1. High Risked Red Eye
Nawat Watanachai
Ramathibodi
Hospital
Mahidol University

2. Low Risk Red Eye



Lid
• Blepharitis
Lacrimal system
• Dacryocystitis
Conjunctiva
• Conjunctivitis
• Pterygium & Pinguecula

3. High Risked Red Eye
1.
2.
3.
4.
Corneal defects
• Abrasion
• Ulceration
Acute glaucoma
Acute uveitis
Scleritis

4. 1. Corneal Defects

1.1 Abrasion
1.2 ulceration


5. 1. Corneal defects
1.1 corneal abrasion
- Only corneal epithelium lost
- cleaner
1.2 cornel ulcer
- Epithelium defect with
stromal defect
- Much more severe/ infected

6. 1.1 Corneal abrasion



History
• Trauma
Symptoms
• Sudden Pain
• Lacrimation
• Photophobia
• Blurred vision
Signs
•
•
•
Ciliary injection
Irregular light
reflex
Fluorescein
staining

7. 1.1 Corneal Abrasion
Rx








Remove FB+/Pressure patching
Debridement
Contact lens
Lubrication
Stromal puncture
Generally cure in 24-48
hrs
Watch closely for
superimposed infection

8. 1.2 corneal ulceration



History
• Trauma+/ Vegetative materials
 Occupational accident
• Immune defect
Symptoms : pain, lacrimation,
photophobia, blurred vision
Sign : ciliary injection, white corneal
stromal lesion, F stain

9. 1.2 Corneal ulceration


Infection
• Bacteria : Staph, Strept,
Pseudomonas, Bacillus
• Fungus : Aspergillus, Penicillium
• Virus : HSV, HZV
• Parasite
Non infection
• Neurotrophic
• Immune mediated

10. 1.2 Corneal Ulceration Rx




Antimicrobial
agents
• Broad spectrum
• Rapidly heavily
treat
Cycloplegics
Steroid +/Penetrating
keratoplasty

11. 2. Acute glaucoma





Sudden onset of
increasing intraocular
pressure
Pressure may as high as
50-60 mmHg
Rapid optic nerve
damage due to
insufficient vascular
supply
Other structural damage
Normal IOP is around
8-21 mmHg

12. 2. Acute glaucoma


angle-closure glaucoma
• Primary
• Secondary
 Lens dislocation
 Neovascular glaucoma
Open-angle glaucoma
• Acute uveitis
• Phacolytic glaucoma

13. 2.Acute Angle-Closure Glaucoma

Mechanism
• Relative pupillary
block
• Iris bombe
• Iridotrabecular
contact

14. 2. Acute Angle-Closure
Glaucoma
• Relatively common in Orientals
• > 40 years
• Women > men

POAG Risk factors
• Increased lens thickness
• Small corneal diameter
• Short axial length

15. 2.Acute Angle-Closure Glaucoma
Symptoms
- Very severe
Pain
- Nausea &
vomiting
- Halos
- Blurred vision
- Marked red eye

16. 2.Acute Angle-Closure Glaucoma

Signs
• Ciliary flush
• Elevated IOP
• Corneal edema
• Fixed,oval,
dilated pupil
• Glaukomflecken

17. 2. Acute Angle-Closure
Glaucoma

AIM
• Decrease IOP
• Restore vision
• Prevent re-increase IOP

18. 2.Acute Angle-Closure Glaucoma
Medical Rx





Hyperosmotic agents
Carbonic anhydrase inhibitors
Beta-blockers
Alpha 2 agonists
Miotics

19. 2.AACG Surgical Rx

Iridectomy : the definitive treatment

20. 2.AACG Surgical Rx


Goniosynechialysis
For case of anterior
synechia

21. 2.AACG Surgical Rx

Filtering
surgery :
trabeculectomy

22. ตั้งใจเรียนหน่อยครับ

23. 3. Uveitis
Inflammation of the uveal tract
Opaque media  blurred vision
Inflammation  red, pain, swell
Tissue damage  glaucoma, cataract, retinitis etc.

24. 3. Uveitis : Classification



Anatomical
Clinical
Etiological

25. 3. Uveitis :
Anatomical Classification




Anterior uveitis
Intermediate uveitis
Posterior uveitis
Panuveitis
A
I
P

26. 3. Uveitis
anatomical classification
post
ant

27. 3. Uveitis :
Clinical classification


Acute
• Sudden onset
• < 6 week persistence
• Recurrent
chronic
• Prolonged persistence
• Less symptomatic

28. 3. Uveitis :
Etiological Classification


Exogenous
• Infectious eg.
Toxoplasmosis,
Toxocariasis, TB
Endogenous
• systemic
diseases eg.
SLE, RA
• Idiopathic

29. 3.1 Anterior Uveitis

Symptoms
• Photophobia
• Pain
• Decreased vision
• Lacrimation

30. 3.1 Anterior Uveitis
• Signs
 Ciliary injection
 Keratic precipitates
 hypopyon
 Aqueous cells/flare
 Iris atrophy
 Synechiae

31. 3.2 Intermediate Uveitis


Symptoms
 Floaters
 Decreased vision
 Mild eye pain
Signs
 Anterior vitreous
cells
 Mild ciliary
injection

32. 3.3 Posterior uveitis

Symptoms
• Floaters
• Impaired vision

Signs
Vitreous
cells/flare
 Choroiditis
 Retinits
 Vasculitis


33. 3. Uveitis & Arthritis




Ankylosing spondylitis
Reiter’s syndrome
Psoriatis arhritis
Juvenile RA

34. 3. Uveitis & Systemic
diseases
Non-infectious
Sarcoidosis
Behcet’s disease
Vogt-Koyanaki-Harada syndrome
Infectious
AIDS
Acquired syphilis
Tuberculosis
Leprosy

35. 3. Uveitis & Infections



Parasite
• Toxoplasmosis
• Toxocariasis
Fungus
• Histoplasosis
• Candidiasis
Virus
• Herpes zoster
• Herpes simplex
• Congenital
rubella

36. 3.Uveitis
Goal of Treatment
Prevent visual complications
 Relieve discomfort
 Treat the underlying disease,
if possible


37. 3.Uveitis
Treatment

Cycloplegics / mydriatics
• Relieve ciliary spasm
• Prevent posterior synechia
formation
• Synechialysis

38. 3.Uveitis
Treatment Options


Steroids
• Topical
• Periocular
• Systemic
Side effects
•
Ocular
Glaucoma
 Cataract
 Corneal
complications

•
Systemic

39. 3.Uveitis
Treatment options

Immunosuppressive
agents
• Cytotoxic drugs
• Cyclosporins
0001

40. 4. Scleritis


Diffuse
Nodular
-Inappropriate pain
-Scleral thickening
-Systemic disease
-Not response to drugs

41. High and Low Risked Red Eye
Red eye
High risk
Symptoms Pain
Discomfort/
irritation
Conjunctival
constrict/ NR Normal/ reactive
Injection
Pupil
Ciliary
Dilate/
VA
Red reflex
IOP
Decrease
Decrease/ absent
Increase/ decrease/
normal
Cloudy/ irregular
Cornea
Low risk
normal
Normal
normal
Clear/ normal

42. May the ‘light’ be with you!