Common Eye Conditions &

their management
in
Primary Healthcare

Dr. Adel Al-Beri

Consultant Family Medicine
 Common Eye Symptoms Present to
Primary Healthcare

• Red eye
• Eye itching
• Eye pain and abnormal eye sensation
• Watering of eye
• Loss of vision: acute/chronic
• Diplopia
• Lumps & bumps
• Headaches
 Common Eye Conditions presenting to Primary
Healthcare
• Blepheritis • Herpetic keratitis
• Conjunctivitis • Herpetic keratitis
• Iritis • Flashes & floaters
• Subconjunctival hemorrhage • Retinal detachment
• Conjunctival foreign bodies • Diabetic retinopathy
• Corneal foreign bodies • Glaucoma
• Stye • Cataract
• Calazion • Ptosis
 Eye History & Physical Examination
• Inspection & gentle palpation
• Eye movement
• Led eversion
• Light reflex
• Red reflex
• Visual acuity
• Visual field
• Applantion tonometry
• Funduscopy
• Fluorescein test
 Red Eye
The most common presenting symptom of
patients presenting with ophthalmic
problems/emergency

Red eye can be painful or painless

Or
Accompanied with or without discharge
Or
Accompanied by blurring of vision or not
 Examples of tests

Schiotz Tonometer Applanation tonometry

Fluorescein strips Fluorescein test

 Eye wash

Undine eye irrigator Eye wash by syringe

 What cause a red eye?

Red eye is caused by either:

• Dilatation of:
- conjunctival blood vessels e.g. conjunctivitis
- Episcleral vessels e.g. episcleritis
- Scleral vessels e.g. scleritis
Or
- Accumulation of blood in subconjunctival space
i.e. subconjunctival hemorhage
 Eye discharge
Discharge in a red eye is caused by:

• Exudate or transudate from conjunctival

vessels
• Due to overproduction of tears
• Due to blockage of tear passage
 What causes a discharge in a red eye

Discharge in a red eye is caused by either:

• Exudate/transudate from conjunctival

vessels
• Due to over production of tear
• Due to blockage of tear passage
 Viral conjunctivitis Mucopurulent conjunctivitis/bacterial

Allergic conjunctivitis Vernal catarrh or Spring catarrh

Chemical induces conjunctivitis

 Stye & internal hordeolum
Acute infection of
meibomian glands

The treatment is topical

antibiotic & incision by
eye specialist
 Chalazion

It is:
chronic granulomatous inflammation of the
mebnium glands

Treatment:
Incision and curettage
 What cause pain in a red eye?
Pain is caused by irritation of:

• Conjunctival nerves e.g. dull ache in conjunctivitis

• Corneal nerve pain in corneal ulcer
• Ciliary nerves: pain in scleritis, uveitis and angle closure glaucoma

It is important to remember that the orbit is surrounded by air

sinuses & inflammation
of these is an important cause of
pain around the eye
 What causes visual loss in a red eye?

• Corneal edema/ulceration

• Hazy anterior chamber (flare/cells)

• Dilated pupil
 Cause of painless red eye
• Subconjunctival hemorrhage
• Episcleritis
• Localized red eye such as pterygium &
Pinguecula

Please note that all of the above do not usually

have accompanying discharge or epiphora
 Subconjunctival hemorrhage

Management:

Reassurance it is a self limited condition

& folloup
 Pterygium
• It is fibrovascular
proliferation of the
conjunctival and
subconjunctival tissues

• Presented as fleshy lesion

growing over the cornea

• Management if encroaching
over field axis then surgical
excision
 Pinguecula
• Presentation
- It present as yellow deposit in
the palpebral aperture
- Usually seen in the nasal
quadrant but can be in
temporal as well
- Has been linked to exposure
and seen more in equatorial area

• Treatment:
- Observation
 Episcleritis
• Inflammation of the episcleral tissues.
Relatively common, benign, self-limited

• Simple episcleritis, vascular congestion is

present

• Nodular episcleritis is characterized by a

discrete, elevated area of inflamed
episcleral tissue.

• Steroid can help but might lead to dependence

 Causes of watery red eye
• Blepharitis and secondary dry eye
• Conjunctivitis
• Keratitis
• Acute dacryocystitis
 Bleperitis
It is:
• Inflammation of the lid margin
• Anterior: involves the eye lashes
• Posterior involves the mebonium
glands

Mangement:
o Led hygine
o ocular lubricantes
o antibiotics
 Causes of a painful red eye
• Corneal abrasion
• Ocular foreign body: conjunctival / corneal
• Corneal ulcer
• Uveitis (iritis)
• Angle closure glaucoma
• Scleritis
• Endophthalamitis
Conjunctival foreign body
 Traumatic corneal abrasion

Diagnosis:

• History & physical examination

• Fluorescein test

Management:

• Ocular lubricants/antibiotics
• -/+ eye patching
 Corneal ulcer
Management:

Urgent referral to hospital eye

emergency services (HES)

Corneal ulcer with Fluorescein stain

 Corneal foreign body
Management:

• Superficial semidetached FB
can be removed by eye
irrigation or swab

• Deep FB refer to eye specialist

 Anterior Uveitis
Clinical presentation:
Patient presented with a red eye
with blurring of vision,
photophobia and dull ache pain
with no discharge

Management:
Immediate referral to emergency
eye services
 Angle closure glaucoma

It is:
caused by blocked drainage canals in the eye, resulting in a sudden rise in
intraocular pressure, develops very quickly and demands immediate
medical attention

Presentation:
Painful red eye with blurring of vision, headache and vomiting

Management:
Immediate referral to eye emergency services
 In summary
When confronted with a patient with an eye problem:

• Decide weather it is painless or painful

• Identify the structure of the eye which is involved
• Try to ascertain if the cause is
infective/traumatic/allergic
• Always rule out trauma
• Check intraocular pressure and vision
• And if in doubt ask for advice
Thank You