus, paramycovirus (measles, mumps) & rubella. • Patient presents with: – Acute onset of diffuse red eye, discharge (watery), excessive lacrimation/epiphora, photophobia & feel discomfort, cough & cold (AdenovirusURTI)
- 43. • Findings: – last longer than bacterial type, diffuse conjunctival injection, preauricular lymphadenopathy, follicles & chemosis, lid oedema. • Management: – Self limiting condition. Antibiotic eye drops (for example, chloramphenicol) symptomatic relief, prevent secondary bacterial infection. – Chronic, protracted course persistent corneal lesions and symptoms steroid eye drops may be indicated
- 44. • Use cold compresses & lubricants e.g. artificial tears for comfort. • Topical vasoconstrictors & anti-histamines – for severe itchiness. • Strict hygiene (highly contagious). Viral conjunctivitis Adenovirus conjunctivitis of the right eyeand enlarged preauricular nodes
- 45. • Different serotypes are responsible for 2 forms of ocular infections: – Inclusion keratoconjunctivis – Trachoma • Investigations: – Often difficult and special bacteriological tests may be necessary to confirm the clinical suspicions – Culture of scrapes. – Giemsa stain to screen for intracellular inclusion body of Chlamydia. – Presents of Chlamydial antigens using immunofluorescence.
- 46. • STD, serotypes D-K. Not treated adequately chronic course (up to 18 months). • S+S: palpebral conjunctival follicles, preauricular lymphadenopathy, watery/stringy mucopurulent discharge, micropannus associated with subepithelial scarring, chemosis, lid oedema • a/w GU symptoms (vaginitis, cervicitis, urethritis) and unresponsive to antibiotics • Management: – topical and systemic erythromycin, tetracycline (C/I neonates and pregnant women). – Associated venereal disease should also be treated – check the partner for symptoms or signs of venereal disease
- 47. • Commonest infective cause of blindness • Serotypes A-C, chronic, endemic in unhygienic places. • Vector: housefly. Encouraged by poor hygiene, overcrowded, dry, and hot climate. • Signs: subconjunctival fibrosis (hallmark), diffuse inflammation papillary enlargement, follicles, trichiasis (eyelashes directed backwards), corneal scarring (recurrent keratitis and trichiasis) blindness. • Management: – Oral/ topical tetracycline or erythromycin. – Azythromycin (alternative) single oral dose. – Entropion and trichiasis surgery.
- 48. Trachoma: scarred tarsal plate Chlamydial conjunctivitis
- 49. • ACUTE VS CHRONIC (important to differentiate) • Feat: usually both eyes. Itchiness (main feature), lid swell, conjunctival injection, chemosis • Mostly after allergen exposure and settles after few hours • Family history of atopy, recent contact with chemicals or eye drops usually present. • Similar symptoms may have occurred in the same season in previous years.
- 50. Typesof allergic conjunctivitis: • Seasonalallergic conjunctivitis (SAC) • Perennial allergic conjunctivitis (PAC) • Vernal keratoconjunctivitis (VKC) • Atopic keratoconjunctivitis (AKC) • Giant papillary conjunctivitis (GPC)
- 51. Rapid onset (IgE-mediated) Features: itchy, lid swelling, conjunctival injection and oedema (chemosis), lacrimation. 2 type: seasonal allergic conjunctivitis - hay fever at time of high environmental pollen, seasonal in pattern. perennial allergic conjunctivitis- caused by allergens other than pollen (eg: house dust mite), no seasonal pattern. Management: topical antihistamine (levocabastine) systemic antihistamine (terfenadine) Mast cell stabilizers (e.g. sodium cromoglycate, nodocromyl, iodoxamide)
- 52. VKC and AKC. GPC( not a true ouclar allergic reaction). Often affect male children with history of atopy Signs and Symptoms: Itchiness lacrimation redness both eye Photophobia Limbal follicles and white spots giant cobblestone ~ papillary conjunctivitis coalesce Ulcer and infiltration ~ vernal keratoconjunctivitis Mucoid discharge ~ giant papillary conjunctivitis (allergy to foreign body)
- 53. • Management: – Inital therapy: mast cells stabilizers or antihistamines, or agents with both properties (eg. Olopatidine) – Topical steroids (severe cases) – GPC topical mast cell stabilizers. Stop for a period of time or permanently lens wear.
