Red Eye 2

Question 1

Degenerative Changes in Conjunctiva”

Answer 1

Pinguecula”

Question 2

Pinguecula”

Answer 2

! An overgrowth of vascular conjunctiva onto
the cornea associated with destruction of the
superficial layers of the nasal cornea”
! May encroach upon the visual axis or cause
astigmatism “
! No treatment is needed. Lubrication with
artifical tears and occasional mild steroid
drops”
! Cause is unknown, but chronic sunlight
exposure and eye irritation may contribute”
! Welding is a significant occupational risk

Question 3

Pterygium”

Answer 3

•  Non-cancerous growth of the conjunctiva overlying
the sclera”
•  Primary symptom is a painless area of elevated white
tissue with blood vessels on the inner or outer edge
of the cornea”
•  Treatment – none unless the pterygium begins to
block vision –then Sx removal; wear uva & uvb
blocking sun glasses, wide brim hat”
•  Due to collagen degeneration of the subconjunctiva
resulting from exposure! –  Sunlight and wind!
–  Risk factors are exposure to sunny, dusty, sandy, or
windy areas, i.e., farmers, fisherman, people living near
the equator!
–  Rare in children

Question 4

Sudden painful monocular loss of vision -

DDx

Answer 4

Acute (angle closure) glaucoma"
" Acute anterior uveitis (iritis)"
" Endophthalmitis"
" Temporal arteritis"
" Optic neuritis"
" Keratitis (corneal inflammation)

Question 5

Red Eye, pain, maybe change in Va”

Answer 5

Glaucoma”

Question 6

Glaucoma”

Answer 6

Atrophy of retinal ganglion cell layer in presence of increased
intraocular pressure”
–  Increased IOP has not been defined as causative”
–  Risk factors”
•  Fam Hx glaucoma”
•  Increasing age”
•  DM”
•  Obesity”
•  Hx of Ocular trauma”
–  Leading cause of blindness among African Americans

•  Primary open-angle glaucoma”
–  Mc glaucoma”
–  Occurs in 15% of over 80 crowd”
– Anterior Chamber (AC) anatomy appears normal, but
aqueous outflow is reduced”
– Progressive visual field loss begins peripherally and
occurs so slowly Pt may not be aware of it until late in
progress of disease”
–  Intraocular tension is an effective screen

Question 7

Glaucoma—Pathophysiology”

Answer 7

•  Chronic (Wide-angle) Glaucoma”
–  Common and degenerative in the elderly”
–  Obstruction of canal of Schlemm “ diminished
outflow of aqueous humor”
–  Intraocular pressure increases slowly and
asymptomatically”
–  Increased pressure compresses blood flow to retina =
ischemia and damage to retinal cells”
•  As pressure increases, more of the retina and optic disc are
damaged”
–  Damage is irreversible, eventual blindness”

Question 8

Types of Glaucoma

Answer 8

•  Congenital"
•  Secondary"
•  Juvenile"
•  Chronic open angle"
•  Acute closed angle"
•  Many different

 types"

Question 9

Acute glaucoma!

Answer 9

•  Emergency"
•  Can be more gradual"
•  Red eye"
•  Achy, abdominal pain"
•  Misty vision"
•  Go from light into dark"
•  Small eye, shallow anterior chamber, 
pupil mid dilated, "
•  Iris/lens contact"
•  Push the iris forward"
•  Eye feels hard"

Question 10

Acute closed angle glaucoma”

Answer 10

•  Often starts in the evening. Especially in
those over 50 years.
•  Severe pain first. Impaired vision and
haloes around lights. May have history of
past episodes relieved by going to sleep
(the pupil constricts during sleep).
•  Refer even if attack spontaneously
resolves.

Question 11

Acute Angle Closure Glaucoma (AACG) “

- Diagnosis

Answer 11

History - acute onset, higher risk in farsighted

Symptoms - pain, halos (around lights), visual loss (usually peripheral), nausea/vomiting

signs - conjunctival injection, corneal edema, mid-dilated/fixed pupil, increased IOP (normal: 10-20 mmHg)

Question 12

Glaucoma”

Answer 12

•  Angle-closure glaucoma”
–  Ophthalmic emergency”
– Pt presents with red painful eye”
•  Nausea and vomitting are common”
•  Pupil is usually fixed in a mid-dilated position, and cornea
appears cloudy d/t pressure driven edema”
•  The iris is bowed forward by posterior accumulation of
aqueous humor, sealing off the anterior chamber angle”
–  Presence of crescent shadow”
•  Risk factor: “”
–  Narrowed anterior chamber angle”