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Acute Red Eye - Master the Differential Diagnoses with Mind Map — Transcript

by Pranesh Balasubramaniam · 7,078 words · 1,128 segments · language en · Watch on YouTube

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0:00Hello friends and welcome to the
0:02tradition of King's cross and today we
0:04will discuss a very important topic that
0:06is acute red eye
0:08I'm going to take this topic via a mind
0:10map which you can download for free from
0:12the description box below it's going to
0:14be a PDF so please download that PDF
0:16onto your phones or onto your tablets
0:18and have them handy as I am taking this
0:21mind map topic Branch by Branch or step
0:24by step so by the end of this class you
0:26should be able to diagnose a patient
0:28with acute red eye and you should be
0:30able to give them the appropriate
0:32referrals or treatment accordingly
0:34now this is not a standalone lecture on
0:38all the conditions causing the acute red
0:39eye but rather I am going to give you
0:41simple important tips and tricks to pick
0:44up these conditions in your daily
0:46practice and make sure that you give
0:48them the right treatment and refer them
0:50appropriately
0:51so without any further delay let's jump
0:54into our mind map Based Teaching as you
0:57can see here this is going to be the
1:00Mind map which you will be
1:01having or reading through on your phone
1:03or on your laptop no matter what it is
1:05now this is going to be a huge mind map
1:07a mind map which has not just a text but
1:11also images incorporated into them all
1:13right so it makes much more easier much
1:15more illustrative and far more effective
1:17in Remembering these Concepts okay now
1:22you can download this PDF from the link
1:25given in the description box below on
1:27this video now if you're going to have
1:29this mind map with you can access this
1:31lecture what you're watching right now
1:33by clicking on this link it goes to the
1:35lecture this lecture this has lots of
1:37branches you can see there are lots of
1:39aspects in this in the speed if I'm just
1:41going to condense everything together
1:43okay I'm just going to fold all the
1:45branches
1:47so now what you'll be seeing here is you
1:49just see the Bare Bones a bad skeleton
1:51I'm just going to expand I'm just going
1:52to go from this centrifugal approach I'm
1:54going to start from the basic start from
1:56the core of this mind map expand it
1:58further all right look at this please
2:00acute red eye is going to be an
2:03important condition which we will come
2:04across day in and day out the best way
2:07to classify this is going to be acute
2:09red eye with defectivision and without
2:11defective Vision all right
2:14I will take it one by one first we'll
2:17focus on with defectivation why this is
2:19important is because in your in your
2:21clinic if you see a patient with an
2:22acute red eye and a defectivision which
2:24means there is more important okay and
2:27it is could be possibly Vision
2:29threatening when compared to the
2:30conditions which cause acute red eye
2:32without defective vision
2:34okay what are the conditions which
2:36causes acute red eye with defectivision
2:38easily put acute keratitis acute angle
2:41closure glaucoma acute anteriorveitis
2:44and acute endophthalmitis and last but
2:47not the least the injuries namely your
2:50chemical injury and the mechanical
2:52injury so please have these in mind we
2:55will go one by one again I just want to
2:57tell you that I'm not going to explain
2:59everything in detail I'm just going to
3:01give the signs and symptoms of each so
3:03that you are getting it straight okay
3:06so acute keratitis means
3:09there is going to be an inflammation of
3:11the cornea okay acute angular glaucoma
3:14there's going to be increased
3:15interacular pressure because of the AC
3:17or the angles are getting closed thereby
3:19it is impeding the outflow of the uh the
3:22aqueous humor thereby causing a certain
3:24onset increase in IOP acute and revertis
3:27which means that it's going to be
3:28intense inflammation in the anterior
3:29chamber causing lots of problems end of
3:32thalamatis means uh inflammation of the
3:34inner coats of the eyeball it's it's
3:36much more Vision threatening than the
3:38other conditions actually
3:40an injuries you have mechanical injuries
3:41which means there can be trauma because
3:43of a blunt force or or a sharp force
3:47then we have the chemical injuries
3:49either alkaloid acid burns so if you can
3:51see there is going to be one common
3:52denominator in all these things in some
3:55way or the other either cornea is
3:57involved or you have a impact on the
4:00media clarity
4:01because of these two reasons there's
4:03going to be a defective Vision okay so
4:06coming back to the acute keratitis the
4:08symptoms and signs
4:10you have pain
4:12redness grittiness discharge this
4:15discharge is going to be very important
4:17okay glare discharge because it's mostly
4:21infection so you have this purulent
4:22discharge coming out glad because the
4:26cornea is involved so the cornea has
4:28been getting inward what happens it
4:29exposes the the corneal nerves are
4:32getting exposed to the Sun or the normal
4:34light therefore causing photophobia
4:36which is a painful sensitivity to light