- 55. CLINICAL FEATURES BACTERIAL VIRAL CHLAMYDIAL ALLERGIC Itching - - - ++ Hyperemia ++ + + + Discharge Purulent & yellow crust Watery Mucopurulent Clear& stringy Chemosis ++ ± - ++ Lacrimation/ epiphora + ++ + + Follicles - + ++ + Papillae + - ± + Pseudomembranous / membranous ± ± - - Preauricular lymphadenopathy - ++ + - Concurrent keratitis ± ± + - Conjunctival scraping & cytology (giemsa) Predominantly neutrophi l cellular reaction Lymphocytes & monocytes (mononucle ar response) Mixed neutrophilic& mononuclear response (former cell type predominate) * Eosinophil& eosinophilic granules *Pathognomonic – basophilic cytoplasmic inclusion body
- 56. • Neonatal conjunctivitis. • Any conjunctivitis occurs in the 1st 28 days of life. Notifiable disease • Important: immature eye defences → severe conjunctivitis, with membrane formation and bleeding → serious corneal disease and blindness. • 2 important causative agents: – Neisseria gonorrhoea (corneal perforation) – Chlamydia trachomatis (chronic corneal scarring) *Exclude venereal disease in parents • Other causes: Bact conjunctivitis (usually gram +ve), HSV (corneal scarring).
- 57. • DDx: Congenital blocked nasolacrimal gland Congenital glaucoma • Corneal examination is important exclude any ulceration. • Management: – refer to ophthalmologist – Swab and send for culture test (mandatory) – N.gonorrhoeae penicillin topically (local disease) and systemically (systemic disease) – Chlamydia topical tetracycline ointment (local disease) and systemic erythromycin (systemic disease) – HSV topical antivirals
- 58. RedEye C onjunctiva C ornea Sclera Iris and CiliaryBody Anterior C hamber E yelid Orbit
- 59. Inflammation of the uveal tract ( iris, ciliary body, choroid) Uveitis Anterior Uveitis Iritis Iridocyclitis Cyclitis Posterior Uveitis Choroiditis RedEye CornealUlcer Acute Conjunctivitis Acute Iridocyclitis Acute Congestive Glaucoma
- 60. • Inflammatory - due to autoimmune disease • Infectious - caused by known ocular and systemic pathogens • Infiltrative - secondary to invasive neoplastic processes • Injurious - due to trauma • Iatrogenic - caused by surgery, inadvertent trauma, or medication • Inherited - secondary to metabolic or dystrophic disease • Ischaemic - caused by impaired circulation • Idiopathic - a category used when thorough evaluation has failed to find an underlying cause
- 61. • Ocular pain • Photophobia • Blurring of vision • Red eye
- 62. 1) sarcoidosis, TB - SOB, cough 2)Behcet’s, psoriasis - skin problems 3)ankylosing spondylitis, juvenile chronic arthritis, Reiter’s - back pain, arthritis 4) IBD - alteration of bowel habit 5) In AIDS – Cytomegalovirus – Human syncytial virus – Cryptococcus – Toxoplasma – Candida
- 63. • Reduced visual acuity • Ciliary injection : diffuse superficial conjunctival hyperemia that would indicate conjunctivitis, as opposed to the circumlimbal redness of anterior uveitis. Blurred vision and photophobia are usually absent with conjunctivitis. • Keratitic precipitates ( on corneal endothelium) : in acute cases KPs may be fine and white; in chronic cases, large and yellowish. Colored or pigmented KPs suggest prior episodes of anterior uveitis.
