The eye is the most delicate organ in the body , any trivial proplem in the eye must be managed under supervision of ophthalmologist , this is only simplified hand out for house officers about the common eye complains , and the author is not responsible of any harm or mistakes done by non specialist depending on data in this hand out .
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The eye is the most delicate organ in the body , any trivial proplem in the eye must be managed under supervision of ophthalmologist , this is only simplified hand out for house officers about the common eye complains , and the author
is not responsible of any harm or mistakes done by non specialist depending on data in this hand out .
Non traumatic red eye
1- viral conjunctivitis : 2- MPC :
H : sudden onset , history
of recent ARI دور برد , watery
discharge , severe FB sensation ,
start in one eye then affect the
other .
O/E : diffuse injection bulbar
and palpepral ± lid edema ±
conjunctival chemosis or even
subconj hemorrhage ± follicles in
the conj ( slit lamp ) .A palpable
preauricular lymph node strongly
supports the diagnosis but is not
present in the majority of cases.
TTT : 1- كمادات باردة :
decrease viral proliferation .
2- Combined ED :
maxitrol , optidex , … x 5
3- Tears guard ,
orchatears ED x 5 ( for FB
sensation ) .
Prognosis : = infectious : كيس
المخدة يبقى نظيف و ميستخدمش فوط
self limited in 2 weeks = حد
H : عينى مضايقانى و بتشكنى و بتعمص و جفونى بتبقى الزقة
الصبح
O/E : redness mainly palbebral + MP
discharged + adherent lashes .
TTT : 1- يزال العماص صباحا بماء دافىء
2- Antibiotic ED : levoxin ED x5
3- Ab EO : Terramycin EO مرهم داخل العين
قبل النوم
Prognosis : = infectious : كيس المخدة يبقى نظيف و
ميستخدمش فوط حد
3- Allergic conjunctivitis :
H : itching + recurrence + allergies
( skin , chest , nose ) + watery discharge
O/E : diffuse redness + lid edema
TTT : 1- 2 كمادات باردة - Combined ED :
maxitrol , optidex , … x 5
3- Tears guard , orchatears ED x 5 ( for
FB sensation ) .
4 – Mast cell stabilizers or anti H .
NB :
###In pediatric better to avoid quinlones and miphenicol : use Tobrex ED x5
Also better avoid terramycin ( may cause allergy ) : use Fusithalmic Viscous
ED
### Hyperacute bacterial conjunctivitis characterized by an abrupt onset, a
copious purulent discharge, and rapid progression, is usually associated with a
gonococcal infection in a sexually active adolescent or adult. The conjunctiva
becomes bright red and chemotic, and an inflammatory membrane (consisting
predominantly of leukocytes and fibrin) may develop on the tarsal conjunctival
surface. Preauricular adenopathy is often present, and there is marked swelling
of the lids, with aching and tenderness on palpation. if left untreated, the
infection may involve the cornea, rapidly causing peripheral ulceration and
ultimately leading to perforation.
Treatment with topical antibiotics (ciprofloxacin) + a single 1-g dose of
intramuscular ceftriaxone
4- Spring cattarah : ( severe allergy )
H : child 5-15 years , recurrence in the
summer of
بيدعك فى عينه و بتحرقه و فيها افرازات بيضاء بتلزق و
بتزيد مع الشمس وا لتراب
O/E : diffuse redness + lid edema + dirty
sclera ± papillae on the palbepral conj
( cobble stone ) ± jelly like mass on upper
limbus or pannus of previous attacks ± milky
discharge on the palbepral conj .
TTT : 1- البعد عن الشمس و التراب + كمادات باردة
2- Combined ED : maxitrol , optidex , … x 5
3- Tears guard , orchatears ED x 5 ( for FB sensation ) .
4 – Mast cell stabilizers or anti H .
* Mastocytx ED x2 ( rapid effect but contraindicated for long
durations > 1.5 month ) .
* Orchazide Ed x4 ( 2 weeks only )
تخبر المريض ان يستمر على العالج اسبوعان فقط ثم ياتى بعد ذلك لتوقف الكورتيزون و
: االوركازيد ثم يستمر باقى الصيف
* Tears guard .
* Mirolast ed x3 ( mast cell stabilizer can be used for 3 months
safely but not for children < 3 years old ) .
Prognosis : = usually resistant to TTT = some times its associated
with keratoconus .
5- Dry eye ( diagnosed by exclusion and some specific tests )
H : الهوا و الشمس والتكييف و التلفزيون يتعبه
discomfort ± itching
O/E : ± exposed areas more affected ( 3^ , 9 ^ ) ± whitish frothy discharge
at the canthi ± white palbebral conj .
TTT : 1- tears guard ED ……….x5 ( ممكن يستمر عليه الن هذا النوع ليس به مواد حافظة
)
2- Thilotears gel , or corner gel ….. x 3
6- phylectenular conjunctivitis :
O/E :
1- phylectn : painless 1-3 mm , grayish nodule may be multible .
