RED EYE – differential diagnosis RED EYE l„Red eye“ is sign of pathology of anterior or posterior ocular segment, of orbit or of ocular adnexa. Anamnesis lSystemic disease lEye disease lDevolopment of difficulties lCharacter of diffuculties Eyelids - blepharitis lBlepharitis - anterior and posterior l lChronic anterior blepharitis lAnterior blepharitis affects the area surrounding the bases of the eyelashes and may be staphylococcal or seborrhoeic Eyelids - blepharitis lBurning, grittiness and mild photophobia with remissions and exacerbations lSymptoms are usually worse in the mornings Eyelids - anterior blepharitis lStaphylococcal blepharitis lHard scales and crusting mainly located around the bases of the lashes (collarettes) . lMadarosis, trichiasis and poliosis in severe long-standing cases. l lSeborrhoeic blepharitis lHyperaemic and greasy anterior lid margins with sticking together of lashes lThe scales are soft and located anywhere on the lid margin and lashes l showimage Chronic seborrhoeic blepharitis showimage Eyelids – posterior blepharitis lChronic posterior blepharitis l lCaused by meibomian gland dysfunction l Eyelids – posterior blepharitis lSigns of meibomian gland dysfunction : l lCapping of meibomian gland orifices with oil globules lPouting, recession, or plugging of the meibomian gland orifices lHyperaemia and telangiectasis of the posterior lid margin lPressure on the lid margin results in expression of meibomian fluid that may be turbid or appear like toothpaste lThe tear film is oily and foamy and froth may accumulate on the lid margins or inner canthi showimage Orbit – preseptal cellulitis lInfection of the subcutaneous tissues anterior to the orbital septum. lCauses ¡Skin trauma - laceratio, insect bites (S. aureus or S. pyogenes) ¡Spread of local infection - from an acute hordeolum or dacryocystitis. ¡From remote infection of the upper respiratory tract or middle ear by haematogenous spread lSigns - Unilateral, tender and red periorbital oedema showimage Orbit - Bacterial orbital cellulitis lLife-threatening infection of the soft tissues behind the orbital septum, mainly in children lThe most prevalent causative organisms are S. pneumoniae, S. aureus, S. pyogenes and H. influenzae. l lPathogenesis lSinus-related - ethmoidal, typically affects children and young adults. lExtension of preseptal cellulitis lLocal spread from adjacent dacryocystitis, and mid-facial or dental infection lHaematogenous spread l Orbit - Bacterial orbital cellulitis lPresentation is with a rapid onset of severe malaise, fever, pain and visual impairment l lSigns lUnilateral, tender, warm and red periorbital oedema lProptosis, lid swelling lPainful ophthalmoplegia lOptic nerve dysfunction l Orbit - Bacterial orbital cellulitis lComplications lOcular complications - exposure keratopathy, raised intraocular pressure, occlusion of the central retinal artery or vein, endophthalmitis and optic neuropathy lIntracranial complications - meningitis, brain abscess and cavernous sinus thrombosis lSubperiosteal abscess - along the medial orbital wall lOrbital abscess in post-traumatic or postoperative cases. orbitální celulitida showimage Dry Eye Disorders lThere is inadequate tear volume or function resulting in an unstable tear film and ocular surface disease. l lKeratoconjunctivitis sicca (KCS) refers to any eye with some degree of dryness. lXerophthalmia describes a dry eye associated with vitamin A deficiency. lXerosis refers to extreme ocular dryness and keratinization that occurs in eyes with severe conjunctival cicatrization. lSjögren syndrome is an autoimmune inflammatory disease which is usually associated with dry eyes. l Dry Eye Disorders lSymptoms l lfeelings of dryness, grittiness and burning - worsen during the day, transient blurring of vision, redness and crusting of the lids showimage Conjunctiva lConjunctival injection is diffuse, beefy-red and more intense away from the limbus lInstillation of 10% phenylephrine drops will constrict the conjunctival and superficial episcleral vasculature l bakteriální konj Conjunctivitis lBacterial - H. influenzae, S. pneumoniae, S. aureus l lPapillary reaction over the tarsal plates lMucopurulent