Unilateral Red eye

Jasmine. R Abdulrahman

Contents

▪ Clinical Presentation

▪ Patient History

▪ Entrance Testing And Refractive Status

▪ Anterior Segment Evaluation

▪ Ddx

▪ Assessment And Plan

▪ Discussion

Clinical Presentation

▪ HPI : Sunday afternoon▪ A 22 y.o Palestinian Male c/o a constant red irritated eye OD x 8d

▪ Discharge? YES

▪ Tearing? YES

▪ Pain? YES (6/10)

▪ FB sensation? itching? YES

▪ Blurry? YES

▪ Lid swelling? YES

▪ Spec, Surg, Trauma, DIPL, HA? NO

▪ Fever? Cold? NO▪ All family members get red eye and use expired eye drops bottle ▪ All of them use the same bottle !

▪ Light Sensitivity? burning? NO

Patient History

PMH:o unremarkable

Medications:o Dexefrino Collihist

FMH:o HTNo Cancer (lung,

leukemia)

POH:o unremarkable

FOH:o Unremarkable

Allergies:o Antibiotic ( can't

specify)

Entrance Testing

▪VAsc: ▪ 20/40-1

OD, OS P.H: 20/20-2 OD,OS

▪Pupils: ▪ 5mm/4mm ERRL (-)APD

▪EOM:▪ S&F OD,OS

▪Confrontations: ▪ FTFC OD, OS

▪ (-) Preauricular Nodes

Refractive status

▪K’s▪OD: 45.00/46.50 @090▪OS: 44.50/44.00 @060

▪AR▪OD: -2.75 -0.75 × 175▪OS: -1.50 -1.00 × 060

Anterior Segment Evaluation

▪ Tentions [A] : OD 18 mmHg @ 1:50 pm

OS 20 mmHg @ 1:50 pm

Anterior Segment Evaluation

Anterior Segment Evaluation

Right eye Left eye

Slit lamp evaluation

Right eye Left eye

▪ Tr-1MGD, G1+ lid swelling and erythemiaL/L tr-1 MGD.tr-lash debris

▪ G3+ diffuse conj. Injection, 1+ SN SCH conj quiet

▪ 1-2+ scattered SPK’s, G1 tear film debris Epith tr-1 tear film debris

▪ Clear Stroma clear

▪ Clear Endith clear

▪ Deep and Quiet 4X4 AC Deep and quiet 4X4

▪ Flat and brown Iris Flat and brown

▪ Clear Lens clear

Differential diagnosis

▪ Nasolacrimal duct obstruction

▪ Pharyngoconjunctival fever

▪ Nongranulomatous anterior uveitis

▪ HSV keratoconjunctivitis

▪ VZV keratoconjunctivitis

▪ Ocular chlamydial infections

▪ Vernal keratoconjunctivitis

▪ Blepharoconjunctivitis

▪ Contact lens keratoconjunctivitis

▪ Foreign body

▪ Epithelial keratitis

Assessment and Plan

Assessment

1. Severe viral keratoconjuctivitis OD ( EKC)

▪ Severe oedematous eyelids▪ Severe conj. Injection with SN

SCH

Plan

1. D/C dexefrin and collihist▪ Rx: oflox ophthalmic solution QID

OD▪ Pt education on contagious

condition▪ Recommemd pt to change

pillowcases, bed sheaths, towels.▪ RTC in 1 day for status check

After one day

▪ Pt. use oflox with excellent compliance as we advised him

▪ There is no improvement on the S&S’s!!

▪ We decide to CMP with using refresh artificial tears QID ou

▪ RTC in 1 week for status check

▪ He bring his brother (10 y.o)

▪ The same S&S but both eyes affected.

▪ We removed a pseudomembrane from the left eye.

▪ His cornea was affected with multiple infiltrates

▪ We prescribed dexacol for him

Viral Conjunctivitis 

▪ Epidemic keratoconjunctivitis (EKC) is a viral conjunctivitis caused by a group of adenoviruses.

▪ It is one of the most common causes of acute conjunctivitis.

▪ with characteristic clinical features ▪ sudden onset of acute follicular conjunctivitis▪ watery discharge▪ Hyperemia▪ Chemosis▪ and ipsilateral preauricular lymphadenopathy. 

symptoms

▪Itchy eyes

▪Tearing

▪Redness

▪Discharge

▪Light sensitivity (with corneal involvement)

Signs

▪Swelling and erythema of the lid

▪Conjunctival hyperemia

▪Chemosis

▪Follicular reaction, mainly in the lower palpebral conjunctiva (the earliest and most common sign)

▪Subconjunctival and petechial hemorrhage

Work Up

Diagnosis

clinical features

AdenoPlus test Lab tests

AdenoPlus test

Video

Work Up

Supportive management

Cold compresses

Topical corticoster

oids

Cycloplegic agents for

severe photophobi

a

Topical agents that

have antiviral activity

Artificial tears

Etiology

Eti

olog

yclosed institutions

19 documented serotypes cause epidemic keratoconjunctivitis (EKC)

Direct contact with eye secretions

air droplets 

swimming pools

Patient education

PPt

Referrence

▪ Medscape drug, disease &procedures. Epidemic Keratoconjunctivitis. Retrieved from http://emedicine.medscape.com/article/1192751-overview#aw2aab6b2b3aa.

▪ http://www.youtube.com/watch?v=ozaumqs-NOs

▪ Medscape drug, disease &procedures. Viral conjunctivitis. Retrieved by 12 April from http://emedicine.medscape.com/article/1191370-workup

▪ Meyer-Rüsenberg B. Epidemic Keratoconjunctivitis—the current situation and recommendations for prevention and treatment. Dtsch Arztebl Int 2011; 108(27): 475–80. DOI: 10.3238/arztebl.2011.0475

▪ Mark Wood. Conjunctivitis: Diagnosis and Management. Community Eye Health. 1999; 12(30): 19–20.

▪ Darougar, M. P. Quinlan, J. A. Gibson, and barrie R. Jones. Epidemic keratoconjunctivitis and chronic papillary Conjunctivitis in london due to adenovirus type 19. British journal of ophthalmology, 1977, 61, 76-85

▪ Carlos Pantoja Melendez. Et.al. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents. Molecular Vision 2009; 15:557-562

▪ Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers PM, Gesser C: Epidemic Keratoconjunctivitis—the current situation and recommendations for prevention and treatment. Dtsch Arztebl Int 2011; 108(27): 475–80. DOI: 10.3238/arztebl.2011.0475

▪ Carlos Pantoja Melendez. Et.al. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents. Molecular Vision 2009; 15:557-562

Thank you