4:38and obviously have defectives because
4:39corn is involved so what history will
4:41ask in these patients quickly
4:44it's important to elicit the history of
4:46contact lens wear which is very
4:47important
4:49in a developing country like India the
4:51important history to us is going to be
4:52history of trauma trauma with organic
4:55matter which causes fungal ulcers or
4:58fungal keratitis in developed countries
5:00you have to ask history of contact lens
5:03wear especially patients who have worn
5:06their contact lens and they have slept
5:07without removing them the next day
5:10morning they find themselves having an
5:11acute red eye with defective Vision
5:13watering because of the contact lens
5:15induced keratitis what it was click
5:17contact lens induced keratitis Please be
5:20aware of that all right
5:22always elicit the history of swimming
5:24while wearing contact lenses or any
5:27history of contamination of contact lens
5:28these two are very important
5:30contact lens where
5:32or contact lens induced keratitis can
5:34because of two important infectious
5:35organisms one is pseudomonas secondness
5:39is going to be a bacteria
5:42having finished the symptoms and history
5:44involved with acutecretitis let's move
5:46on to the signs involved here
5:51what are the signs the patient will have
5:53a ciliary congestion note the scenery
5:55congestion is different from a diffuse
5:57congestion what you will see in an acute
5:59conjunctivitis this is a septum corneal
6:02or a ciliary congestion which means the
6:04celery vessels are involved in
6:05congenital condition is going to be more
6:07of a diffuse condition the congenitals
6:09are going to be involved okay
6:11presence of an infiltrator accounting
6:13ulcer is going to be the sign in acute
6:15keratitis which is very obvious
6:18the more important is
6:19if you're going to see a hyperb ion that
6:22indicates a more of a deeper infection
6:24okay it's not just a superficial
6:26infection more for deeper infection so
6:28patients can present with hyperpion
6:30which is very important the patients may
6:32have an anterior chamber reaction as
6:33well and more importantly in viral
6:35keratitis
6:38infections there's going to be loss of
6:40corneal Sensations so with this basic
6:43idea about acute keratitis I'm going to
6:45go for the next differential diagnosis
6:47of a patient with acute red eye and
6:50defectivision that's going to be acute
6:51angle closure glaucoma very important
6:53very important because in keratitis you
6:56will have an obvious answer right before
6:58as you will see a corneal lesion but in
7:00acute angular glaucoma you will not see
7:02anything on the cornea you just see a
7:04corneal Haze we'll compare that in a
7:06moment now let's look at the symptoms
7:07now apart from this acute red eye
7:09presentation patient won't have severe
7:11pain and more importantly the pain which
7:13makes you sick the pain which makes the
7:15patient go crazy they kind of vomit
7:18so vomiting is an important history to
7:20be asked in a patient with acute
7:22agriculture glaucoma
7:24defective Vision because of the coronal
7:26edema corneal Haze colored haloses are
7:30very important is to be honest which is
7:31very unique to agriculture glaucoma in
7:33our in our scenario it's quite unique in
7:35a few deny patient with colored Halos
7:37think of an angle closure attack
7:39all right
7:41look at the signs what are signs you
7:42will see in this patient and in obvious
7:45increase in IOP this increase in IOP is
7:46not just a nominal it's going to be a
7:48very high increase in IOP 50 to 80 mm
7:50will be will be the you know the amount
7:52of the rise in IOP ciliary congestion
7:56like your keratitis
7:59which can even go to the stoma but it's
8:01mostly you'll see an epithelial edema in
8:03these patients so microcystic epithelial
8:05edema a shallow anterior chamber depth
8:09is very important and you should also
8:10check the other eyes as well that's
8:12that's very crucial uh very important uh
8:15point for any Resident out there so you
8:17see an anclosure glaucoma look for the
8:19other eye look for any signs of of risk
8:22factors for agriculture that more
8:24importantly smaller eyeballs or in case
8:26of high plus power or hypermetropia
8:29all right
8:31now there are three important signs
8:34which you will see in a patient who have
8:36had a previous agriculture attack which
8:38you may see in a current or or a recent
8:40uh attack as well a previous anglos
8:43attack means you have three important
8:44signs what you call so both Triad you
8:46will have a fix it semi-diluted pupil
8:49which can even have in in the current
8:51anglicosia deck as well because of
8:53sphincter ischemia is going to be this
8:55fixed semidelity pupil patches of Iris
8:57atrophy again because of iron is getting
9:00affected because of the ischemia and you
9:02can have subcapsular opacities which are
9:05secondary to this alense epithelial
9:07necrosis what you call as a glaucoma
9:09fleckin very important like I said
9:13these three are gonna form this words
9:16Triad
9:17always look for the other eye look for
9:19shallow AC shallow answer chamber depth
9:22look for smaller eyeballs or high
9:24hypermetropias plus because of
9:27C and hypermetropia the eyeball is going
9:29to become small smaller eyeballs crowded
9:31anterior Chambers more risk for angle
