Home
This site is intended for healthcare professionals
Advertisement

Ophthalmology Series: Red Eye Assessment | Tim Fetherston

Share
Advertisement
Advertisement
 
 
 

Summary

This postgraduate teaching session led by ophthalmologist Tim Fetherston provides essential guidance on how to assess red eyes, as well as outlining a scheme to use. Participants will gain an insight into the interesting facts, tricks, and pitfalls in distinguishing and managing the main four red eye conditions. Tim will discuss the importance of obtaining an accurate history and recognizing urgent eye problems, with a particular focus on conjunctivitis, which may manifest differently in neonates and adults. Furthermore, the session will delve into diagnosing the various bacterial organisms and the digital management of these cases. Moreover, there will be an emphasis on the pattern of redness in the presence of different clinical features. Finally, there will be a Q&A session. Don't miss out on this fantastic opportunity to upgrade your medical skillset!

Generated by MedBot

Description

This teaching session is also available as audio MP3 please click here. Please use Slide Feedback for attendance certificate

Tim Fetherston, Ophthalmologist

Topic: Assessment of the Red Eye

The session focused on the assessment of "red eyes", potentially through remote consultations. Tim Fetherston discussed the significance of gathering an accurate patient history and recognizing eye problems, even when a clinical presentation might not be typical.

Key Points:

Patient Consultation:

  • Patients generally present with symptoms/signs rather than a diagnosis.
  • Vital questions include discerning if the condition is acute or chronic, if the patient is a contact lens wearer, the type of discomfort felt, and if there's any history of allergies. It's essential to identify if the vision is affected and if there's any family history.

Remote Consultation Tool: The use of a 'selfie' photo can be invaluable for remote consultations to provide a clearer picture of the issue.

Main 'Red Eye' Conditions Covered:

  • Conjunctivitis
  • Iritis (Uveitis)
  • Corneal issues (abrasion, trauma, ulcer, etc.)
  • Acute (angle closure) Glaucoma

Recognizing Types of Conjunctivitis:

  • Bacterial Conjunctivitis: Sticky, purulent discharge. Might be caused by Gonococcus, especially in severe cases or in neonates. Other possible organisms include Chlamydia.
  • Viral Conjunctivitis: Usually associated with the Adenovirus and is often bilateral. It’s highly contagious, and eyelid swelling is typical.
  • Allergic Conjunctivitis

Trauma or Foreign Bodies (FB):

  • Traumas can have numerous causes ranging from assault to accidents with power tools. Notably, metal FBs can leave rust rings.
  • Chemical exposures and traditional medicines can also play a role.

Pattern of Redness:

  • The distribution of redness is crucial in diagnosis. For instance, Conjunctivitis involves the entire ocular surface, while conditions like Iritis and Glaucoma might only cause redness in particular areas.
  • It's essential to discern if the redness is most intense around the corneal edge.

Red Eye Conditions:

  • Iritis/Uveitis: Causes photophobia, pain, and potential loss of vision.
  • Acute Glaucoma: A rare condition with a 'rock-hard' eye and hazy cornea. Symptoms might include severe pain, headache, and possible vomiting.
  • Corneal Lesions: Typically, they cause redness around the cornea and some vision impairment.

Conclusion:

For a proper assessment of the red eye, one should ask the right questions, ensuring the consistency of history with findings. Knowing the symptoms, recognizing any discharge, identifying the pattern of redness, checking the vision, and assessing the pupil's state are essential steps. Depending on these assessments, the patient can then be treated or referred for specialized care.

Learning objectives

06/09/2023

Learning objectives for the Postgraduate Remote Teaching Session – MedAll Assessment of the Red Eye:

  1. Identify key questions to ask when assessing a red eye.
  2. Recognize patterns of redness or congestion that can indicate a particular condition.
  3. List the symptoms and signs associated with common red eye conditions.
  4. Comprehend the different management options for red eye conditions.
  5. Understand the importance of referring red eye cases when necessary.
Generated by MedBot

