Common Causes

• Allergies • Infections

– Ocular – Cornea, uveitis, endophthalmitis – Orbital – Orbital cellulitis

• Inflammation – Uveitis – Scleritis / episcleritis

• Glaucomas • Trauma

– Foreign bodies – Chemical injuries

History

• PAINFUL vs PAINLESS • Onset • Laterality • Contact history • Contact lens user • Trauma / recent surgery • Other symptoms

– Itch, pain, headache, nausea – Photophobia – BOV

• Medical history – Immunocompromised, thyroid

Examination

Eye Features

Visual acuity • Good • Poor

Cornea • Clear vs hazy • Foreign body • Infiltrates • Scar • Stain with fluorescein

Conjunctiva • Sectoral • Circumciliary • Diffuse • Subconj hemorrhage ± chemosis

Anterior chamber • Shallow? • Hypopyon • Hyphema

Examination

Eye Features

Pupils • Reactive • Fixed, mid-dilated • Irregular • Peaked • RAPD

Lens • Red reflex • White cataract

Orbit • Preseptal / orbital cellulitis • Proptosis • Lagophthalmos

Other features • Discharge • Associated symptoms

What we will be covering

• Corneal / conjunctival disorders

• Glaucoma

• Uveitis / inflammatory causes

• Retina

• Orbit and ocular adnexa

Common CORNEAL conditions

Dry eyes • Symptoms

– On-off • BOV • Tearing • Redness

– Discomfort – FB sensation – “Tiredness”

• Treatment – Lubricants

• Drops • Ointments

Conjunctivitis

• Viral

• Bacterial

• Blepharoconjunctivitis

• Allergic

Viral Conjunctivitis

• Common organisms – Adenovirus

• Symptoms – Tearing + discharge

– Itch

– Redness

– Laterality

– Glare / photophobia

– Contact history

– Chronology

Viral Conjunctivitis - 2

• Clinical features

– Uniform conjunctival injection

– URTI symptoms

• Management

– Symptomatic

– Hand and contact hygiene

– Reassurance

Bacterial Conjunctivitis

• Severe and sight threatening • Neisseria, Chlamydia

• Clinical features – Copious, purulent discharge

– Conjunctival injection and chemosis

• Management – Copious irrigation

– Systemic antibiotics

– Systemic screening + partners

Ophthalmia Neonatorum

• Ophthalmic emergency!! • 2 weeks from birth • Vertical transmission • Organisms

– Neisseria + Chlamydia – Others: S Pneumoniae, Hemophilus – Viral

• Management – Antibiotics – Treat parents

Allergic Conjunctivitis

• Acute allergies

• Seasonal allergic conjunctivitis

• Perennial allergic conjunctivitis

• Vernal keratoconjunctivitis

• Atopic keratoconjunctivitis

• Giant papillary conjunctivitis

Acute Allergies

• Usually can pinpoint allergen

• Self-limiting

• Clinical features

– Lid edema / erythema

– Unilateral / bilateral

– Discharge

– No papillae

– No corneal involvement

Vernal KC

• Allergic disease of the conjunctiva

• A/w asthma, eczema, allergic rhinitis

• Boys > Girls

• Younger

• Clinical features

– Papillae on tarsal plate

– Limbal follicles

– Shield ulcers

Treatment

• Removal of allergen!!

• Systemic – Antihistamines

– Steroids

– Management of other associated conditions

• Ocular – Lubricants +++++

– Steroids

– Mast cell stabilisers / Anti-histamines

– Steroid-sparing agents

Blepharoconjunctivitis

• Anterior – Crusting

– Lid margin changes

– Madarosis / trichiasis

– Cicatricial changes

– Preseptal

• Posterior – Orifice plugging

– Erythema, discharge

– Corneal changes

Contact Lens

• Serious / urgent

– CL-related ulcer

• Serious / not urgent

– Contact lens overwear

• Not serious

– Scar

• Old corneal ulcer

– Dry eyes

Contact Lens Overwear

• Symptoms – Eye pain, redness – Glare / photophobia – Tearing

• Clinical features – PEES ++, SEIs, SPKs – Corneal vascularisation

• Treatment – CL holiday – Lubricants – Antibiotics

CL-related Ulcer

• Pseudomonas Aeruginosa

• Clinical features

– Localised injection

– White lesion on the cornea

• Management

– CL holiday

– Topical Fortified antibiotics

Infective Keratitis

• Bacterial

• Fungal

• Viral

• Parasitic

Viral Infective Keratitis

• HSV vs VZV

• Clinical features – Dendritic ulcer or geographic ulcer

– Terminal bulbs

– Stromal keratitis

– Uveitis

– Episcleritis / Scleritis

– Retinal complications

• Management – Topical antivirals

– ± topical steroids

– ± oral antivirals

Fungal Infective Keratitis

• Filamentous vs Yeasts

• Predisposing factors – Trauma (vegetative)

– Immunosuppression

• Clinical features – Gray-white ulcer with feathery edges

– Satellite lesions

– Ring infiltrate

• Treatment – Anti-fungals

Parasitic

• Acanthamoeba

• History – Contact lens user

– Contact with brackish, dirty water, eg, rivers, lakes

– Trauma

• Clinical features – Pain out of proportion to clinical signs

– Early

– Late

Subconjunctival hemorrhage

• Benign, self-limiting • Etiology

– Spontaneous – Trauma – Valsalva – Blood thinners – Systemic disorders

• Management – Reassurance, – Exclude other traumatic injuries – Lubricants

Foreign Body

• Subtarsal vs Corneal • Subtarsal

– Usually non-specific event – Management

• Removal • Ensure no infection • Antiobiotic and lubricant cover

• Corneal – Hammering, grinding, drilling – Management

• Can attempt removal • Refer to A&E

Chemical Injury

• Ocular emergency

• Acid vs Alkali injury

• Management – Acute

• Copious irrigation

• Reduce inflammation

• Promote healing

• Prevent infection

• Reduce pain

– Chronic • Complications

Corneal Abrasion / Recurrent Corneal Erosion

• Stain with Fluorescein

• Pain on waking up

• Poor attachment of epithelium to underlying basement membrane

• Management

– Lubricants

• Drops and ointments

– Antibiotics