Transcript COMMON PROBLEMS IN PHC

Presented by:
Awatif K. Al-Mutairi
Hind K. Bin-Drees
Sarah N. Al-Gubaisi
Supervised by:
Dr. Al-Johara Al- Quaiz
Red Eye
Iron deficiencyAnaemia
acne
RED EYE
Outlines:
• What is red eye?
• Red eye in PHC.
• DDx.
• How to deal with pt. with red eye?
A 14-year-old boy. Complains of itching eyes for
three years with sticky clear discharge. VA 6/6 .
Six-year-old male. Painful eye for ten days. Had
malaria one month ago. Corneal sensation
reduced when tested. VA 6/60 .
25 year-old woman. No pain or discharge.
Complained of red eye since this morning. VA
6/6 .
19 -year-old male. Complains of gritty foreign
body sensation, painful eye for three days with
sticky yellowish discharge. VA 6/9 .
Back ground
Cardinal sign of ocular inflammation.
Most cases can managed effectively by the
PC provider.
Account ≈ 2% of GP consultation (at least
1 case/week).
In KSA, trachoma prevalence was 22.2% in
1984, while in 1994, it was 10.7%.
Conjunctivitis in KSA is very common but
least researched.
Pathophysiology
Due to dilatation of BVs in the eye.
 BV either ciliary OR conj. Injection
Ant. cil. a.
(cornea,iris,
cili.body)
superficial a.
↑↑redness
↔ ê topical VC
DDx
Blepharitis
either staphylococcal or seborreic,
FB sensation, burning,
matting of the lashes,
Worse in the morning.
Cellulitis
Preseptal:
tender, swollen, red lid,,,
??? insect bites, minor trauma, and
sinus disease.
Orbital: tender, swollen, and red eyelid.
Dacrocystitis
Pain, redness, and swelling over
lacrimal sac
Tearing and discharge from the sac.
The vision is unchanged
Antibiotics, if not improve >>> refer
Conjunctivitis
Viral:
– Watery discharge, redness,
discomfort , photophobia.
– Bilateral
– lymphoid follicles
– Enlarged tender preauricular
nodes.
Conjunctivitis (Cont.)
Bacterial:
– acute redness(pink eye),
grittiness, burning
– mucupurulent discharge
– crusted eyelids on waking
Conjunctivitis (Cont.)
Chlamydia (trachoma):
– red, mildly irritated eye, mucopurulent
discharge.
– lids stuck together on awakening.
– Unilateral, preauricular node, papillae
Conjunctivitis (Cont.)
• allergic rhinoconjunc.:
– red , itchy, watery eyes,
– sneezing , watery nasal discharge
Conjunctivitis (Cont.)
• Vernal keratoconjunctivitis
– itching, lacrimation, burning , FB
sensation, photophobia.
– Hx of atopy,
– Giant Papillae, Tranta's Dots.
Keratoconj. Sicca
sandy sensation, dryness, burning
peak in the afternoon
Rx: eye lubricants
Corneal abrasion/ulcer
Pain (a.m), ↓ ↓ VA, photophopia
FB, bacterial,
 fungal(contact lenses),
herpis(dendritic keratitis)
Scleritis
globe is tender, sclera swollen, ↓ ↓ VA
Deep scleral injection
If sever, deep violet discoloration
Iritis + Uveitis
Pain, perilimbal flush, ↓ ↓ VA,
photophopia, small pupil.
minor trauma, chronic inflammatory
conditions UC.
???
acute glaucoma, cataract.
Acute angle closure glaucoma
red, hard eye,
mid dilated pupil,
cloudy cornea
unilateral
Medication
salt solution, alcohol, ground cowries,
human sputum, bird and lizard faeces,
urine, …etc.)

corneal ulcers ,scars or eye
perforations
How to approach the patient
At first: is this emergency case?
Neonates should always be referred
to an ophthalmologist.
Management
Rule out serious
ophthalmic conditions
YES
NO
Blepharitis
Hordeolum
cellulitis
Conjunctivitis
Refer
URGENTLY
corneal
abrasion
Management (cont.)
Blepharitis
Lid hygiene
Abcs
(fusidic acid
Tetracycli)
Hordeolum
HOT
COMPRESS
NO Abcs
(??stye)
cellulites
periorb.
Abcs
Orbital
refer
Conjunctivitis
corneal
abrasion
Superficial
deep
LA
Abcs
Erythrom
refer
NSAID
Management (cont.)
Conjunctivit
is
Watery
discharge
Preauric.LN
(Viral conj.)
Adeno.
Cold comp.
Herpis
<refer >
Severe
itching
(allergic)
Cold comp.
Antihist.
Mucopurul.
stick lid
(a.m)
(bact. Conj.)
Preaur.LN.
hx sex.
Contact
(chlamydia)
lid vesicle
(HSV, HZ)
Abcs
(Fucithalmic)
1wk.
REFER
Not improve
A 14-year-old boy. Complains of itching eyes for
three years with sticky clear discharge. VA 6/6.
Six-year-old male. Painful eye for ten days. Had
malaria one month ago. Corneal sensation
reduced when tested. VA 6/60 .
25 year-old woman. No pain or discharge.
Complained of red eye since this morning. VA
6/6 .
19 -year-old male. Complains of gritty foreign
body sensation, painful eye for three days with
sticky yellowish discharge. VA 6/9 .
conclusion
Refrences
• Farina A.2005.red eye evaluation.e-medicine.
• Yorston d., Zondervan m.2005. Red eye: the role of primary
care.community Eye Health Journal Vol 18 No.53 2005 p78
• Allan V. Diagnosis and Treatment of Red Eye.Primary Care Case
Reviews: Volume 4(1) March 2001 pp 23-31
• Leibowitz H. The red eye. N Engl J Med. 2000. 3;343(5):345-51.
• Jacobs DH. Evaluation of the Red Eye. UpToDate 2003.
• Tabbara KF, al-Omar OM. Trachoma in Saudi Arabia.
Ophthalmic Epidemiol. 1997 Sep;4(3):127-40
• www.sunmed.org/redeye/htm
• http://www.eyeweb.org/the_red_eye.htm