Diseases Processes of the Eye - Red Eyes and Emergencies Notes

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OPTM3105 – Disease Processes of the Eye

  • Presented by Alex Hui, OD, PhD, GradCertOcTher, FAAO.
  • Acknowledgment to Dr. Kristine Dalton for sharing the presentation.

Lecture Outline

  1. Lecture Objectives
    • Discuss differential diagnosis of red eyes.
    • Create a workup plan for red eyes in primary optometric clinics.
    • Discuss management of ocular emergencies.
  2. Differential Diagnosis of Red Eyes
  3. Clinical Workup of Red Eyes
  4. Ocular Emergencies

Red Eye Presentation

  • Common Causes of Red Eyes: • Infection • Inflammation • Anterior uveitis/Iritis • Angle Closure Glaucoma • Allergy • Trauma (foreign bodies) • Trichiasis • Entropion/Ectropion • Subconjunctival hemorrhage • Blepharitis • Acne rosacea • Injected pinguecula • Recurrent corneal erosion • Contact lens-related problems • Dry eye • Episcleritis • Scleritis
    • Conditions vary in urgency, some sight- or life-threatening.

Clinical Assessment of Red Eyes

  • Initial Assessment:
    1. Case History:
      • Acute/chronic presentation, unilateral/bilateral, progression, discomfort, pain levels, vision effect, discharge nature.
      • Previous treatments, systemic diseases, trauma history, and history of contact lens use should be noted.
    2. Examination Techniques:
      • Visual Acuities
      • Monocular, functional assessment.
      • Gross Inspection
      • Identify obvious abnormalities.
      • Pupil Assessment
      • Look for anisocoria or sluggish reactions.
      • Further Tests
      • Slit lamp exam; tonometry; fundus exam if necessary.

Differential Diagnosis Framework

  • Utilize clinical signs and history to guide diagnosis for:
    • Painful vs. non-painful conditions.
    • Assess ocular surface: conjunctiva, pupil, cornea, and anterior chamber characteristics.
    • Identify patterns of redness and discharge to differentiate causes.

Types of Case Presentations

  • Traumatic Red Eyes:
    • With Pain:
      • Corneal foreign bodies, penetrating injuries, abrasions, chemical burns, uveitis, etc.
    • Without Pain:
      • Subconjunctival hemorrhage, often resolving in 2-3 weeks without significant complications.
  • Non-Traumatic Red Eyes:
    • Differentiation based on discharge type (painful vs. not painful).
  • Clinical Signs Examination:
    • Visual acuity tests, injection patterns, pupil reactions, and intraocular pressure measurements.

Management of Red Eyes

  • Diagnose correctly since treatment is guided by differential diagnosis.
  • Treatment Options:
    1. Anti-infectives (topical/oral).
    2. Anti-inflammatories (topical).
    3. Anti-allergy medications (topical/oral).
    4. Artificial tears / ocular lubricants.
    5. Lid hygiene, bandage contact lenses.
    6. Referral for specialist management if scope exceeds clinician's experience.

Recognition of Ocular Emergencies

  • Key Indicators:
    • Redness + Pain + Vision Loss = Severe disease (e.g., corneal ulcers, orbital cellulitis).
    • Distinguish between urgent conditions needing immediate treatment and non-emergencies.

Vision Loss Conditions

  • Emergent Causes:
    • Sudden changes: vascular occlusions, retinal detachments, trauma, vitreous hemorrhage.
    • Gradual changes: optic neuritis, glaucoma, cataracts.
    • Transient symptoms: TIA, migraines, etc.

Life-Threatening Conditions

  • Incidents to Monitor:
    • Necrotizing fasciitis, orbital cellulitis, significant vascular pathology, and necrotizing scleritis may signify systemic disease.

Summary

  • The diagnosis of red eyes presents significant challenges due to varied conditions.
  • Emphasis on thorough case history and systematic diagnosis improves management and promotes patient safety.