Conjunctival injection?
Engorgement of large & superficial bulbar conjunctival vessel
Move with conjunctiva
Constrict with tropical vasoconstrictor: phenylephrine
Definition of red eye?
Conjunctival injection?
Conjunctival congestion?
Red eye: discoloration of the eye due to sclera/conjunctiva hyperaemia
injection:
Redness and swelling caused by dilation of blood vessel secondary to inflammatiry or infectious process
Congestion: abnormal accumulation of fluid usually blood in body part, organ or area
Ciliary injection?
Indicating?
Injection of deep conjunctival and episcleral vessel surrounding cornea
Involve ranch of anterior ciliary arteries
Indicate: inflammation of cornea, iris or ciliary body
Acute viral conjunctivitis
Sign and symptoms?
Due to adenovirus
Sx and sign:
- Conjunctival chemosis
- Eyelid edema and follicles
- Tender and palpable preauricular LN
- Pseudomembrane formation
- Keratoconjunctivitis (keratitis)
Treatment viral conjunctivitis
- Spontaneous resolution within 2-3week + tropical eye drop
2. Pseudomembrane and keratitis - tropical steroid under supervision ophtalmologist
Bacterial conjunctivitis
Causes?
Sx and sign?
Treatment
Cause: s. Pneumonia, s. Aureus, H. Influenza, moraxella catarrhalis
Sx: mucopurulent, eyelid edema, red eye
Ix: swab c&s, pcr
Tx: topical antibiotic: chloramphenicol, gentamicin, ciprifloxacin
Allergic conjunctivitis
Acute allergic
Sx: papillary hypertrophy at superior tarsal conjunctival, limbitis, keratitis
Itchiness, watery or mucus discharge and chemosis
A/w allergic rhinitis
Treatment allergic conjunctivitis
- Avoidance allergen
- Topical anti histamine: levocabastine
- Mast cell stabilizer: olapatadim
- Ophtalmology referal
- tropical steroid: flurometalone
- suptarsal steroid injection: triamcinolone
Bacterial keratitis
Causes?
Risk factor?
Causes: pseudomonas aeruginosa, staphylococcus aureus, streptococci sp.
Risk factor: prolong contact lens, trauma, steroid usage, DM
Sx of bacterial keratitis and investigation
Sx:
- Corneal opacity
- Mucopurulent discharge
- Hypopyon
Ix:
1. Corneal scraping for gram stain and C&S
Treatment bacterial keratitis
- Topical antibiotic: forfitied gentamicin
- Tropical steroid:
- to resuce scaring
- may cause corneal perforation, then can use cyanoacrylate glue - Corneal transplant - penetrating keratoplasty
Fungal keratitis
Causes and risk factor?
Yeast - candida
Filamentous - fusarium and aspergillus
Risk factor
- Vegetative material exposure
- Immunocompromised
- Prolong tropical steroid usage
Symptoms and investigation for fungal keratitis
Sx:
- Cornel infiltrate
- suppurative (candida)
- feathery & satellite lesion (filamentous)
- endothelial pluque
Ix:
Corneal scraping - gram & giemsa stain
Culture on sabouraud dextroseagar
Treatment for fungal keratitis
- Topical antifungal: amphotericin
- Systemic antifungal: fluconazole, voriconazole
- Corneal transplant
Acanthamoeba keratitis
Protozoa
Risk factor: swimming with contact lens
Sx:
- severe eye pain,
- ring infiltrate
- Perineural infiltrate
Investigation and treatment of acanthamoeba keratitis
Ix:
I. corneal scraping C&S
II. Non-nutrient agar
Tx:
Corneal debridment
Topical amoebicide: polyhexamethylene biguainide, chlorhexidine, propaminide
Viral keratitis
Causes?
Sx?
Herpes simplex keratitis - HSV type 1
Sx:
I. epithelial - dendritic ulcer
II. Necrotizing stromal and disciform (endotheliasis)
III. Disciform keratitis - central stroma edema with surrounding (wessely) immune ring
IV. Descement membrane fold
V. Keratic precipitate
VI. Elevated IOP, decrease corneal sensation
4 Treatment of HSV keratitis
- Tropical antiviral: ointment aciclovir
- Systemic antiviral: oral aciclovir
- Topical steroid**: disciform keratitis
* *contraindicated in dendritic ulcer - Corneal transplant
Corneal abrasion?
Corneal Epithelial defect d/t trauma, contact lens
Sx
- Painful
- Redness
- Tearing
- Foreign body sensation
Diagnosis of corneal abrasion?
Treatment?
Dx: de-epithelialized stained with fluorescein
Tx:
- Eye pad
- Prophylaxis
- Vitamin c
- Pain relief
Orbital cellulitis?
Bacterial cause usually sinus related especially ethmoid sinus
Sx: fever, unilateral periorbital & lid edema, proptosis, painful ophtalmoplegia, ON dysfunction
Investigation and treatment for orbital swelling?
Ix:
CR scan orbit & paranasal sinus
MRI
Septic workout
Tx:
IV antibiotics: ceftazidime, ceftriaxone, vancomycin, metronidazole
Surgical drainage
Endophythalamitis?
Intraocular infection/inflammation
Exogenous vs endogenous
Causes: bac/fungal
Sx: reduce vision, RAPD +ve, eyelid swelling, chemosis, hypopyon, vitritis, choriorenititis
Investigation and treatment for endothalmitis
Ix: B scan ultrasound, vitreous tap for c&s
Tx: Intravitreal antibiotics: ceftazidime, vancomycin, amphotericin B Topical/systemic antibody Mydriatics Pars planar vitrectomy
