RED EYE WITH

NORMAL VISION
Diska Astarini
I11109083

Red Eyes with Normal Vision

Without secret
Pterygium
Pseudopterygium
Pinguecula
Subconjunctiva Hematomes
Episcleritis
Scleritis

With secret
Conjungtivitis

PTERYGIUM

Pterygium
Wing-shaped fold of fibrovascular tissue arising
from the interpalpebral conjunctiva and extending
onto the cornea
Usually nasal in location
Related to sunlight exposure and chronic
irritation
More common in individuals from equatorial
regions.

Symptoms
Usually asymptomatic
Aggressive or recurrent pterygium may also cause
restrictive strabismus and distortion of the eyelids

Triangular
fold
of
conjunctiva growing from
the medial portion of the
palpebral fissure toward the
cornea
Pterygium that has grown
on to the cornea and
threatens the optical axis

Treatment
Protect eyes from sun, dust, and wind
For an inflamed pterygium:
Mild: Artificial tears
Moderate to severe: A mild topical steroid (e.g.,
fluorometholone 0.1%, or loteprednol 0.2% to
0.5%)

Surgical removal is indicated when:

50% reoccur within 4 months of excision and
nearly all within 1 year

Pseudoterygium
A pseudopterygium due to conjunctival scarring
differs from a pterygium there are adhesions
between the scarred conjunctiva and the cornea
and sclera.
Causes : corneal injuries and/or chemical injuries
and burns

Symptoms & Treatment

Pseudopterygia cause pain and double vision

Treatment :
lysis of the adhesions
excision of the scarred conjunctival tissue
coverage of the defect (this may be achieved with a free
conjunctival graft harvested from the temporal aspect).

PINGUECULA

Pinguecula
Harmless grayish yellow thickening of the
conjunctival epithelium in the palpebral fissure.
Etiology:
hyaline
degeneration
of
the
subepithelial collagen tissue. Advanced age and
exposure to sun, wind, and dust foster the
occurrence of the disorder.

Appearance

less transparent than normal conjunctiva

often have a fatty appearance
are usually bilateral
located nasally much more often than temporally
Usually asymptomatic

Elevated conjunctival lesion encroaches on nasal limbus

Treatment
In general, no treatment is required
cases of pingueculitis
weak topical steroids (eg, prednisolone
0.12%) or
topical nonsteroidal antiinflammatory medications

SUBCONJUNCTIVAL
HEMORRHAGE

Subconjunctival Hemorrhage
Extensive bleeding under the conjunctiva frequently
occurs with conjunctival injuries
Etiology:
Occur spontaneously in elderly patients (as a result of
compromised vascular structures in arteriosclerosis)
Occur after coughing, sneezing, pressing, bending over, or
lifting heavy objects

 Extensive bleeding under the conjunctiva

Treatment
usually harmless and resolve spontaneously
within 1-3 weeks
The patients blood pressure and coagulation
status need only be checked to exclude
hypertension or coagulation disorders when
subconjunctival
hemorrhaging
occurs
repeatedly

EPISCLERITIS

Episcleritis
inflammation of the loose connective tissue
between the sclera and the conjunctiva
Sectoral (and, less commonly, diffuse) redness of
one or both eyes, mostly due to engorgement of
the episcleral vessels. These vessels are large
and run in a radial direction beneath the
conjunctiva

Etiology
Idiopathic: Most common.
Infectious: e.g., herpes zoster virus (scars from an
old facial rash may be present, may cause
episcleritis or scleritis).
Others: e.g., rosacea, atopy, and thyroid disease.

Symptoms
Acute onset of redness and mild pain in one or
both eyes
Typically in young adults
A history of recurrent episodes is common
No discharge.

 Typical hyperemia an inflammation of the radial

episcleral blood vessels

Treatment
Mild artificial tears (e.g., Refresh Tears)
Moderate to severe a mild topical steroid (e.g.,
fluorometholone 0.1%, loteprednol 0.5%) often
relieves the discomfort.
Oral NSAIDs may be used as an alternate steroidsparing initial therapy (e.g., ibuprofen 200 to 600 mg
p.o, or naproxen 250 to 500 mg p.o., with food or
antacids).

