red eye (high risk) by thann
TRANSCRIPT
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RED EYE (HIGH RISK)EXTERN AKECHANOK WATCHARAPUNJAMART
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RED EYE (HIGH RISK)
• Infectious Keratitis/ Corneal Ulcer
•Anterior Uveitis
•Acute angle closure glaucoma
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Infectious Keratitis/Corneal Ulcer
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Infectious Keratitis/Corneal Ulcer• Infection
• Bacterial: Adnexal infection, lid malposition, dry eye, CL• Pseudomonas aeruginosa
• Staphylococcus aureus
• Streptococci.
• Viral: HSV, HZO• Fungal: Candida,Fusarium,Aspergillus,Penicillium• Protozoan: Acanthamoeba in CL wearer
• Mechanical or trauma
• Chemical: Alkali injuries are worse than acid
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Clinical features• Blurred vision
• Ocular pain
• Photophobia
• Epiphora
• Purulent discharge
• Eye lid swelling
• Ciliary injection
• corneal infiltration, ulcer
• Hypopyon
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รปแสดงกระจกตาตดเชอเหนเปนวงเลกสขาว (Focal corneal ulcer) (ขอบคณภาพถายผปวย จากคลนกกระจกตา รพ.ธรรมศาสตร เฉลมพระเกยรต)
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Investigation• Corneal scraping
• May not be required for a small infiltrate,particularly without an epithelial defect and away from the visual axis.
• Conjunctival swabs• Particularly in severe case, may be culture when corneal
scape is negative
• Contact lens cases• Bottles of solution and lens for culture
• Gram strain,Giemsa stain ,KOH ,Culture
• Sensitivity reports
REFERENCE:
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Treatment• Fortify broad spectrum
antibiotic
• Antifungus : Amphotericin B eye drop,Natamycineye drop
• Acyclovir eye ointment
• Cycloplegic drug ( 1% Atropine eye drop)
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Anterior Uveitis
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Anatomical Classification• Uveitis : an inflammation of uveal tract
• Anterior uveitis
• Iritis : inflammation primarily involves the iris
• Iridocyclitis : in which both iris and pars plicata of the ciliary body
• Intermediate : Inflammation predominantly involving the pars plana,the peripheral retina and the vitreous
• Posterior uveitis : involves the fundus posterior to the vitreous base
• Retinitis : Primary focus in the retina
• Choroiditis : Primary focus in the choroid
• Vasculitis : which may involve veins, arteries or both
• Panuveitis
• Endophthalmitis : implies inflammation, often pururent, involving all intraocular tissue except the sclera
• Pandophthalmitis : involves the entire globe,often orbital extension
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Definition : Acute : Sudden onset and limited duration
Chronic : Persistent inflammation,Prompt relapse
(in less than 3 months)
Recurrent : repeat episodes separated by period of
inactive without treatment lasting at least 3 months
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Anterior uveitis • Most common form of uveitis (75%)
• Acute anterior uveitis is the most common form of anterior uveitis ,accounting for three-quarters of cases
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Main symptoms
• Sudden onset of unilateral pain
• Photophobia
• Redness
• Decrease vision
• Lacrimation
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Signs• Ciliary injection (circumcorneal
flush)
• Fine white keratic precipitaes (KP)
• Aqueous flare and cell in anterior chamber
• Iris nodules (Koeppe & Busaccanodule )
• Iris atrophy
• Rubeosis iridis
• Miosis
• Posterior synechiae
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Causes • Autoimmune
- Juvenile rheumatoid arthritis
- Ankylosing spondylitis - Reiter’s syndrome
• Infections- Syphilis
- TB- Herpes Zoster
• Malignancy- Leukemia
- Lymphoma- Retinoblastoma
• Other- Traumatic uveitis- Retinal detachment- Ideopathic
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Type of Anterior Uveitis1. Suppurative
2. Non supurative
2.1 Granulomatous uveitis
- chronic, posterior uveitis
- infection Toxoplasma, TB
- injury : sympathetic ophthalmia
2.2 Non granulomatous uveitis
- more common
- Anterior uveitis
- Hypersensitvity phenomenon —» Steroid
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Differentiation of Granulomatous & nongranulomatous uveitis
Feature Granulomatous Nongranulomatous
Onset
Course
Pain
Photophobia
Blurred vision
Anterior segment
Injection
Iris nodule
(Koeppe,Busacca
nodules
KP
Fundus
Recurrence
Insidious
Long
None or minimal
Slight
Marked
+
+++
Mutton fat
Nodular lesion
Sometimes
Acute
Short
Marked
Marked
Marked,moderate
+++
+
Small fine
Diffuse involvement
Common
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Complication• Anterior, posterior synechiae
• Rubeosis iridis
• Band keratopathy
• Cataract
• Secondary glaucoma
• Retinal detachment
• Cystoid macular edema
• Hypotony – phthisis bulbi
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Aim of Treatment
1. Relief of pain
2. Improve vision
3. Prevent complication
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Treatment1. Medical therapy
- specific Rx.
- Non specific Rx.
1.1 Corticosteroid- Topical
-Systemic
1.2 Cycloplegic
1.3 Cytotoxic agent
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Treatment
2. Surgical therapy
2.1 Cataract —» cataract extraction
2.2 Glaucoma —» Trabeculectomy
2.3 Vitreous opacification
—» Parplana vitrectomy
2.4 Retinal detachment—» Laser, SBP ( sclera
bucking procedure)
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Acute angle closure glaucoma
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What is glaucoma?
• A disease of progressive optic neuropathy
with loss of retinal neurons and their axons (nerve fiber layer) resulting in blindness if left untreated.
Robert N. Weinreb, MD1; Tin Aung, MD, PhD2,3; Felipe A. Medeiros, MD, PhD1
JAMA. 2014;311(18):1901-1911. doi:10.1001/jama.2014.3192.
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Clinical picture of glaucoma
1. High intraocular pressure
2. Optic disc change
cupping & degeneration
3. Visual field defect
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GLAUCOMACup-to-disk ratio
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GLAUCOMA
Normal
DISK CUPPING
Glaucoma
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GLAUCOMA
Glaucomatous cupping
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Cardinal signs
•ปวดตา•ปวดหว•ตามว (มองเหนสรง)•ตาแดง•คลนไสอาเจยน
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How to maintain Intraocular pressure ?
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Normal
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c - Iris outflow
a - Conventional outflow-90%
b - Uveoscleral outflow
Aqueous outflow
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Open angle glaucoma
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Angle closure glaucoma
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Sign- ciliary injection
- corneal edema
- shallow anterior
chamber
- semidilated pupil
- increase IOPCorneal oedema
Ciliary hyperaemia
Dilated pupil
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Management1. Medical treatment
1.1 Osmotic treatment- 20% Mannitol intravenous drip ( 250 ml)- 50% glycerine (1-2 ml/kg.)
1.2 Carbonic anhydrase inhibitor- Acetazolamide (Diamox) oral
- Topical : Brinzolamide : Dorsolamide
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Management1.3 Cholinergic agent
- 2% Pilocarpine ed. —» Miotic —» decrease
papillary block
1.4 B-Blocker
- 0.5% Timolol maleate ed.
1.5 Selective Sympathominetic- Alphagan ed. (Brimonidine)
1.6 Prestaglandin deviation
- Lagtonoprost
- Travanoprost
- Bimatoprost
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2. Surgical treatment- Laser iridotomy
- Peripheral
iridectomy
- Trabeculectomy
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THANKS YOU