- 64. • Hypopyon • Vessels on iris dilated • Pigment and fibrin deposits on the anterior surface of the lens are suggestive of synechiae. The presence or absence of posterior subcapsular cataract should be well documented because PSC is a frequent complication of both the disease and the therapy. • Posterior synechiae - irregular pupil • Anterior synechiae - may occlude drainage angle
- 66. Marked circumcorneal congestion with contracting fibrin in the anteriorchamber and apupil in mid-mydriasis. Posterior synechiae between iris and lens after iridocyclitis givethe pupil the shape of cloverleaves
- 67. • Sympathetic ophthalmia (sometimes referred to as sympathetic ophthalmitis or sympathetic uveitis) is a rare form of bilateral panuveitis. It is a specific type of uveitis in response to trauma to one of the eyes.
- 68. • A first episode of unilateral nongranulomatous acute uveitis can be diagnosed by history and clinical examination alone and does not need laboratory investigation. If history and examination are normal but the uveitis is granulomatous, recurrent or bilateral, the following screening investigations should be carried out: • Full blood count and ESR • HLA-B27 • Antinuclear antibody • Screening tests for syphilis and tuberculosis • Chest x-ray
- 69. • General measures Drops to dilate the pupil (cyclopegics) such as cyclopentolate 1% or atropine 1% should be prescribed, but this is best done by a specialist as this treatment is contraindicated in narrow angle glaucoma. - To prevent adhesion of the iris to the anterior lens capsule(posterior synechia), which can lead to iris bombe and elevated IOP - To stabilize the blood-aqueous barrier and help prevent further protein leakage (flare). - To relieve pain by immobilizing the iris When using cyclopegics, the patient should be warned that the pupil will appear large and they will have a temporary problem with vision in the eye in which the drops have been administered.
- 70. • Steroids Steroid eye drops such as prednisolone 1% are the first line treatment for the management of the inflammation. In more severe cases, steroid injection or even systemic therapy may be required. They should normally be prescribed by a specialist, as they can cause corneal ulceration when the diagnosis is herpes simplex infection, steroid glaucoma and on prolonged use, steroid cataract.
- 71. • Adjunctive therapy Secondary causes should be treated as appropriate. • Surgery Removal of the vitreous may be necessary when persistent floaters severely impede visual acuity.This procedure may also be useful as a combined therapeutic and diagnostic test as, once removed, the vitreous can be analysed to exclude infection or malignancy.
- 72. • Posterior synechiae - these commonest complication of anterior uveitis, if numerous can cause blockage of aqueous flow leading to a rise in intra-ocular pressure and can complicate cataract operations • Cataract • Glaucoma • Retinal detachment • Neovascularisation of the retina, optic nerve, or iris • Cystoid macular edema(swelling of the macula)
- 73. • Primary narrow or closed angle glaucoma is the most common cause for glaucoma emergency cases. In acute congestive cases, the onset is usually sudden. • Condition in which the iris is apposed to the trabecular meshwork at the angle of the anterior chamber of the eye, the outflow of aqueous from the eye is blocked, which causes a rise in intraocular pressure (IOP) • Immediate treatment is essential to prevent damage to the optic nerve and loss of vision. RedEye CornealUlcer Acute Conjunctivitis Acute Iridocyclitis Acute Congestive Glaucoma
- 74. • Angle closure may occur via 2 mechanisms. The iris may bepushed forward into contact with the trabecular meshwork, as in pupillary block or it may be pulled anteriorly, as occurs with other inflammatory conditions. • In older people, incidence of primary ACG increases as thelens enlarges, and the depth and volume of the anterior chamber decrease. • Patients with hyperopic eyes are more likely to have shallow anterior chambers and narrow angles, predisposed to develop ACG. Dilation of the eye may precipitate an attack of acute ACGbecause the peripheral iris relaxes when dilated to midposition, it may bow anteriorly and maximize iris-lens apposition, possibly causing pupillary block.
- 75. 1)Onset of severe ocular pain, nausea and vomiting, headache, and blurred vision is sudden. 2)Patients may complain of seeing haloes around lights. Haloes and blurry vision are the result of corneal edema. 3)The attack may have been precipitated by pupillary dilation, possibly during an ophthalmic examination. Patients with acute ACG are extremely uncomfortable and distressed. 4)Some patients may experience intermittent episodes of partial angle closure and relatively elevated IOP without ever experiencing a frank attack of ACG. 5)Patients may be totally asymptomatic, or they may report incidents of mild pain with slightly blurred vision or seeing haloes around lights. These symptoms resolve spontaneously as the angle reopens.