SCLERITIS

Scleritis
Diffuse or localized inflammation of the sclera.
Classified according to location:
Anterior (inflammation anterior to the equator of
the globe)
Non-necrotizing anterior scleritis (nodular or diffuse)
Necrotizing anterior scleritis (with or without
inflammation)

Posterior (inflammation posterior to the equator of

the globe)

Epidemiology & Etiology

Scleritis is less frequent than episcleritis.
Older age (50-60 years old)
Women are affected more often than men

Etiology
Approximately 50% of scleritis cases (which tend
to have severe clinical courses) are attributable to
systemic autoimmune or rheumatic disease

Systemic diseases that can cause scleritis

CONJUNCTIVITIS

Conjunctivitis
An inflammatory process involving the surface of the eye
and characterized by vascular dilation, cellular infiltration,
and exudation.

Classification by duration:
Acute conjunctivitis. Onset is abrupt and initially
unilateral with inflammation of the second eye within one
week. Duration is less than 4 weeks.
Chronic conjunctivitis. Duration is longer than 3 to 4
weeks

Etiology
Causes of conjunctivitis may be fall into two broad categories

Noninfectious

Infectious

bacterial
viral
parasitic
mycotic

from a persistent irritation

refractive error
allergic
toxic
as a result of another
disorder (such as Stevens
Johnson syndrome)

Symptoms
Reddened eyes and sticky eyelids in the
morning due to increased secretion.
Swelling of the eyelid closed (pseudoptosis)
Foreign-body sensation, a sensation of
pressure, and a burning sensation
Intense itching allergic reaction.
Photophobia and lacrimation (epiphora)
Simultaneous presence of blepharospasm
corneal involvement (keratoconjunctivitis)

Newcastle Disease
Conjunctivitis
Rare disorder characterized by burning,
itching, pain, redness, tearing, and (rarely)
blurring of vision.
Often occurs in small epidemics among
poultry workers handling infected birds or
among veterinarians or laboratory helpers
working with live vaccines or virus.
Chemosis, a small preauricular node, and
follicles on the upper and lower tarsus.

Acute Hemorrhagic Conjunctivitis

AHC is characterized by conjunctival
congestion, vascular dilatation, and onset of
edema.
Etiology
:
family
Picornaviridae
(picornaviruses) Specifically, CA24 and EV70
Signs : painful, chemosis, tearing, lid edema,
and tiny subconjunctival hemorrhages. The
hemorrhages are petechial at first and then
coalesce, appearing post-traumatic. The
cornea may be involved with a fine punctate
keratopathy and, rarely, subepithelial opacities.

Acute Hemorrhagic
Conjunctivitis (AHC)

Treatment :

self-limited

The conjunctivitis resolves

within 46days, but the
hemorrhages clear more
slowly.

Symptomatic treatment to
make the patient as
comfortable

antibiotics are not needed

except in the presence of
bacterial superinfection.

Trachoma
Trachoma is initially a chronic follicular
conjunctivitis of childhood that progresses to
conjunctival scarring.
C. trachomatis
signs and symptoms : tearing, photophobia,
pain, exudation, edema of the eyelids, chemosis
of the bulbar conjunctiva, hyperemia, papillary
hypertrophy, tarsal and limbal follicles, superior
keratitis, pannus formation, and a small, tender
preauricular node.

Trachoma
a substantial number of children
must have at least two of the
following signs:
1. Five or more follicles on the flat
tarsal conjunctiva lining the upper
eye lid.
2. Typical conjunctival scarring of the
upper tarsal conjunctiva.
3. Limbal follicles or their sequelae
(Herbert's pits).
4. An even extension of blood
vessels onto the cornea, most
marked at the upper limbus.

Trachoma
For control purposes, the World Health
Organization has developed a simplified method
to describe the disease. This includes the
following signs:
TF: Five or more follicles on the upper tarsal
conjunctiva.
TI: Diffuse infiltration and papillary hypertrophy
of the upper tarsal conjunctiva obscuring at least
50% of the normal deep vessels.
TS: Trachomatous conjunctival scarring. TT:
Trichiasis or entropion (inturned eyelashes).
CO: Corneal opacity.

Trachoma

Trachoma
tetracycline, 11.5 g/d orally in four divided
doses for 34 weeks; doxycycline, 100 mg
orally twice daily for 3 weeks; or erythromycin,
1 g/d orally in four divided doses for 34 weeks.
azithromycin is effective treatment for trachoma
given orally as a 1-g dose in children.
Topical
ointments
or
drops,
including
preparations of sulfonamides, tetracyclines,
erythromycin, and rifampin, used four times
daily for 6 weeks, are equally effective.

