Lecture causes red eyes

2021-02-02 12:00 AM

Treat according to the cause, if possible, it is recommended to do fresh microscopy, direct microscopy, bacterial culture and antibiotic.

Outline

Red eyes are one of the reasons why patients come to see a doctor. Red eyes are caused by the vascular system, and there will be different manifestations of erectile dysfunction depending on the cause of the red-eye. There are two types of reunion:

Superficial erection (conjunctivitis): Due to the superficial vascular system of the erectile conjunctiva, bright red, when applied adrenaline 0.1% vessels will shrink and the conjunctiva will white.

Deep erection (corneal fringe convergence): Due to deep vascular system convergence (anterior ciliary artery) should be represented by a ring of convergence around the corneal margin, dark red and fading toward the same map.

Diagnose

Circumstances of illness

The illness can come on suddenly or slowly. If the cause is due to trauma, it is necessary to find foreign bodies. Pay attention to epidemiological factors (in the family or in the community, there are outbreaks of red-eye pain, ...). It is important to ask about the history of the eye and systemic disease.

Double-eye exam and comparison

Examination in order of each eye. Flip the eyelashes, locate the redness, apply fluorescein to check for corneal ulcers Pay attention to the coordinated signs: Watery eyes, photophobia, eye twitching - think keratitis. Sticky eyelashes, a lot of use when waking up - think of conjunctivitis.

Depending on the redness and edema, three types of red eyes are distinguished

Eye redness with conjunctival erection

Acute conjunctivitis

Causes of infection by bacteria (staphylococci, streptococci, pneumococcal, gonorrhea, ...), viruses (herpes, adenoviruses), chlamydia, ...

Subjective symptoms usually start with sandy eyes, watery eyes, dryness, burning, and sensitivity to light. Objective symptoms: a lot of eyes make two lids stick together when waking up (if the eyes are dirty yellow like pus - usually caused by bacteria; if the eyes are used and sticky - usually viral). Vision usually does not decrease or decrease very little. Swollen lashes, erectile conjunctiva, sometimes edema. There may be hemorrhage under the conjunctiva, granules on the conjunctiva, papillae on the cartilage or eyeball conjunctiva, granulomas, membranes, or pseudomembrane on the conjunctiva depending on the cause. The eyeball usually doesn't hurt. However, in some forms there may be keratitis accompanying, or in some cases due to improper or untimely treatment, there may be corneal ulcers and loss of vision.

Treat according to the cause (if possible, it is recommended to do fresh microscopy, direct microscopy, bacterial culture, and an antibiotic): If mild inflammation: chloramphenicol 0.4%, desomedin 0.1%. If inflammation is severe: need to use broad-spectrum antibiotics (cebemycin, norfloxacin, ofloxacin, ...).

Hemorrhage under the conjunctiva

Is a common, not serious condition. The cause can be spontaneous, possibly after whooping cough, it can be some systemic illness (high blood pressure, diabetes, blood clotting disorders), possibly trauma (then seek eye wound or foreign object covered by hemorrhage).

Subjective symptoms: stinging, red eyes. Objective symptoms: purulent or focal hemorrhage. Treatment: depending on the cause, strengthen the vascular wall.

Red eyes caused by radiation

The reason is the arc light (welder).

Subjective symptoms: severe eye pain, watery eyes, photophobia. Objective symptoms: swelling of two lids, conjunctival erectile, may have hemorrhage of the eyelids and eyeballs (if repeated repeatedly, it will damage the cornea). Need emergency treatment with dicaine 1% 2-3 times, then issue eye application vitamin A. Especially need prevention by propagating labor protection rules for welder workers.

Conjunctivitis with blisters (blisters)

Localized conjunctivitis, the cause is unknown but can also be caused by an allergy to tuberculosis. There are two clinical forms: blister conjunctivitis (focal inflammation on the conjunctiva) and conjunctivitis with blisters (inflammatory foci located at the edge of the cornea).

Mechanical symptoms: pain, photophobia, watery eyes, unabated or slightly decreased vision (symptoms of muscle function are clearly manifested in the form of keratitis with blisters). Physical symptoms: On the conjunctiva or corneal margins emerges one or more pale yellow inflammatory nodules, the surrounding conjunctiva converges and has many blood vessels entering. These are specific inflammatory nodules (taking the substance in the inflammatory foci and taking the cytology test will find many lymphocytes, polymorphonuclear leukocytes, giant cells, but no tuberculosis bacteria).