9:33closure
9:34what I'm going to talk now is going to
9:36be about what I was talking is about the
9:37primary angle crochet now we're going to
9:38talk about the secondary angle closure
9:40which means
9:42there's going to be a secondary course
9:43which is causing the agriculture it's
9:45going to be a most commonly will be a
9:47lens induced in mature cataracts in very
9:49thin scatter the cat is going to bulge
9:51causing an angle closure what you call
9:53as a lens induced or here in our case a
9:56facomorphic glaucoma
9:59okay very important now coming to the
10:02other important differential diagnosis
10:04for acute red eye with defectivision we
10:07have the acute anterior uveitis
10:10what are the symptoms you will ask in
10:11these patients the patients will have
10:13pain redness watching there's going to
10:16be defectivision which is plus or minus
10:17sometimes you may see patients with less
10:21defectivision as well okay but but for
10:24all practical purposes consider uvitis
10:26and acute red eye with defectivision
10:27okay Glam glare is an important symptom
10:30it's a symptom not just we saw in case
10:32of UV address but we also saw in
10:35keratitis as well so any involvement of
10:37cornea exposure of corneal nerves or an
10:40intense AC reaction Anderson reaction
10:42inflammation you can expect glare
10:46the key point about UV it is is that
10:48always illicit systemic history always
10:50look for systemic science systemic
10:52history includes history of joint takes
10:55back pains oral ulcers and he passes to
10:57your tuberculosis history of general
10:59ulcers history of any contact with with
11:01pets at home okay there's a big spectrum
11:05of History you should elicit to diagnose
11:08UV antispations systemic Association the
11:12key feature is history of recurrent
11:13episodes which you will not see in many
11:15other conditions a patient with acute
11:17red eye coming with recurrent episodes
11:19of this acute red eye think of uveitis
11:22okay
11:24science
11:25the oculars it's what are the ocular
11:27signs you would say you have to look for
11:29these things very important always look
11:31for celery congestion what are other
11:33conditions which you saw we had cereal
11:34condition you had serial condition you
11:35will see here you will see in case of
11:38your acute glaucoma you'll see in acute
11:40keratitis as well so ciliary congestion
11:42is a deeper Condition carrotic
11:44precipitates Nothing But inflammatory
11:46Aggregates uh settled on the back of
11:49cornea or on the endothelium keratic
11:51precipitates which can be of two types
11:52granular matters and non-granular
11:54matters depending upon what type of
11:56kinetic precipitates they are you can
11:58even make a diagnosis of the condition
12:00what is causing the ubiitis always
12:02assess and look for anterior chamber
12:04reaction look for cells and flat so AC
12:07cells are nothing but these small tiny
12:09dot as you can see on this picture this
12:11is called anterior chamber cells nothing
12:12but the wbcs flat is going to be this
12:15the Smoky appearance the smoke or the
12:18fog there okay it's called flare flare
12:20happens because of protein leak so in
12:22the anterior chamber always look for AC
12:24cells and fair and great them very
12:26important
12:28when you have intense reaction high
12:30amount of flair high amount of cells
12:32more of inflammation happening in the
12:33anterior chamber what happens uh the
12:35inflammatory cells are going to form a
12:37coagulant form is going to form a
12:38membrane and adhere to the pubic or as a
12:41fibrinous membrane look for them as well
12:43in a very severe or high grade
12:45inflammation
12:47sometimes inflammation will be so much
12:49that they may settle down to the
12:50anterior chamber forming a hypop ion now
12:53we saw hyperpion incarnate ulcers or
12:55keratitis as well you will also see
12:57hyperpion in uviitis also uvitis with
13:00hyperpine is going to be a very
13:02important thing to consider because very
13:04few a diagnosis are there for uvators
13:07with Hyper pain disease second is going
13:09to be HLA B27 Associated ankylosing
13:12spondylitis
13:14or zero negative Spondylitis now this is
13:17going to cause this very intense acute
13:19AC reaction which is strong enough to
13:21cause a Hyperion this hyperb ion in
13:23these two conditions are going to be
13:24sterile Hyperion they are not infective
13:26they're basically happening because of
13:28intense inflammation in bed sheets you
13:30will see this mobile Hyperion in HLA B27
13:33you will see an immobile fixed hypercoin
13:36because of fibrinous content
13:38the other signs are going to be presence
13:40of posterior cyanide which means a
13:42festooned people question pupil means
13:44like a flower like or a flower shaped
13:46pupil which you will see in these
13:47patients uh posterior cyanike means the
13:50iris goes and ideas back to the uh lens
13:53capsule forming this posterior Sinai K
13:55or additions between the iris and the
13:57lens capsule
13:59because of uvi because there's intense
14:01inflammation is going to affect the lens
14:02as well causing complicated cataracts
14:05the important thing to consider is that
14:07whenever you see a patient who's having
14:08acute anteriorate is always examine the
14:11fundus look for signs of intermediate
