THE RED EYES

Maria Larasati, Ophthalmologist

THE RED EYES

Red eyes, normal vision

Red eyes, decreased vision

In developing countries accounts for 40% eye problems

Congestion of conjunctival blood vessels

Conjunctival Injection

1. Posterior Conjunctival arteries

2. Mobile, loosely attach in
bulbar conjunctiva
3. Fornix location
4. Larger toward periphery
5. Blanching in adrenalin drop

Ciliary injection

1. Anterior ciliary arteries

2. Immobile with movement

3. Corneal circumference
4. Lesser toward fornix
5. No reaction in adrenalin drop

Red Eyes, normal vision

Conjunctivitis
(bacterial/viral/chlamidyal/allergic)

Pterygium

Subconjunctival hemorrhage

Episcleritis and scleritis

CONJUNCTIVITIS
Clinical presentation
Discharge:
watery, mucoid, purulent or mucopurulent
Nonspecific:
watery eyes, irritation, stinging, foreign body
sensation, photophobia or itchiness
Conjunctival injection
Eyelid swelling
Tarsal conjunctiva: papillae/follicles/membrane
Cornea and pupils usually normal

Differentiating Bacterial vs Viral

Clinical Finding

Bacterial Disease

Viral Disease

Bilateral disease at onset 50-74%

35%

Conjunctival response

Papillary or nonspecific

Follicular

Conjunctival discharge

Mucopurulent (thick
and globular)

Watery or mucoid

Conjunctival membrane

Late onset

Early onset

Preauricular adenopathy No

Yes

Concurrent otitis media

10%

20-73%

Follicles are hypertrophied mucosaassociated lymphoid tissue

Papillae are basically edematous

conjunctival tissue that is prevented
from expanding laterally by the connective
tissue network

Conjunctivitis

Follicles

Papillae

Redness

Chemosis

Purulent discharge

Gonnococcal conjunctivitis

Gonococcal conjunctivitis

5 min
after wash

CONJUNCTIVITIS
Management
- GP competencies
- Eye hygiene
- Eyedrops:
viral self-limiting, antibiotics
bacterial antibiotics
allergic/vernal antiallergy, steroids(!)

- 3 days w/o improvement: refer

PTERYGIUM
Triangular fibrovascular tissue

Risk factors :hot climate, chronic dryness

and high sunlight exposure
Apex always in the cornea side, often with
Fe deposits

PTERYGIUM

PTERYGIUM
Management:
Excision with conjuctical graft
Lamellar keratoplasty

SUBCONJUNCTIVAL HEMORRHAGE
No pain, no discharge
Well-demarcated

Self-limiting within 2 weeks

EPISCLERITIS AND SCLERITIS

Sclera covered by 3 vascular layers:
- Conjungtival blood vessels
- Superfisial episcleral vessels(in Tenon layer);
with phenilephrin: blanching
- Deep vascular plexus

EPISCLERITIS AND SCLERITIS

Episcleritis:

common, benign, self-limiting

young adult

related to systemic disease

types: - simple (sectoral,diffuse)

- nodular

EPISCLERITIS AND SCLERITIS

Scleritis:
granulomatous inflammation
rheumatoid arthritis, connective tissue disorder
less common

severity: mild-severe (necrotizing)

types: - anterior scleritis (non-necrotizing /

necrotizing)
- scleritis posterior

EPISCLERITIS AND SCLERITIS

Simple, sectoral episcleritis

early necrotizing scleritis

non-necrotizing, diffuse scleritis

Scleral necrosis

Episcleritis and Scleritis

Management:
Episcleritis
- Steroids/NSAID eyedrops
- Systemic ibuprofen/flurbiprofen

Scleritis
- Oral NSAID

- Oral Steroid
- Combination

Red Eyes, Decreased Vision

Keratitis

Cornea Ulcer

Anterior Uveitis (iritis, iridocyclitis)

Acute Glaucoma

Endophthalmitis

KERATITIS
Cornea:
Frontmost part of eye
Main component in refraction (70%)
Tear film

KERATITIS
Keratitis:
Inflammatory cells infiltration
Corneal opacity
Superficial / deep
Cause: Infection (Viral/bacterial/fungal)
Also: Dry eyes, trauma, drug toxicity, UV exposure,
contact lens irritation, allergy, immunogenic states,
chronic conjunctivitis
May progress to cornea ulcer

KERATITIS-CORNEAL ULCER
Clinical presentation
- photophobia
- periocular pain
- foreign body sensation
- ciliary flush

- corneal opacity
Diagnosis : - reduced cornea sensibility
- fluorescein test
- assessment of corneal regularity

KERATITIS CORNEAL ULCER

Management:
- Refer to ophthalmologist
- Medication based on causative microorganism
virus antiviral
bacteria antibiotic
fungi antifungal
- Corneal scar

ANTERIOR UVEITIS
Inflammation of iris and ciliary body
Usually auto-immune
Isolated or part of systemic condition:

- ankylosing spondilitis
- juvenile rheumatoid arthritis
- Sindroma Reiter
- sarkoidosis
- herpes simpleks
- herpes zoster
- sindroma Behet (with stomatitis aftosa)

ANTERIOR UVEITIS
Clinical presentation:
- periocular pain

- photophobia
- usually mild decrease of vision
- ciliary flush

- small, irregular pupil, due to adhesion to

lens surface permukaan lensa

ANTERIOR UVEITIS
Clinical presentation:
- indistinct iris crypts
- cornea opacity
- cells and flare in AC
keratic precipitates, hypopion
- IOP changes

ANTERIOR UVEITIS
Management:
- Refer to Ophthalmologist
- Work-up
- Medication:
- cycloplegics eyedrops
- corticosteroids eyedrops
- oral corticosteroids oral (prn)
- Glaucoma drugs

Acute Glaucoma
ocular emergency
sudden IOP elevation
block of aqueous humor outflow
elder patients
Asians >>

Acute Glaucoma
Management:
- Refer to ophthalmologist
- Immediately lower IOP:
Pilocarpine 2%
Timolol 0.5%
Asetazolamid
Oral glycerin /IV manitol
surgery / laser iridotomy

Endophthalmitis
Purulent intraocular infection
Caused by infection through the cornea, trauma
post-surgery (mainly: cataract surgery), or
endogenous
Bacterial/fungal
Most common: staphylococcus aureus, proteus
and pseudomonas
If with extraocular infection: panophtalmitis

Endophthalmitis
Clinical presentation:
- periocular pain
- chemosis
- eyelid swelling
- corneal opacity
- anterior uveitis
- hypopion

Endophthalmitis

Endophthalmitis
Management:
- Refer to ophthalmologist
- Aqueos / vitreous tap
- intravitreal antibiotic/antifungal
- systemic antibiotic
- Panoftalmitis: evisceration

THANK YOU