Treatment: according to the cause; In place, antibiotics can be combined with anti-inflammatory corticoids.

Pterygium

As fibrous hyperplasia of the conjunctiva of the eyeball in the fissure region, the apical triangle toward the center of the cornea and the base towards the isotope (if the dream is the inner corner) or towards the same outer map (it is the outer corner dream). The cause is not clear; There are many theories (micro-trauma theory, ultraviolet theory, recently there are studies on the role of the P53 gene in dream development). Favorable factors: humid, sunny, windy, dusty, ...

Figure: Pterygium inner angle degree 3

Subjective symptoms: stuttering, entanglement, decreased vision if dreaming develops in the cornea center. Objective symptoms: the dream consists of three parts: the dream head (which is the part of the dream that crawls into the cornea), the dream body (the main part of the dream has a triangular shape), and the dream neck (between the dream body and the dream head. classification of dream According to Cornand (1989), the dream is divided into 3 degrees: the I- the dream is 1-2mm beyond the corneal margin, the dream head is raised, the dream body is not thick, there are several blood vessels facing the cornea; degree II- the dream head encroaches on the cornea 2-4mm, the dream is active, the dream body is thick, many blood vessels, Fuchs Island can be seen (the infiltrated foci before the dream head); level III- invasive dream head cornea is more than 4mm, dream progresses strongly, the dream body is thick, the blood vessels converge, eyesight is much reduced According to the classification of the Central Eye Hospital: the dream is divided into 4 degrees; level 1 of the dream develops through the edge of the cornea 1mm membrane; degree 2 - the dream head has not yet reached the radius of the cornea; degree 3 - the dream head grows beyond half the radius of the cornea; degree 4 - when the dream head develops to the cornea center. Treatment: for dream 1 - keep clean, apply for medicine. For dream 2 and above - tenonectomy, however, attention should be paid to the possibility of recurrence. In recent years, ophthalmologists have been applying the self-induced apical conjunctive to my with mitomycin C when needed, significantly reducing the recurrence rate.

Spring conjunctivitis

The cause is an allergy to the weather, which usually develops according to the season (spring-summer). The disease develops in men more than women and mainly in teenagers. The disease develops into puberty and resolves on its own, but there are also cases that develop in the elderly.

 Subjective symptoms: pruritus (usually appearing in bouts in the morning or evening), possibly stinging, burning, photophobia, and sticky and sticky secretion. Objective symptoms: During exacerbations, the erectile conjunctiva, the corneal margin may be thickened and swollen. Typical polygonal-shaped papillae development on cartilage conjunctiva. There may be superficial dot keratitis, corneal ulcer.

Figure: Papillae in spring conjunctivitis

Treatment: symptomatic treatment is mainly (antihistamine treatment, stabilizing mast cells). During exacerbations, it is possible to combine antiallergic drugs and corticoid administration (caution should be exercised when using corticoids: prolonged use should not be used to avoid complications of glaucoma, cataract). If the papillae on the conjunctiva are large and abundant, b- rays can be applied with a total dose of 3 -5 minutes.

Red eyes with deep erection (corneal fringe convergence)

Inflammation and ulcers of the cornea

Causes: bacteria (gram + cocci or gram- bacillus, fungus (Aspergillus, Fusarium), virus (Herpes).

Subjective symptoms: Dizziness, dizziness, photophobia, watery eyes, eye and headache pain, blurred vision.

Objective symptoms: swelling of the eyelids, conjunctival erection, and marginal erection, decreased vision. The cornea is cloudy due to inflammatory cell infiltrates, the surface is shiny and rough. If the epithelium is not damaged: fluorescein (-) staining; if there are superficial or ulcerative epithelial lesions: fluorescein (+) staining. There may be a precursor pus, iris-lash reaction, possibly corneal perforation during strong necrotic ulcers. The following morphologies are possible: superficial keratitis (epithelial injury only), deep keratitis (damage from the parenchyma inward), corneal ulceration (loss of corneal matter).

In the form of corneal ulcers:

If the cause is viral: Usually caused by the herpes virus. Early-stage appears lesions in the form of dots, fibers or stars, they can be ulcerated (ulcer with a branch or map), the corneal sensation is reduced or lost, or relapse. When the disease is cured, usually on the surface of the cornea still remains a tree-shaped shady (traces of old ulcers) and will disappear gradually.