14:14and posterior uviated that's why it's
14:16always important to dilate the patient
14:19and examine the fundus because we might
14:21be looking at a pan uveitis involving
14:23the entire eye tanduviate this means the
14:26anterior part the intramino orbitrous
14:28part could be even with the retain as
14:29well so pannivatives don't miss out
14:31always dilatency if the media is clear
14:33else do a b scan to assess how the
14:35posterior uh media is or how the
14:39vitreous cavities
14:41all right we discussed about this
14:43important ocular Signs Now the systemic
14:46signs are again multiple like I said uh
14:48patients especially uh with HLA B27
14:51associated
14:53zero negatives squanded arthropathy they
14:55can present this intense
14:57acute entryway this so ask for history
14:59of back pain also look how they're
15:00posture is sometimes these patients can
15:02present with with the back pain or
15:04spondylosis or Spondylitis now we are
15:07finished this we have finished acute and
15:09regret it's not coming to the next
15:10differential diagnosis for acute red eye
15:13with defectivision that's going to be
15:14your acute end of thalamitis very
15:17important please pay attention to this
15:19because many doctors uh ophthalmologists
15:23surgeons they are sued because patients
15:27end up with endophthalmatis after
15:28cataract surgery
15:30because essentially enduring cataract
15:32surgery if things go wrong for example
15:33if you're going to make a complication
15:35or or not a sterile atmosphere is being
15:38maintained infections can get into the
15:40eye causing inflammation or infections
15:42because of uh involved in the inner
15:44coats of the eyeball what you call as
15:45end of thalamitis
15:48so end of that is symptoms ask the
15:51history of any recent cataract surgery
15:52not just that always ask hysterectomy
15:54intra vital injection so it's not just
15:56your cataract surgeries anything which
15:58goes into the eye can lead to infections
16:01getting into the eye leading on to end
16:02of that matters any history of ocular
16:05trauma again can cause and systemic also
16:07any history of long-standing intravenous
16:09lines intravenous injections look for
16:11any systemic sepsis
16:13pain defectivision redness will be the
16:15common complaints and there's going to
16:17be a preceding floaters because of
16:19involvement of inflammation in the
16:20vitreous cavity what he calls a vitritis
16:23inflammation of vitreous okay the
16:26science involved are going to be similar
16:28to your acute enter UK sometimes can
16:31mimic like uveitis okay so we have to be
16:33aware of that patients will have a
16:35ciliary congestion they're going to have
16:37carnal edema
16:38uh which you may not see in case of your
16:41uvitis but edema you may see con edema
16:43will be very typical stromal edema which
16:46will be very very typical in case of
16:48your acute end of thermitis kinetic
16:50precipitates which you already saw in
16:52case of your ubiodes as well hyperpion
16:54is a very important feature of acute end
16:57of thermitis okay so you see an intact
17:00cornea which means there is no Cardinal
17:02breach but you see Hyperion think of
17:04uvitis and think of end of thermitis you
17:07see hyperpion think of three keratitis
17:09uveitis end of thermometers okay
17:13in the anterior chamber you may see AC
17:15reaction or you may see vitreous in the
17:18anterior chamber why Victory is in the
17:20anterior chamber because during cataract
17:21surgery we might have breached we might
17:24have opened up the posterior capsule
17:25which leads which is coming out from the
17:27vitreous cavity all the way into the
17:28anterior chamber all right it's very
17:30important and that's why it's very
17:31important to us as the lens status of
17:33the patient patients may be pseudophysic
17:35and loss of PC positive capsule you
17:38should also look for that
17:40and please do a b scan to look forward
17:42with Traders as you can see in this
17:44picture in this base can it shows lots
17:45of this multiple small dot like
17:47hyperechoic capacities there dot ecos
17:50which means that there can be uh
17:53inflammation of the vitrus cavity what
17:54you call as vitritis
17:57sofa clear okay this is an important
18:00aspect I'm just going to I'm I'm dealing
18:02with these conditions in a much more
18:03detail way because
18:05these are all emergencies
18:07okay these are all emergencies these are
18:09all uh can be side-threatening in many
18:12ways sometimes even life threatening
18:14okay now let's speak of the injuries as
18:16far as injuries are concerned can be
18:18either because of a mechanical trauma or
18:19can because of chemical injury
18:21mechanical trauma can be either because
18:24of a of a Sharp instrument or can
18:26because of blunt instruments so you can
18:28have a sharp trauma you can have blunt
18:29trauma this is an important
18:31classification which every resident
18:33should know it's called as a Birmingham
18:34eye trauma terminology system which
18:37gives a very neat classification of how
18:39to how to classify how to differentiate
18:41this ocular injuries caused by
18:43mechanical trauma into close globe or an
18:46open Globe injury a closed Globe injury
18:47means there is no breach of the ocular
18:49Integrity or the ocular surface and open
