THE RED EYES

Maria Larasati
Josiah Irma
Ophthalmologist
 THE RED EYES

• Red eyes, normal vision

• Red eyes, decreased vision
•In developing countries accounts for 40% eye problems
Red Eyes
Caused by:
 Increase of blood vessel supply

 Decrease of outflow (Caused by

occlusion)
 Vessel dammage

Location : a. Posterior conjungtiva

a. ciliarry anterior / episklera
2 Vascular System of EyeBall :
Ciliary Anteriro Sytem, consist of:
Anterior Cilliary Artery (9)
Posterior Cilliary Brevis (7)
Long Ciliarry Artery (4)
Central Artery System
Retina (12)
 Red Eye

Decreased Normal Vision

Vision

Acute Not Acute

Pain Without Pain
IOP N IOP N +

Episcleritis Gradual Sudden

Keratitis Glaucoma Scleritis
Acute Uveitis Hordeolum
Sinus Conjungtivitis
cavernosus pingueculitis Subconjungtiva
Trombosis bleeding

Chronic
Conjungtivitis
Blepharitis
pterigyum
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 Watery or mucoid
and globular)
Conjunctival membrane Late onset Early onset
Preauricular adenopathy No Yes
Concurrent otitis media 20-73% 10%
Follicles are hypertrophied mucosa-
associated lymphoid tissue

Papillae are basically edematous

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

Taken External Disesase and Conea AAO Section 8

 Follicle

Taken External Disesase and Conea AAO Section 8

Conjunctivitis

Papillae Follicles Purulent discharge

Redness Chemosis
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 non-necrotizing, diffuse scleritis

early necrotizing 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 Behçet (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
“Cell” are individual cells floating in the anterior chamber. They look like dust specks floating in a movie
theater projector light. “Flare” is protein floating in the anterior chamber from inflamed blood vessels. It looks
like smoke floating in that same theater.

 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