red eye with normal vision

8/19/2019 Red Eye With Normal Vision

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RED EYE WITHNORMAL VISION

Diska Astarini

I11109083


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Red Eyes with Normal Vision

Without secret With secret

Pterygium

Pseudopterygium Pinguecula Subconuncti!a "ematomes #piscleritis

Scleritis

$onungti!itis


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PTERYI!M


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Pterygium

• Wing%shaped &old o& &ibro!ascular tissue arising&rom the interpalpebral conuncti!a and e'tending

onto the cornea

• (sually nasal in location

• )elated to sunlight e'posure and chronic

irritation

• *ore common in indi!iduals &rom e+uatorial

regions,


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Symptoms

• (sually asymptomatic

• Aggressi!e or recurrent pterygium may also cause

restricti!e strabismus and distortion o& the eyelids


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Trian"#lar $old o$

%onn%ti'a "rowin" $rom

the medial (ortion o$ the

(al(e)ral $iss#re toward the

%ornea

Ptery"i#m that has "rown

on to the %ornea and

threatens the o(ti%al a*is


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-reatment

• Protect eyes &rom sun. dust. and /ind• or an in&lamed pterygium

– *ild Arti&icial tears

– *oderate to se!ere A mild topical steroid 2e,g,.

&luorometholone 0,1. or loteprednol 0,4 to0,56

• Surgical remo!al is indicated /hen

+,- reo%%#r within . months o$ e*%ision andnearly all within / year


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Pseudoterygium•

A pseudopterygium due to conuncti!al scarringdi&&ers &rom a pterygium there are adhesions

bet/een the scarred conuncti!a and the cornea

and sclera,

•$auses corneal inuries and7or chemical inuriesand burns


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Symptoms -reatment

• Pseudopterygia cause pain and double !ision

• Treatment 0

• lysis o& the adhesions

• e'cision o& the scarred conuncti!al tissue

• co!erage o& the de&ect 2this may be achie!ed /ith a &ree

conjunctival graft har!ested &rom the temporal aspect6,


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PIN!E1!LA


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Pinguecula

• "armless grayish yello/ thickening o& theconuncti!al epithelium in the palpebral &issure,

• #tiology hyaline degeneration o& the

subepithelial collagen tissue, Ad!anced age ande'posure to sun. /ind. and dust &oster the

occurrence o& the disorder,


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Appearance

• less transparent than normal conuncti!a

• o&ten ha!e a &atty appearance

• are usually bilateral

• located nasally much more o&ten than temporally• (sually asymptomatic


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#le!ated conuncti!al lesion encroaches on nasal limbus


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-reatment

• In general. no treatment is re+uired

• cases o& pingueculitis

/eak topical steroids 2eg. prednisolone0,146 or topical nonsteroidal anti%

in&lammatory medications


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S!21ON3!N1TIVALHEMORRHAE


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Subconuncti!al "emorrhage

• #'tensi!e bleeding under the conuncti!a &re+uently

occurs /ith conuncti!al inuries

• #tiology – ccur spontaneously in elderly patients 2as a result o&

compromised !ascular structures in arteriosclerosis6

– ccur a&ter coughing. snee:ing. pressing. bending o!er. or

li&ting hea!y obects


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-reatment

• usually harmless and resol!e spontaneously

/ithin 1%3 /eeks

•-he patient;s blood pressure and coagulationstatus need only be checked to e'clude

hypertension or coagulation disorders /hen

subconuncti!al hemorrhaging occurs

repeatedly


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#piscleritis

• in$lammation o$ the loose %onne%ti'e tiss#e)etween the s%lera and the %onn%ti'a

• Sectoral 2and. less commonly. di&&use6 redness o&

one or both eyes. mostly due to engorgement o&the episcleral !essels, -hese !essels are large

and run in a radial direction beneath the

conuncti!a


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#tiology

• Idiopathic *ost common,

• In&ectious e,g,. herpes :oster !irus 2scars &rom an

old &acial rash may be present. may causeepiscleritis or scleritis6,

• thers e,g,. rosacea. atopy. and thyroid disease,


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Symptoms

• Acute onset o& redness and mild pain in one or

both eyes

• -ypically in young adults• A history o& recurrent episodes is common

•


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• -ypical hyperemia an in&lammation o& the radial

episcleral blood !essels


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-reatment

• *ild arti&icial tears 2e,g,. )e&resh -ears6

• *oderate to se!ere a mild topical steroid 2e,g,.