Figure: Ulcerative cornea tree branches

If the cause is caused by bacteria: the ulcer has a rough margin, dirty necrosis. Especially if the cause is caused by the green pus bacillus, the disease usually progresses very quickly, characterized by a dirty, yellowish-white purulent secretion, a diffuse corneal infiltration of inflammatory cells with a central ulcer, and a ring abscess. at the circumference of the ulcer by an inner corneal ring. The disease progresses rapidly, possibly complete necrosis and corneal perforation after 48 hours. If the cause is staphylococcal or streptococci: typical morphology is an ulcer or one round or yellow-white oval abscess with an infiltrate density of dense inflammatory cells in the parenchyma, the cornea around the ulcer is usually clear.

If the cause is fungal: the ulcer is round or oval in shape, gray-white or yellowish, with a clear boundary. The ulcer is usually thick, high, and has a dry, scaly surface. In other cases, ulcers have an unclear margin, surrounded by infiltrated foci, such as cotton, linked together in the parenchyma. The disease can also begin with superficial corneal ulcers, underneath are dense abscesses that can occupy all of the corneal thickness and develop into the anterior chamber. Anterior chamber pus may be present and abnormally increased or decreased.

For a definitive diagnosis, in addition to clinical symptoms, it is necessary to rely on subclinical tests: fresh microscopy, direct examination of corneal ulcer secretions, and culture of bacteria or fungi. For ulcerative keratoconjunctivitis due to virus: take lice to curl the ulcer margin and do cytology test (typical result: multicellular cells with peri particular chromatin condensation, Lipschutz inclusions, degenerative cells personalization).

Treatment principles: Whatever the cause, it is treated according to three general principles: specific anti-inflammatory (antibiotic) and nonspecific (but absolutely contraindicated to use corticoid in all forms of ulcers. corneal); anti-stick (1-4% atropine, if the pupil is not dilated, the combination of atropine 1% and adrenalin 0.1% injected under the conjunctiva 4 points close to the edge); corneal epithelial regeneration nutrition (vitamins A, B2, C). If there are complications of corneal perforation: a corneal transplant can be treated. If the ulcer is persistent, long-lasting: corneal removal and amniocentesis can be removed.

Figure: Corneal abscess

Iritis-eyelid inflammation

Causes: Due to bacteria, fungi, viruses (can be from the outside, from the neighborhood to the bloodline, from the inside out), the autoimmune factor.

Subjective symptoms: Eye pain, pain spreading to the eye socket. Lash (+). Fear of light, watery eyes, blurred vision.

Objective symptoms: Reduced vision in one eye or both. The eye pressure may increase due to inflammatory cells blocking or sticking in the anterior corner or attaching the iris to the front of the lens. Eye pressure can drop due to atrophy of the eyelids. The cornea can be cloudy, have Descemet membrane edema and folds, precipitate the posterior surface of the cornea (precipitation can be scattered all over the back of the cornea, but usually deposited in the center and lower part of the cornea forming a triangle with a top The precipitate can also be arranged in a star shape or rhomboid shape or sometimes as tiny dots or speckled like sheep fat). Room charge: hydrostatic (Tyndall +), anterior room pus may be present. Swelling of the iris, loss of shade, loss of porosity. The pupil shrinks have lazy reflexes or lose its reflection to light, the pupil has exudate and iris pigment when the pupil is unevenly dilated when the pupil has applied atropine and has a star fruit shape.

It is necessary to distinguish between iritis - glaucoma with acute angle-closure glaucoma: in iritis - glaucoma on the back of the cornea is a gray-white, copper inflammatory precipitate. shrinking uterus. In acute angle-closure glaucoma, corneal deposition is the iris pigment, dilated pupils.

Treatment principles: specific and nonspecific anti-inflammatory (antibiotic, anti-inflammatory); anti-adhesion (atropine 1-4%, if the pupil is not dilated, the combination of atropin1% and adrenalin 0.1% is injected under the conjunctiva at 4 points close to the edge); pain relief, sedation, and physical enhancement.

Acute angle-closure glaucoma (see glaucoma pathology section). Click here

Redness due to certain diseases in the vicinity of the eyeball

Tear gland inflammation

Swollen upper lids, the outer corner feels enlarged tear glands due to swelling. The eyeball is pushed inwards, downwards, and protruding first, and limited movement of the eyeball out and up.