discharge l lGonococcal keratoconjunctivitis - pseudomembrane formation, Lymphadenopathy, Corneal ulceration showimage showimage Conjunctivitis lViral conjunctivitis l lAdenoviral keratoconjunctivitis - the most common external ocular viral infection lSporadic or occur in epidemics in hospitals, schools and factories lTransmission of this highly contagious virus -respiratory or ocular secretions lDissemination is by contaminated towels or equipment such as tonometer heads Conjunctivitis lPresentation l lUnilateral watering, redness, discomfort and photophobia lThe contralateral eye is typically affected 1-2 days later, but less severely lEyelid oedema and tender pre-auricular lymphadenopathy. lFollicular conjunctivitis showimage Conjunctivitis lAcute allergic rhinoconjunctivitis lSeasonal allergic conjunctivitis (hay fever) - onset during the spring and summer lThe most frequent allergens are tree and grass pollens l lPerennial allergic conjunctivitis causes symptoms throughout the year with exacerbation in the autumn when exposure to house dust mites, animal dander and fungal allergens is greatest lPresentation - redness, watering and itching, associated with sneezing and nasal discharge showimage Cornea – infectious keratitis lKeratitis – bacterial (P. aeruginosa ,S. aureus, S. pyogenes) lRisk factors - Contact lens wear, trauma lPresenting symptoms - pain, photophobia, blurred vision and discharge lSigns lAn epithelial defect, infiltrate around the margin, circumcorneal injection lStromal oedema and small hypopyon lProgressive ulceration may lead to corneal perforation and endophthalmitis. showimage Cornea – infectious keratitis lKeratitis – fungal (stromal infiltrate with indistinct margins, surrounded by satellite lesions, hypopyon) showimage Cornea – infectious keratitis lKeratitis viral – herpes simplex virus llinear-branching (dendritic) ulcer, corneal sensation is reduced showimage Episclera lEpiscleritis – simple (sectoral or diffuse) , nodular – young, female l lPresentation - always sudden lThe eye becoming red and uncomfortable within an hour of the start of an attack - hotness, pricking or generalized discomfort lWithout systemic associations showimage showimage Sclera lScleritis - oedema and cellular infiltration of the entire thickness of the sclera l lAnterior non-necrotizing scleritis – diffuze or nodular lRedness,pain which may spread to the face and temple l showimage showimage Sclera lNecrotizing anterior scleritis with inflammation lpain - severe and persisten lScleral thinning due to necrosis allows the blue choroid to show through the translucent hydrated scar tissue that has replaced normal sclera showimage Sclera lScleromalacia perforans l lSpecific type of necrotizing scleritis without inflammation that typically affects elderly women with long-standing rheumatoid arthritis lYellow scleral necrotic plaques near the limbus without vascular congestion showimage Glaucoma - Acute congestive angle closure showimage Uveitis lAnterior uveitis may be subdivided into: lIritis in which the inflammation primarily involves the iris. lIridocyclitis in which both the iris and ciliary body are involved lCiliary injection - peripheral hyperemia of the anterior ciliary vessels which produces a deep red or rose color of the corneal stroma, and must be distinguished from hyperemia of the conjunctival vessels. May spread to the perilimbic corneal tissue. Called also ciliary flush. Anterior uveitis lCiliary (circumcorneal) injection lMiosis due to sphincter spasm Endothelial dusting by myriad of cells is present early and gives rise to a 'dirty' appearance lAqueous cells lAqueous flare reflects the presence of protein due to a breakdown of the blood-aqueous barrier lAqueous fibrinous exudate lHypopyon lPosterior synechiae may develop quite quickly and must be broken down before they become permanent showimage Acute endophtalmitis lAcute inflammation of all ocular structure lEndogennous or exogennous (surgery,trauma) lSigns - chemosis, corneal injection, relative afferent pupil defect, corneal haze, fibrinous exudate and hypopyon, vitritis with impaired view of the fundus Acute endophthalmitis showimage End !!!! l DSCF4359