18:51Glow means the globe is basically open
18:54the closed loop can be either a
18:56contusion or can be a lamellar a
18:58laceration whereas an open Globe will be
19:00either a laceration or a rupture a
19:03contusion and rupture are basically
19:05caused because of a blunt injury the
19:07others can be caused because of
19:08penetrating trauma last solution can
19:10again be classified into penetrating
19:12injury or Perforating injury or
19:14intraocular foreign body all right so
19:16these three are going to be very
19:18important as for acceleration is
19:19concerned now that's with the mechanical
19:21trauma
19:23so moving on to the chemical injuries
19:25which means there can be either acid or
19:26alkal injuries always note that The
19:29Alkali are more destructive and
19:31comparative acid that's important to
19:32answer you know to understand as far as
19:34signs are concerned though I have
19:36classified this chemical injuries as a
19:38part of this acute red eye with
19:39defectivision
19:41white I can also be seen in very severe
19:44burns because of the intense reaction
19:47intense Burns that can be ischemia and
19:49this ischemic can cause blanching of the
19:51congenital vessels blanching off the
19:53perilimbal vessels leading on to this
19:54suspicious white eye so this whiter
19:57indicates a severe degree indicates
19:59ischemia all right
20:01having that in mind always examine for
20:03lid burns look for any retained Alkali
20:06particles or any lime particles in the
20:08foreign
20:10look for these particles which can
20:12constantly release Alkali leading onto
20:14destruction of the ocular surface
20:17the patient can have conjunctival
20:19chemosis they can have congestion they
20:21can have conjunctival Burns scarring as
20:23well uh cornea you have Cornell edema
20:26epitheliopathy it can be very severe
20:28enough to even cause a stromal necrosis
20:29and also look for AC reactions in these
20:32patients as well
20:33so now having completed the the injuries
20:36the mechanical and the chemical injuries
20:37let's quickly go on to the next half of
20:40the topic that is acute red eye
20:42presenting with no defective vision
20:46okay so we finished with the
20:48defectivision now we're going to without
20:49defective Vision so the without
20:51effectivision
20:52there can be these conditions which can
20:55cause an acute radiant without
20:56defectation namely acute conjunctivitis
20:58allergic conjunctivitis episcleritis
21:01anterior scleritis sub congenital
21:04Hemorrhage foreign body of the
21:06conjunctive or cornea and finally the
21:07epithelial defect of cornea so please
21:10note that now all these conditions need
21:13not always present without any
21:15Refrigeration there can be an Associated
21:17blurring of vision being a part of this
21:20especially when they're going to involve
21:22the cornea where they're going to
21:24involve some part of the visual visual
21:26pathway from the cornea until the cortex
21:27can happen anywhere and they can again
21:30cause defectivision let's talk about a
21:32more important is going to be acute
21:34conjunctivitis
21:36and they're present with symptoms such
21:38as a discharge or stickiness redness
21:40irritation pain may or may not be there
21:42like I said only if corn is going to get
21:44involved in case of kerato
21:45conjunctivitis the patient can have a
21:47defective Vision a history of a
21:49generalized illness or a spread among
21:51family contagiousness because these uh
21:54acute infective conjunctivals especially
21:56viral infection can spread by sharing
21:58off common objects like fomites sharing
22:01of towels so they can have this spread
22:04in the family sexual history is very
22:06important now let's uh so let's explain
22:07a minute on this understand a patient an
22:10adult patient coming to you with acute
22:12conjunctivitis if you want to suspect
22:13chlamydia or gonococcal always ask for a
22:16sexual history because these two are
22:18going to be sexually transmitted
22:19diseases all right that's number one
22:22what is even more important is that when
22:24a mother who's affected with chlamydia
22:25or gonococcal infections she can uh
22:28transmit the infections to the baby to
22:32the neonate while while giving out the
22:34baby the infections can be transferred
22:36from the vaginal wall to the eye leading
22:39on to an infective conjunctivitis or a
22:41pure infective conjunctivitis happening
22:43in newborn less than four weeks of age
22:46what do you call it as ophthalmia
22:48neonatorium okay and chlamydia and
22:51gonorrhea are going to be too important
22:52implicating factors of ophthalmia and in
22:54a term of which chlamydia is the most
22:56common cause all right so with that in
22:59mind
23:00let's look at the signs involved the
23:03science basically uh the patients can
23:05have a pixel science which is very
23:07important to look most often we tend to
23:09miss these Excel signs especially always
23:12look for blepharitis look for this
23:14blepharoconjunctivitis especially in
23:16cases of herpes simplex viral infection
23:17the patients can have can initially
23:20present with just blepharitis and then
23:22becoming blepharoconjunctivitis
23:28discharge this disease is very important
23:31because depending upon the type of
23:32discharge you can even find what the