- 76. • Examination of a patient who presents with suspected ACG should include gonioscopy, tonometry, biomicroscopy, and ophthalmoscopy. – Diagnosis made by gonioscopic visualization of an occluded anterior chamber angle. – Tonometry demonstrates an elevated IOP , which may be as high as 40-80 mm Hg. – Ophthalmoscopy may reveal a swollen optic disc in an acute attack or excavation if episodes have been chronic. Unilateral involvement and worsening symptoms are common in acute attacks.
- 77. • If an attack persists or if several milder incidents of angle closure have occurred in the past, peripheral anterior synechiae and adhesions may be visible between the cornea and iris. Peripheral anterior synechiae may destroy the trabecular meshwork, while adhesions may cause necrosis and permanent dilation of the iris.
- 78. • Definitive treatment of ACG is laser iridotomy, or, if the iris cannot be accessed by laser, surgical iridectomy. • Laser iridotomy: Treatment of choice for pupillary-block ACG is laser iridotomy. Iridotomy with an argon or Nd:YAG laser. If the cornea is extremely cloudy or the patient cannot cooperate, incisional peripheral iridectomy may be performed instead of a laser procedure.
- 79. Opening inIris Aqueous flow into anteriorchamber Iris recedeto normalposition Opens angle Relieves blockage
- 81. • Laser may be used to create stromal burns in the peripheral iris. As the iris contracts, the anterior chamber angle deepens. Use laser gonioplasty as treatment of ACG due to plateau iris and nanophthalmos, or use it as a temporary measure to open the angle until laser iridotomy can be performed.
- 82. • IV acetazolamide ( ↓ aqueous humor production ) • B blocker ( ↓ aqueous humor production ) • Pilocarpine ( constrict pupil )
- 83. ENDOPHTHALMITIS
- 84. Symptoms m Ocular pain (74% cases) Blurring & diminished vision (94% cases) Headache Increased redness Discharge & watering Photophobia Blepharospas
- 85. SIGNS • Upper lid edema • Conjunctival hyperemia • Chemosis • Purulent discharge • Corneal edema • Endothelial precipitates • Hypopyon • Muddy iris resistant to dil • Vitreous haze • Absent red reflex • Proptosis, peri orbital swelling.
- 87. • Cultures aqueous tap vitreous tap vitreous biopsy
- 88. TREATMENT ANTIBIOTICS Intravitreal VANCOMYCIN 1mg in 0.1ml + CEFTAZIDIME 2.25mg in 0.1ml VANCOMYCIN 1mg in 0.1ml + AMIKACIN 0.4mg in 0.1ml Topical VANCOMYCIN or CEFAZOLINE AMIKACIN or TOBRAMYCIN Systemic CIPROFLOXACIN VANCOMYCIN CEFAZOLINE
- 89. STEROIDS • Intravitreal- DEXAMATHASONE(0.4mg in 0.1ml) • Topical – DEXAMETHASONE(0.1%) • Systemic – PREDNISOLONE
- 90. Cycloplegics - 1% atropine Antiglaucoma - Acetazolamide or Timolol
- 92. Acute conjunctiviti s Acute iridocycliti s Acute congestiv e glaucoma Corneal traumaor infection Incidence Extremel y common Common Uncommon Common Discharge Moderate to copious None None Wateryor purulent Vision No effecton vision Slightly blurre d Markedl y blurred Usuall y blurre d Pain Variable Moderate Severe Moderateto severe
- 93. Conjunctiv al injection Diffuse,more toward fornices Mainly circumcorne al Diffuse Diffuse Cornea Clear Usuallyclear Hazy Changein clarity related to cause Pupilsize Normal Small Semidilated and fixed Normal Pupillarylight response Normal Poor None Normal Intraocular pressure Normal Normal Elevated Normal Smear Causative organism s Noorganisms Noorganisms Organisms found only in cornealulcers due to infection