Similar communities

View all

Similar events and on demand videos

Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

06/09/2023 Postgraduate Remote Teaching Session - MedAll Assessment of the Red Eye Ophthalmology • How to assess Red eyes (maybe remotely…) Tim Fetherston - Ophthalmologist • Outline of a scheme to use • Interesting facts, tricks & pitfalls…. • Recognising urgent eye problems - Questions Tim Fetherston - Ophthalmologist 1 2 Crucial questions i.e. trying to obtain an accurate history • Patients attend with symptoms / signs (not with a diagnosis..!) • What questions do I need to ask? • How do I recognise / interpret clinical signs? Not every clinical presentation is typical Can’t cover everything ! 3 4 Assessing red eyes (maybe remotely) - Crucial (often misConsultation Questions: 4 main ‘Red Eye’ conditions: (We will discuss symptoms & signs) Wikimedia Commons How long? Contact (Acute or lens Everywhere? Localised • Conjunctivitis Assault? Chronic) wearer? Around edge Uand Chisel? Any trauma? Predness?f of cornea • Iritis (Uveitis) Sticky or Any Questions type of 'Painty' • Corneal problems (abrasion, trauma, ulcer etc) watery? discharge? discomfort? Hot... Selfie photo? (For remote Anyone • Acute (angle closure) Glaucoma consultations) else in Is the Does affected? Any history of vision light hurt ? Allergies? affected? (Photophobia) 5 6 1 06/09/2023 Discharge Crucial clinical signs • Discharge • Pattern of redness / congestion • Vision affected or not ? • Pupil normal or not ? Eyerounds.org University of Iowa 7 8 Acute,uni-orbilateral Acute,uni-orbilateral Thinkof ThinkofGonococcalif Thinkof ThinkofGonococcalif Bacterial verysevere,orinneonate Conjunctivitisysevere,orinneonate Conjunctivitis Purulent, Canbeother Chlamydia Purulent, Corganisms Chlamydia Sticky? organisms Sticky? Any UsuallyBilateral Any Discharge? Discharge? Watery ThinkofViral UsuallyAdenovirus Conjunctivitis Ofteneyelidswelling PinkConjunctival'Follicles' HighlyContagious! Wikimedia Commons 9 10 Conjunctivitis – symptoms & signs Conjunctivitis – Types & Management • Discharge Bacterial • ‘Gritty’ discomfort – like sand Swabs ? • Vision usually NOT affected… - if you blink away mucus Chloramphenicol ointment Wikimedia Commons Wikimedia Commons • (BUT: Adenovirus can involve cornea) Viral • Various organisms – management varies Usually don’t routinely swab Supportive treatment Antibiotic / lubricant ointment ?? Advice to avoid cross-infection Chlamydial Have follicles like viral conjunctivitis Specific swabs / PCR testing University of Iowa Refer to GUM University of Iowa 11 12 2 06/09/2023 Conjunctivitis - Neonates Viral Conjunctivitis Usually Adenovirus, but may be Conjunctivitis in first 30/7 = other viral causes … Ophthalmia Neonatorum Commonly Gonococcus or Chlamydial (not always) • Highly contagious Swabs + Refer to Eye unit. • Family etc affected (Treatment - Tetracycline ointment) • Eyelid swelling (We would generally involve Paeds.) • May take week+ to resolve Mother - referral to GUM 13 14 Allergic Conjunctivitis Trauma or FB? • Huge topic • Innumerable causes and variations • Sometimes patients are reticent about history • Some pitfalls or ‘traps’ Wikidoc.org 15 16 Trauma or FB? Refer Hammering or Trauma Refer Chiselling? Hammering or Innumerable causes Esto no es un Blog: Introducción a la historia del arte (Galeano) Abrasion? Assault Baby fingernail Contact lens Trauma or FB? Trauma or FB? 17 18 3 06/09/2023 Refer Refer Hammering or Trauma Hammering or Chiselling? Chiselling? Innumerable causes Innumerable causes Assault Assault Baby fingernail Baby fingernail Abrasion? Contact lens Abrasion? Contact lens Trauma or FB? Trauma or FB? Wind-blown Power tools Wind-blown FB Metallic - FB Power tools leaves rust Chemicals, ring Metallic - Traditional leaves rust medicines ring May be sub-tarsal May be sub-tarsal 19 20 Pattern of redness Alltheocularsurface, bulbar&tarsal Justaround thecornea What is the pattern / distribution of the redness or congestion ? PatternofRedness congestion With conjunctival irregularity 21 22 Pattern of Redness Pattern of Redness - 1: Conjunctivitis Conjunctivitis All theocularsurface, bulbar&tarsal Iritis, All around Glaucoma Justaround Just one Ulcer thecornea area Corneal problem FB Episcleritis Keratitis 'Band' of PatternofRedness congestion Scleritis NOT most intense Pterygium, BULBAR and Pingueculae around the corneal With TARSAL conjunctival edge irregularity Scars conjunctival involved Neoplasm Typically … vision normal, pupil normal 23 24 4 06/09/2023 Pattern of Redness - 2: Iritis / Uveitis Pattern of Redness - 2: Iritis / Uveitis fornices relatively Iritis un-involved Photophobia Pain Loss of vision Most intense around the cornea Iritis - usually small pupil, may be irregular - If unilateral, cause rarely found - - If bilateral, look for systemic inflammatory prob. - TB, Sarcoid, Rheumatoid, Autoimmune etc… 25 26 Pattern of Redness - 3: Acute Glaucoma Pattern of Redness - 3: Acute Glaucoma RARE RARE Mid-dilated, fixed, vertically oval pupil Severe pain & headache, +/- vomiting High pressure, ‘Rock-hard’ eye, Hazy cornea Corneal oedema - Loss of vision with ‘Rainbow’ haloes around lights 27 28 Pattern of Redness - 4: Corneal lesions Summary: Corneal lesions typically cause redness around the cornea and some impairment of vision Assessment of the Red Eye Bacterial corneal ulcer • Ask the right questions / keratitis • Is the history consistent with findings? • What are the symptoms? Adenovirus Kerato-conjunctivitis • Is there any discharge? • What is the pattern of redness? Dendritic • Is the vision affected? Ulcer • Is the pupil normal, symmetrical with fellow eye? • Treat or refer? Keratitis 29 30 5