23:34type of infection is the research can be
23:36either of three types one is a watery
23:38discharge a mucoprillan discharge or a
23:40plural and discharge water research is
23:42what you most commonly seen adenoviral
23:44infections the most common cause of
23:46infective conjunctivitis is going to be
23:48viral and most common virus is going to
23:50be adenoviral
23:52is more commonly seen in chlamydial
23:54infections purulent is seen in the
23:57bacterial infections and more
23:59importantly the gonococcal infections
24:01this can prevent this hyper acute severe
24:03prudent in neonates what you call as
24:05ophthalmia neonatorium
24:07all right with that in mind let's go to
24:11the other signs here the diffuse
24:13condition is one thing we said that this
24:15is different from the CD recondition
24:17what you see in keratitis or uvitis this
24:19is more for diffuse conditioner so
24:21superficial condition which you most
24:22often you see in the lower palatable
24:23versus a series condition is what you
24:26will see surrounding the limbus so the
24:28other name for this circumcorninal
24:30congestion or perilimal injection are
24:31the names given for the celiary
24:33condition this is more of a diffuse
24:34condition in conjunctivitis
24:37the patient can have chemosis or
24:39conjunctival edema the patients can have
24:41follicles follicles are these grainy
24:43rice grain like particles a rice grain
24:45like lesions which are seen on the lower
24:47palpable conjunctival they're nothing
24:48but lymphoid Aggregates these lymphoid
24:51Aggregates are important because in a
24:53baby in in a neonate who's going to have
24:56a viral infection while conjunctivitis
24:58the baby will not have any follicles
25:00because there's going to be a delay
25:03development of lymphoid tissue that's
25:05why you will not see follicles in
25:06neonatal conjunctivitis it's an
25:07important thing instead they will be
25:09having papillae so papillae can be
25:12present in bacterial conjunctivitis
25:15sometimes the discharge can be severe
25:17enough to come a membrane called the
25:18pseudo membranes and conjunctiva always
25:20differentiate this from the true
25:22membrane what we see in diphtheria
25:25like I said uh presence of infection
25:27within the conjunctiva no defectivision
25:29but if the involvement is going to go to
25:31the cornea that becomes a defective
25:32Vision in case of this Arduino viral
25:35keratoconjunctivitis where you can see
25:37these multiple small white dots on the
25:38cornea they're called as a superficial
25:40punctate keratitis or sub-epithelial
25:42keratitis now these things can cause
25:44blurring or vision
25:46pre-auricular lymphadenopathy is going
25:48to be another important sign to elicit
25:50in viral conjunctivitis we have finished
25:52the acute infective conjunctivity so
25:54let's move on to a very underrated it's
25:56the allergic conjunctivitis always think
25:58of allergy conjunctivitis they may not
26:00always present in acute red eye but
26:02again a chronic redness which most often
26:04has hitching they'll have this water
26:06sticky discharge with history of allergy
26:08atop asthma or any seasonal occurrence
26:11as well as signs are concerned always
26:13look for this water mucoid or rope
26:16discharge a sticky ropey discharge that
26:18they should typically tell in the
26:20morning uh presence of papillae we saw
26:22that papillae was also found in
26:24bacterial conjunctivitis
26:26is more specific for allergy
26:29congencoitis and most often they have
26:30seen in the upper tassel conjunctiva and
26:32these papilla can become like a Big
26:33Blocks a cobblestone papillae in case of
26:37your Vernal keratoconjunctivitis very
26:40important
26:50you will see patients having these very
26:53very typical signs called as a limbal
26:55papillae hornetranta spots and viral
26:58ulcer of the cornea as well where you'll
26:59have it effectivision
27:01now these patients constantly rub their
27:03eyes because of allergy that can lead to
27:05this conical deformation of corn what
27:07you call as a keratoconus so look for
27:09signs of keratoconus which happens
27:10because of constant rubbing in patients
27:12with allergic conjunctivitis all right
27:16episcleritis is going to be one of the
27:18again important causes for acute red dye
27:21without defectivism which is quite
27:22common especially in young to middle
27:24aged females with history of recurrence
27:26so patients often present with this
27:28redness with or without pain which is
27:29frequently occurring episodic
27:31occurrences are quite characteristic of
27:33Epic scleritis signs the patient will
27:36have a sectoral condition it's not like
27:37a complete Condition it's more of like a
27:39sector only one quadrant is being
27:41involved you can have either have a
27:42nasal or the or the temporal quadrants
27:45or areas can be involved the patient may
27:47or may not have a nodule over the
27:49congestion this is where it's important
27:51to differentiate this from a pinky
27:53cooler which is in flame called
27:54inflamedicular or pinky colitis or an
27:57inflamed early terrorism so always have
27:59that in mind
28:00on the contrary anterior scleritis might
28:04look like episcleritis in some aspect
28:06but they are much more deep seated
28:08they're much more ominous much more