&luorometholone 0,1. loteprednol 0,56 o&ten

relie!es the discom&ort,

• ral


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S1LERITIS


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Scleritis•

Di&&use or locali:ed in&lammation o& the sclera,

$lassi&ied according to location

• Anterior 2in&lammation anterior to the e+uator o&

the globe6 – Non4ne%roti5in" anterior s%leritis 2nodular or di&&use6

– Ne%roti5in" anterior s%leritis 2/ith or /ithout

in&lammation6

• Posterior 2in&lammation posterior to the e+uator o&

the globe6


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#pidemiology #tiology

• Scleritis is less &re+uent than episcleritis,• lder age 250%=0 years old6

• Women are a&&ected more o&ten than men

#tiology

• Appro'imately 50 o& scleritis cases 2/hich tend

to ha!e se!ere clinical courses6 are attributable to

systemic autoimmune or rheumatic disease


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1ON3!N1TIVITIS


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$onuncti!itis

• An in&lammatory process in!ol!ing the sur&ace o& the eye

and characteri:ed by !ascular dilation. cellular in&iltration.

and e'udation,

• $lassi&ication by duration

• A%#te %onn%ti'itis6 nset is abrupt and initially

unilateral /ith in&lammation o& the second eye /ithin one

/eek, Duration is less than > /eeks,

•1hroni% %onn%ti'itis6 Duration is longer than 3 to >/eeks


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#tiology

In$e%tio#s

• bacterial

• !iral• parasitic

• mycotic

Nonin$e%tio#s

• &rom a persistent irritation

• re&racti!e error • allergic

• to'ic

• as a result o& another

disorder 2such as Ste!ens?@ohnson syndrome6

$auses o& conuncti!itis may be &all into t/o broad categories


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Symptoms

• Reddened eyes and sti%7y eyelids in themorning due to increased secretion,

• Swellin" o$ the eyelid closed 2 pseudoptosis6

• 8orei"n4)ody sensation. a sensation o$

(ress#re. and a )#rnin" sensation• Intense it%hin"allergic reaction,

• Photo(ho)ia and la%rimation 2epiphora6

• Simultaneous presence o& )le(haros(asm

corneal in!ol!ement 2keratoconuncti!itis6


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Acute "emorrhagic $onuncti!itis

• A"$ is characteri:ed by conuncti!al

congestion. !ascular dilatation. and onset o&

edema,

•#tiology &amily Picorna!iridae2picorna!iruses6 Speci&ically. $A4> and #B0

• Signs pain&ul. chemosis. tearing. lid edema.

and tiny subconuncti!al hemorrhages, -he

hemorrhages are petechial at &irst and then

coalesce. appearing post%traumatic, -hecornea may be in!ol!ed /ith a &ine punctate

keratopathy and. rarely. subepithelial opacities,


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Acute "emorrhagic

$onuncti!itis 2A"$6 Treatment 0

sel&%limited

-he conuncti!itis resol!es

/ithin >?=days. but thehemorrhages clear more

slo/ly,

Symptomatic treatment to

make the patient as

com&ortable antibiotics are not needed

e'cept in the presence o&

bacterial superin&ection,


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-rachoma• -rachoma is initially a chronic &ollicular

conuncti!itis o& childhood that progresses toconuncti!al scarring,

• C. trachomatis

• signs and symptoms tearing. photophobia.

pain. e'udation. edema o& the eyelids. chemosiso& the bulbar conuncti!a. hyperemia. papillary

hypertrophy. tarsal and limbal &ollicles. superior

keratitis. pannus &ormation. and a small. tender

preauricular node,


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-rachoma• a substantial number o& children

must ha!e at least t/o o& the

&ollo/ing signs

1, i!e or more &ollicles on the &lat

tarsal conuncti!a lining the uppereye lid,

4, -ypical conuncti!al scarring o& the

upper tarsal conuncti!a,

3, Cimbal &ollicles or their se+uelae2"erberts pits6,

>, An e!en e'tension o& blood

!essels onto the cornea. most

marked at the upper limbus,


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-rachoma• or control purposes. the World "ealth

rgani:ation has de!eloped a simpli&ied method

to describe the disease, -his includes the

&ollo/ing signs

- i!e or more &ollicles on the upper tarsalconuncti!a,

-I Di&&use in&iltration and papillary hypertrophy

o& the upper tarsal conuncti!a obscuring at least

50 o& the normal deep !essels, -S -rachomatous conuncti!al scarring, --

-richiasis or entropion 2inturned eyelashes6,

$ $orneal opacity,


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-rachoma


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-rachoma

• tetracycline. 1?1,5 g7d orally in &our di!ideddoses &or 3?> /eeksE do'ycycline. 100 mg

orally t/ice daily &or 3 /eeksE or erythromycin.