Body as a whole: high fever, pre-ear lymphadenopathy, poor appetite.

Treatment principles: anti-inflammatory, anti-edema, analgesic, sedative.

Scoliosis

Acute inflammation of the glands of the eyelash and follicles. The cause is usually staphylococcus. The disease begins with swelling of the eyelashes, with a painful point. The pain then localizes and forms pus. Treatment: when pus has not formed yet: hot compresses, use short-wave electric power, ... When pus has formed: inject the pus (absolutely do not prick it early).

Tenon bursitis

It starts with aching eyes, especially at glance. Normal vision at first. Swollen eyelids, erectile conjunctiva, and edema. The eyeballs are light convex and straight, limiting the eyeballs. There may be binocular double vision.

Scleritis, sclera

In general, osteomyelitis and sclera are often accompanied by damage to some tissues in the eyeballs, causing sclera-keratitis, uveitis. The disease develops in the following forms:

Diffuse scleritis and granulomatous hyperplasia: The disease is related to increased induction of bacteria (especially with tuberculosis bacteria), with fungi, viruses, ... corticoid therapy, but if it recurs many times, then need a combination desensitization treatment.

Scleritis with necrotic nodules: Difficult to find the cause, but found that the disease is related to the cause of rheumatism, Wegener's granulomatosis, polyclinic, lupus erythematosus, ... The disease starts with high nodules on the sclera, surrounding erection, pain pressures. These are foci of the purulent or necrotic abscesses. The disease can last for several weeks, the sclera will thin out and maybe necrotic. Topical corticoid treatment is ineffective, requires a combination of systemic treatment and additional non-steroidal anti-inflammatory drugs.

Inflammation of the eye socket

The cause is usually nearby inflammatory foci (acne, stingy eyelashes that were injected early), the infection comes in the bloodstream.

Symptoms: severe eye pain, pain spreading to the head. Eyesight is greatly reduced due to inflammation spreading to the optic nerve. Red, swollen lashes. Strong edema of the conjunctiva, protruding through the eyelid. The eyeballs are straight convex, paralysis of the eye. Loss of corneal sensation. Fundoscopy reveals optic disc edema. Body as a whole: high fever, fatigue, swollen pre-ear lymph nodes, blood count with an increased number of leukocytes (increased rate of neutrophils).

Treat actively and promptly with anti-inflammatory, reduce edema (local and systemic), relieve pain, improve physical condition.

Purulent inflammation of the entire eyeball

Symptoms: severe eye and head pain, constant pain, irritation, complete vision loss. Redness and intense swelling of the lashes. The conjunctival of the eyeball is congested and the edema is strong, protruding through the eyelid. There may be conjunctival perforation and purulent discharge. The eyeballs are radically convex, heavily convex, paralysis of the eye. The cornea is cloudy, there may be pus in the anterior chamber, and the intraocular and pus may drain out if the cornea is punctured. Body as a whole: the patient has a high fever, loss of appetite, insomnia. The anterior ear canal is swollen and painful.

Treatment: Ineffective medical treatment, often removing the eyeball.

Thrombophlebitis inflammation

Causes: due to infection (nearby inflammatory foci, acne, early sting), the infection comes in the bloodstream.

Symptom:

Body as a whole: high fever, severe headache, sometimes lethargy, and signs of meningitis. When critical, you can cool down.

In eyes: decreased or lost vision. Eye pressure increases due to circulatory stasis. Swollen, widespread lashes. The veins around the eyelids are prominent, enlarged, bent, and tender. Conjunctivitis, oedema. Loss of corneal sensation. The eyeballs were pushed out to a straight convex axis, completely paralyzing the eye. Fundoscopy reveals disc stasis.

The prognosis is very heavy. Meningitis, septicemia, lethargy, and death may occur. If it resolves, vision will be affected, possibly completely blindness due to nerve atrophy.

Treatment should be aggressive and timely, systemic and local coordination (specific and nonspecific anti-inflammatory, edema reduction, pain relief, sedation, physical enhancement).

The disease can be prevented by propaganda explaining to people the need to maintain general hygiene and personal hygiene. When there are pimples in the face of inflammatory foci of the whole body, medical facilities should be examined and treated.