Red eye and common eye problems

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1 Red eye and common eye problems Mr Mike Potts Consultant Ophthalmic Surgeon Nuffield Health Bristol Hospital

2 Talk contents Two parts 1- The red eye diagnosis and treatment 2- Lumps and bumps around the eye

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4 The red eye Not easy!!! A slip lamp makes it much easier (is it worth your practice having one?) More than 100 things make your eye red! Red eye means inflammation (conjunctivitis) Itis is inflammation Inflammation is a sign NOT a diagnosis i.e. many things cause inflammation

5 The red eye Common causes: 1.Foreign bodies e.g. rust, sand etc Flourescein and a blue light help 2. Eyelashes e.g. Entropion or Trichiasis but can be subtle and intermittent 3. Contact lenses in any contact lens wearer until proven otherwise IT IS ALWAYS the contact lens

6 The red eye 4. Blephartis and Meibomitis Very common, sticky sore crusty lids Rx drops a waste of time Blepharosol cleaning solution and Oc Maxitrol 5. Dry eye a). tear deficient or b) evaporative dry eye (MGD) Worse as the day go es on Rx a) tear replacement b) MGD treatement

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8 The red eye 6. Infection Bacterial - usually sticky and yellow or green discharge, should not affect vision but may do if severe (Keratitis) Rx G Chloro Oc Chloro Fucithalmic (cream) G Ofloxacin

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10 The red eye 7. Infection Viral usually watery white discharge often with associated sore throat/nose Rx often none unless herpes simplex or zoster then Oc Zovirax 20 years ago viral conjunctivitis used to last a week, now with modern antivirals it lasts seven days. Viruses andeno virus is commonest

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12 8. Allergy The red eye Follicular conjunctivitis (cobble stones on the tarsal plate) Grass, pollen, house dust mite, cats and dogs, contact lenses! (GPC) Exclude chlamydia in young people Rx Sodium Cromoglycate G Opatanol G Predsol

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14 9. Iritis/uveitis The red eye Signs red eye usually unilateral with photophobia (++) and reduced vision Cillary flush and Meiosis Had it before/recurrence Rx steroids but usually refer to Eye Hospital (cant be properly assessed without a slip lamp)

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16 The red eye 10. Subconjunctival haemorrhage Totally painless and normal vision Usually totally benign. Often happens overnight caused by eye rubbing If trauma and extensive refer to Eye Hospital

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19 The red eye - things to do 1. Always check VA 6/10 equals driving! 2. Look and pull eyelid down to check tarsal plate (cobble stones) 3. Evert upper lid if FB suspected + flour and blue light 4. Rx give drops or ointment

20 2. Lumps and Bumps around the eye

21 What is it? Pedunculated, cauliflower surface, often multiple, no blood vessels or telangectasia

22 Rx : excise with cautery to base Viral Papilloma

23 What is it? Smooth,circular,painless when chronic,painful when acute,can rupture anteriarly or posteriarly,in upper lid can affect acuity, can often see plugged meibomian orifice on S L

24 Chalazion blocked m.g. Rx hot bathing compression antibiotics top & oral if acutely infected When chronic Incision & Curretage One Stop at 2CP Prevention ; MGB Soya bag hot bathing Rosacea assoc ; Doxycycline

25 Painful, inflamed, infected, warm, What is it

26 External Hordeolum (stye) Rx Needling and expression Oral and top antibiotics Flucloxaccilin & Oc Chloro

27 What is it? Slow growing, often hairs through it, painless, variably pigmented

28 Intradermal naevus (mole) Rx ; Shave Biopsy with histology

29 What is it? Multiple,painless,often assoc with watery mucous discharge / follicular conjunctivitis

30 Molluscum contagiosum Recognise, shave biopsy with cautery to base, histology

31 What is it? Rolled edges, ulcerated centre, firm & raised, telangectasia painless

32 Nodular BCC Surgical excision ( 2 mm margins )with delayed closure pending Confirmation of clear margins with Laissez Faire healing DXT / Imixoquod

33 What is it? Diffuse, rolled edges,loss lashes, telangectasia, slightly raised

34 Morpheic BCC SURGICAL Excision by oculoplastic specialist Histology with delayed closure until tumour margins confirmed clear

35 What is it? Necrotic centre, Rodent ulceration,? Restriction EOM

36 Squamous cell carcinoma Surgical excision by oculoplastic /orbital specialist, histology to confirm Tumour margins clear

37 What is it? Smooth, cystic,? Transilluminates clear or dark & solid?mobile

38 Accessory lac cyst or Cav haemangioma? Orbital MRI,Surgical excision?ga Whats the 2nd lesion

39 What is it? Crusty inflamed lashes?blepharitis

40 Eyelid Lice Treat the whole body!!

41 Time for a short Quiz!!

42 A. BCC B. Chalazion C. Pappilloma Q1.What is it?

43 Q2.What is this pigmented lesion? A. Malignant Melanoma B. Freckle C. Intradermal naevus

44 A. BCC B. Chalazion C. Sebaceous cyst Q3.What is it?

45 Q4.What is the commonest cause of proptosis? A. Orbital tumour B. TED C. Myopia

46 Q5.What does an exophthalmometer measure? A. IPD B. Lid retraction C. Proptosis

47 Q6.Do you feel you have a better understanding of lid lesions and orbital disease?

48 Any Questions