28:09dangerous because they can be Vision
28:11threatening they can be even
28:12life-threatening as well
28:14so enter scleritis means that you have a
28:17posterior scleritis as well but uh
28:18posterior scleritis you will not see
28:20redness and the status you will see
28:21redness the symptoms are very typical
28:24the patient will have pain the pain is
28:26going to be a very important symptom in
28:27scleritis because the pain is going to
28:29be very severe infer they'll say the
28:31scleritis patients will scream okay
28:33redness defectivision If corn is going
28:36to get involved only if it is involved
28:37if not no or it's going to be a
28:39posterous clear it this can also cause
28:40effectivision
28:42involvement the most common cause of
28:44scleritis or anterior scleritis is going
28:47to be a rheumatoid arthritis so always
28:49always look for this condition
28:51always ask history of rheumat arthritis
28:53history of any joint pain as you can see
28:55in this mind map I have given multiple
28:56Red Blocks red boxes these red boxes
28:59indicate the importance important
29:01clinical take-home messages all right
29:04now let's look at the signs as well
29:06science are concerned the patient can
29:08either have a sectoral or a complete
29:10condition in fact it is important to
29:12note that it can highly mimic like an
29:14episcleritis or sometimes the patient
29:15can have like a UV it is like you have a
29:18complete conditioner as well the key
29:20point is so that sometimes the patient
29:21can have a nodule over risk condition
29:23and this condition is quite
29:24characteristic because this congestion
29:26is not your usual condition what you
29:27will see in it is clear it is they have
29:29this vivacious Hue which means more like
29:31a wired like color you will see
29:32especially under daylight you will have
29:35a spiral edema and most importantly this
29:37congestion will not Blanche when you
29:40instill and vasoconstrictor like
29:42phenylephrine whereas an episcleritis on
29:45installation of phenylephrine there will
29:47be blanching of blood vessels very
29:49important differentiating feature
29:51between episcleritis and scleritis
29:53because the treatment totally differ
29:55all right so this nodule over condition
29:57is another important characteristic
29:59feature of of a nodular scler it is
30:01vertical so now one of the subtypes of
30:03scleritis
30:05in as as this progress what happens the
30:07serial inflammation can kind of thinned
30:09out what you call Malaysia sclero
30:12Malaysia that can lead on to this
30:14exposure this blue issue which is being
30:16shown that nothing but the uvl tissue
30:18shining through the thin sclera
30:21sometimes they can even perforate
30:22because sclero Malaysia preference is a
30:24very important complication of scleritis
30:27if you see a pus pointing over the
30:29nodule please think of scleral abscess
30:31which is most commonly seen infective
30:33scleritis okay very important history of
30:36trauma can lead on to spiral abscess or
30:38think of infective scleritis
30:40also note that like I said in earlier
30:42involvement of cornea and scleritis can
30:45cause defectation what do you call
30:46keratitis
30:48sometimes the posterior sclera can also
30:51be involved what's called what you call
30:52as a posterior scleritis in that case
30:53there's going to be inflammatory uh
30:55fluid which is getting collected in the
30:57subtenon space so on B scan you will see
30:59the so-called T sign the collection of
31:01the fluid in the subtenon space along
31:03with the optic nerve that shadow which
31:05gives like a t which is characteristic P
31:08sign what you will see in case of your
31:09posterior scleric so always do a b scan
31:12you suspect one
31:14now let's move on to sub-conjunctival
31:16Hemorrhage is a very common presentation
31:18many patients especially elderly
31:19patients they often come to subconscious
31:21or SCH is going to be have two extreme
31:24sometimes it can be very trivial trauma
31:25or the patient can have bleeding
31:27disorders or they can have very high
31:29hypertension so ask for history of
31:32trauma history of rubbing high blood
31:34pressure bleeding disorders or well
31:36Salva manure such as exertions too much
31:39of coughing too much of strain always
31:41check blood pressure in these patients
31:43who present with SCH in your clinic the
31:46science can be simple redness but you
31:49can have Associated signs of ocular
31:51trauma as well
31:54please understand this is not going to
31:55be a congestion a congestion is more of
31:57a dilatation of the blood vessels this
31:58is more like a hemorrhage breaking off
32:00blood vessel leading on to diffuse
32:01Hemorrhage so this is a confluent
32:03hemorrhage which can be either sectoral
32:05or can be complete
32:07uh the other signs of blunt trauma blunt
32:09ocular trauma which happens which can
32:11cause this SCH are going to be these uh
32:14always look for any AD in Excel science
32:15look for periodicymosis a fracture of
32:18the floor of orbit can lead on to entry
32:21of air under subcutaneous tissue called
32:23as the emphysema subcutaneous emphysema
32:25which leads to crepitus they can be
32:27involvement of the nerves causing the
32:29cheek anesthesia and because of the
32:31entrapment of the inferior rectus muscle