Trachoma

Dry eye
Clinical condition characterized by deficient
tear production or excessive tear evaporation.
Symptoms: burning, itching, foreign body
sensation, stinging, dryness, photophobia,
ocular fatigue, and redness.
Edema and hyperemic conjungtiva bulbi.
Diagnosis: Shirmer test
Treatment : defense etiology.
Complication : cornea ulcer, secondary
infection, neovascularization cornea.

Vitamin A deficiency

Vitamin A deficiency is the leading cause of

childhood blindness in the developing
world.
A deficiency can occur as a result of
malnutrition, malabsorption, or poor vitamin
metabolism due to liver disease
Patient
complaint:
dry
eye
or
xerophthalmia
(deficiency
mucin
production caused goblet cell damage),
blinking, pain, night blindness (nyctalopia),
decrease vision.

Vitamin A deficiency

Night blindness
Bitot's spots
Corneal xerosis/ulceration
Keratomalacia
Corneal scar

Vitamin A deficiency

Bitots spot

Treatment : Children diagnosed with vitamin A

deficiency must be given a single oral dose of
200,000 IU of vitamin A immediately.

Toxic Follicular Conjunctivitis

Toxic follicular conjunctivitis follows chronic

exposure of the conjunctiva to a variety of
foreign substances, including molluscum
contagiosum of the lid margin, infection of
the lashes by Phthirus pubis, use of eye
cosmetics, and prolonged use of various
eye medications.

Toxic Follicular Conjunctivitis

Signs and symptom: Hyperemia inferior tarsus

and superior tarsus, follicel inferior tarsus and
superior tarsus.

Treatment : stop cause, use of lighter droplets

Superior Limbic Keratoconjunctivitis

SLK is a chronic, focal, ocular surface disease

characterized by episodes of recurrent inflammation of the
superior cornea and limbus, as well as of the superior
tarsal and bulbar conjunctiva.

Slit-lamp appearance of focal

superior bulbar conjunctival
injection is shown with rose
bengal staining.

Slit-lamp appearance of
superior filamentary keratitis is
shown.

Superior Limbic Keratoconjunctivitis

Fine fluorescein or rose bengal punctate

staining is usually evident.
A fine filamentary keratitis of the superior
cornea and limbus may also be present.
A delicate superior corneal pannus
suggests more long-standing disease.
Characteristic symptoms include a gradual
onset of burning, tearing, foreign body
sensation, mild photophobia, and
sometimes mucus discharge.

Diagnosis

The diagnosis of SLK is made from the

history of irritation and photophobia and the
specific pattern of superior corneal and
conjunctival inflammation and staining.
Localized superior filamentary keratitis
reinforces the diagnosis.

Treatment

Mast cell stabilizers and vitamin A

preparations have been used with moderate
success in the treatment of superior limbic
keratoconjunctivitis (SLK).
Topical cyclosporine A has been shown to
provide symptom relief and to improve the
signs of superior limbic keratoconjunctivitis

Membranous Conjunctivitis

It is an acute inflammation of the conjunctiva,

characterized by formation of a true membrane
on the conjunctiva.
Etiology : The disease is typically caused by
Corynebacterium diphtheriae and occasionally by
virulent type of Streptococcus haemolyticus.

Clinical features

1. Stage of infiltration is characterised by:

Scanty conjunctival discharge and severe pain in the
eye.
Lids are swollen and hard.
Conjunctiva is red, swollen and covered with a thick
grey-yellow membrane. The membrane is tough and
firmly adherent to the conjunctiva, which on removing
bleeds and leaves behind a raw area.

Pre-auricular lymph nodes

are enlarged.

Clinical features

2. Stage of suppuration. In this stage, pain

decreases and the lids become soft. The
membrane is sloughed off leaving a raw
surface. There is copious outpouring of purulent
discharge.
3. Stage of cicatrisation. In this stage, the raw
surface covered with granulation tissue is
epithelised. Healing occurs by cicatrisation,
which may cause trichiasis and conjunctival
xerosis.

Treatment

A. Topical therapy
- Penicillin eye drops (1:10000 units per ml)
should be instilled every half hourly.
- Antidiphtheric serum (ADS) should be
instilled every one hour.
- Atropine sulfate 1 percent ointment
should be added if cornea is ulcerated.
- Broad spectrum antibiotic ointment
should be applied at bed time.

Treatment

B. Systemic therapy
- Crystalline penicillin 5 lac units should be
injected intramuscularly twice a day for 10 days.
- Antidiphtheric serum (ADS) (50 thousand units)
should be given intramuscularly stat

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