2- localized superficial conjunctival injection ± blanch by ocumethyl ED
(decongestant ).
3- غالبا طفل صغير عنده سوء تغذية , ديدان , بؤرة صديدية أو درن
Prognosis : reassure that the hemorrhage will clear gradually in two to three
weeks.
9- Scleritis (rare)
or connective-tissue disease (e.g., rheumatoid arthritis).. The redness may be
focal or diffuse, and the underlying sclera is pink. Typically, there is moderate-
to-severe, deep ocular pain and tenderness on palpation. an oral nonsteroidal
antiinflammatory drug may help relieve symptoms in the interim. Treatment
often requires systemic corticosteroids, antimetabolites,
10- Acute angle closure glaucoma :
H : sudden headache , nusea , vomiting ± brusting eye pain, diminution of
vision ( DD acute headache , acute abdomen ) .
O/E :
* tension is stony hard * pupil is greenish vertically dilated
unreactive to light.
* iris is stormy . * cornea is hazy + ciliary injection .
TTT :
1- Admission .
2- Timolol , pilocarbine ED , cidamex , slow k
3- Mannitol 20% 50 ايام3 نقطة /د لمدة 60 ساعة بمعدل 12سم كل
4- Tobradex ED , EO .
5- Laser peripheral iridectomy
11- Acute Anterior Uveitis
Apparoach to red eye
Red eye may be active hyperaemia = inflammation or passive congestion due to venous obstruction e.g. Glucoma , CST.
History : ask for the main eye symptoms :1- Red eye : - O C D - PPT : traumatic or non traumatic ? use contact or not ? recent respiratory infection ? - Past history of similar condition or systemic disease . 2- Vision :
Any discharge may cause colored halos , however vision may be markedly affected in acute glaucoma , corneal ulcer , uvitis .
Examination :1- lid : - rubbing lash may be the cause of red eye . - blepharospasm usually indicates corneal ulcer or uvitis. - lid edema is common in allergy or venous obstruction .
- scales of blepharitis . - lower lid (ectropion) may cause dryness .2- cornea : important to confirm its clear .3- conj : - site of redness - follicles ( viral or trachoma ) - papillae ( chronic irritation e.g. CL , spring catarrh , drugs , trachoma ) - chemosis : usually allergy or viral .3- AC : - to exclude glaucoma ( shallow AC ) - KPS , flare , hypopyon .4- Pupil : e.g . - vertical dilated in glaucoma . - constricted in iridocyclitis .5- Lens 6- Tension : palpatory and compare eyes .7- periauricular LN : viral infection ± .
Summary of red eye :
1- Red eye + discomfort (only) = conjunctiva A) diffuse : -young : Allergy (tobradex) or infection (levoxin , tobrex + fusithalmic VED ) - old : dryness (tearsgaurd x5 , cornergel x3). B) localized : phylectn (tobradex,epifenac,terracortil Eo) , episcleritis (+rivo tab ) , angular blepharits (tetra EO + prisoline zink) , subconj hge (reassurance ).
a) painless : RD , CRVO .b) painful : Acute glaucoma , optic neuritis ( loss of vision in few days with pain in eye movement history of viral infection or MS , O/E : RAPD , swollen optic disk ± ) .
Usually in-significant but fundus ex is to exclude : - Vitrous hge . – retinal tear .
Anti allergic
1- Orchazide ED…x4: Anti H , mast cell stabilizer , use only for 2 weeks .
2- Mastocytx ED…x2: Anti H , mast cell stabilizer , use only for 4 weeks Has rapid effect .
3- Mirolast ED …x2 or x4 (according to sevirty) : mast cell stabilizer , can be used for 4 months without complications , not used in toddlers < 3 years .
4- Tavegyl syrup … x 3 : in lid edema e.g insect
5- steroids : orchapred , FML ,
Anti bacterial
NB: Avoid chlormphinecol in children , pregnancy , long duration Avoid using contact lens when administrating fusithalmic or optifuscin.
Antibiotic + Cortisone
*avoid steroids in : 1- corneal ulcer 2- FB removal 3- children ( if necessary Tobradex , trrracortil EO, FML neo the least penetrating corticosteroids ) .
Aminoglycosides
1- Tobramycin Tobrex (16) قطرة و مرهمTobrin قطرة و مرهم
2- Gentamycin Apigent قطرة و مرهم
3- Neomycin Neo-pol
Quinlones
OflicinOfloxOcuflox Optifloxالمادة Eye Drops األربعة و بعض زيأشهرهم Ofloxacin الفعالة Oflox و
Ciprocin Ciprofar
Okacin Orchacine
Vigamox
TymerZymer
Levoxin
Chlormphinecol Isomephenicol Isoptophenicol
Ocuphenicol Miphenicol ( EO)
دي و المجموعة إن هنا ملحوظه أهمفي سواء الثالجة في تحفظ الزم