1 g7d orally in &our di!ided doses &or 3?> /eeks,

• a:ithromycin is e&&ecti!e treatment &or trachomagi!en orally as a 1%g dose in children,

• -opical ointments or drops. including

preparations o& sul&onamides. tetracyclines.

erythromycin. and ri&ampin. used &our timesdaily &or = /eeks. are e+ually e&&ecti!e,


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-rachoma


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Dry eye• $linical condition characteri:ed by de&icient

tear production or e'cessi!e tear e!aporation,

• Symptoms burning. itching. &oreign body

sensation. stinging. dryness. photophobia.

ocular &atigue. and redness,

• #dema and hyperemic conungti!a bulbi,

• Diagnosis Shirmer test

• -reatment de&ense etiology,

• $omplication cornea ulcer. secondary

in&ection. neo!asculari:ation cornea,


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itamin A de&iciency

• itamin A de&iciency is the leading cause o&

childhood blindness in the de!eloping

/orld,

• A de&iciency can occur as a result o&

malnutrition. malabsorption. or poor !itamin

metabolism due to li!er disease

• Patient complaint dry eye or

'erophthalmia 2de&iciency mucin

production caused goblet cell damage6.

blinking. pain. night blindness 2nyctalopia6.decrease !ision,


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itamin A de&iciency

• Ni"ht )lindness• 2itot9s s(ots

• 1orneal *erosis:#l%eration

• ;eratomala%ia

• 1orneal s%ar


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itamin A de&iciency

• Fitot;s spot

• -reatment $hildren diagnosed /ith !itamin A

de&iciency must be gi!en a single oral dose o&400.000 I( o& !itamin A immediately,


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-o'ic ollicular $onuncti!itis

• -o'ic &ollicular conuncti!itis &ollo/s chronic

e'posure o& the conuncti!a to a !ariety o&

&oreign substances. including molluscum

contagiosum o& the lid margin. in&ection o&

the lashes by Phthirus pubis. use o& eye

cosmetics. and prolonged use o& !arious

eye medications,


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-o'ic ollicular $onuncti!itis

• Signs and symptom "yperemia in&erior tarsus

and superior tarsus. &ollicel in&erior tarsus andsuperior tarsus,

• -reatment stop cause. use o& lighter droplets


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Superior Cimbic Geratoconuncti!itis

• SCG is a chronic. &ocal. ocular sur&ace disease

characteri:ed by episodes o& recurrent in&lammation o& thesuperior cornea and limbus. as /ell as o& the superior

tarsal and bulbar conuncti!a,

Slit4lam( a((earan%e o$ $o%al

s#(erior )#l)ar %onn%ti'al

in&e%tion is shown with rose

)en"al stainin"6

Slit4lam( a((earan%e o$

s#(erior $ilamentary 7eratitis is

shown6


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Superior Cimbic Geratoconuncti!itis

• ine &luorescein or rose bengal punctate

staining is usually e!ident,

• A &ine &ilamentary keratitis o& the superior

cornea and limbus may also be present,• A delicate superior corneal pannus

suggests more long%standing disease,

• $haracteristic symptoms include a gradual

onset o& burning. tearing. &oreign bodysensation. mild photophobia. and

sometimes mucus discharge,


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Diagnosis

• -he diagnosis o& SCG is made &rom the

history o& irritation and photophobia and the

speci&ic pattern o& superior corneal andconuncti!al in&lammation and staining,

Cocali:ed superior &ilamentary keratitis

rein&orces the diagnosis,


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-reatment

•*ast cell stabili:ers and !itamin Apreparations ha!e been used /ith moderate

success in the treatment o& superior limbic

keratoconuncti!itis 2SCG6,

• -opical cyclosporine A has been sho/n to

pro!ide symptom relie& and to impro!e the

signs o& superior limbic keratoconuncti!itis


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*embranous $onuncti!itis

•It is an acute in&lammation o& the conuncti!a.characteri:ed by &ormation o& a true membrane

on the conuncti!a,

•#tiology -he disease is typically caused byCorynebacterium diphtheriae and occasionally by

!irulent type o& Streptococcus haemolyticus,


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$linical &eatures

•1, Stage o& in&iltration is characterised by – Scanty conuncti!al discharge and se!ere pain in the

eye,

– Cids are s/ollen and hard,

– $onuncti!a is red. s/ollen and co!ered /ith a thick

grey%yello/ membrane, -he membrane is tough and

&irmly adherent to the conuncti!a. /hich on remo!ing

bleeds and lea!es behind a ra/ area,

– Pre%auricular lymph nodes

are enlarged,


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-reatment

• A6 To(i%al thera(y

4 Peni%illin eye dro(s


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-reatment

26 Systemi% thera(y4 1rystalline (eni%illin + la% #nits sho#ld )e

in&e%ted intram#s%#larly twi%e a day $or /, days6

4 Antidi(htheri% ser#m


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-"A

red eye with normal vision

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