32:33can lead on to restriction of elevation
32:35leading on to diplopia in these patients
32:37as well so this is the signs of blowout
32:39fracture or fracture of the floor of
32:41orbit
32:43always look for any occult or hidden
32:45conjunctival tear or corneal there
32:47because with this Hemorrhage it may be
32:49very easy to miss out on any occult or
32:51hidden conjunctival or corneal tests
32:54look for hyphemas which may or may not
32:56be there pupil science patient can have
32:58a relative afferent pupillary defect if
33:00there's going to be a traumatic optic
33:02neuropathy Associated depression can
33:04have a traumatic military assets it is
33:06going to be a sphincter tear associated
33:08look for any lens dislocation or capture
33:10and look for fundus signs a fundus signs
33:12can be multiple but more importantly is
33:14that the patient can have a Berlin's
33:16edema or a commercial retain nothing but
33:18the the edema of the retina in case of a
33:21blunt trauma which is transient and all
33:23this book of presence of cherry red spot
33:24if Maca is going to get involved in this
33:26condition okay
33:28the second important sign is going to be
33:29presence of retinal dialysis where the
33:31retina is going to get detached from the
33:33aura Serato there's not a little
33:34Detachment it's a retinal dialysis
33:36there's a Detachment to auras okay
33:39which means that in any patient who
33:41comes with you with subconscious
33:42Hemorrhage when you suspect trauma
33:44history always dilate these patients and
33:46say moving on to foreign body of
33:48conjunctiva and foreign body of cornea
33:51formative conjunctive is very common
33:53again always ask history of any exposure
33:55to foreign body while driving a tooler
33:57then maybe some insect getting into the
33:59eye uh the patient can represent the
34:00grittiness or irritation there can be
34:02pain science you can see an obvious
34:04foreign body on the congenital or you
34:06may not find a conjunctable foreign body
34:09unless you ever the lead and see where
34:11you will see an upper Castle congenital
34:12foreign body
34:13now this foreign body what happens as
34:16the patient closes and opens the lid you
34:18can kind of paint the cornea leading on
34:20this patterned abrasions like a brush
34:22paint like abrasions which you will see
34:24on the cornea after fluorescent staining
34:26so you see this picture which means that
34:27there can be a hidden or a missed
34:30foreign body on the upper tassel
34:31conjunctiva this is called the ice rink
34:34sign very important
34:37foreign body of Cornell
34:40depression again can present with
34:42typical Institute of greatness pain
34:43redness watering and glare why glare
34:46because cornea is getting involved then
34:47all right so patient with history of
34:49welding exposure metallic foreign bodies
34:51as far as the foreign body on corner is
34:53concerned always always make sure that
34:55you are not missing out any secondary
34:57infection or infiltrates you're not
34:58missing out any any perforations or any
35:00kind of a possible penetrating ocular
35:02trauma or even intraocular foreign body
35:04always be aware of that
35:08finally doc we talk about the epithelial
35:10defect of the cornea epileptic again can
35:13be quite common in patients especially
35:14with history of rubbing history of
35:16contact lens where is again an important
35:18history to ask in these patients the
35:20patients can have pain redness watering
35:22or clear okay glare again why because
35:24corn is sitting involved the signs are
35:26going to be again multiple uh the
35:28patients can have congestion severely
35:29congestion they can have this epithelial
35:31defect and after staining of the cornea
35:33with fluorescently then we will detect
35:35the epithelial effect always mention the
35:37size of the epithelial defect check for
35:39foreign body on the cornea check for dry
35:42eye disease and check for any condition
35:43which can cause a recurrent corny
35:45erosions other conditions which can
35:47cause a persistent epithelial defect
35:51all right so now what you've done is you
35:53have completed the two areas we've
35:55completed the the details of acute Redi
35:57uh which can cause defectivision the
36:00other cost of acute red eye without
36:01defectivision now we have done the
36:03differential diagnosis of each in detail
36:05and let's summarize let's summarize I
36:07know it's like uh and it's like too much
36:09information for you guys right now but
36:10but please bear with me this is an
36:12important area the summary will kind of
36:14uh nail the diagnosis will will make
36:16your Concepts more concrete and easy to
36:18remember
36:20first is that an acute red eye patient
36:23can have without effectivision and with
36:25defectivision now you know what are the
36:27causes for both in detail okay secondly
36:31is going to be what are the conditions
36:33which can cause acute red dye with
36:35discharge you can either have acute
36:37conjunctivitis allergy conjunctivitis or
36:39acute characteristics all these three
36:40things can cause an acute red dye with
36:43discharge
36:44okay
36:45now the acute red eye based on
36:48congestion based what type of congestion
36:50is being involved I said we have either
36:52sectoral condition diffuse condition or
36:55Siri recognition
36:56sectoral means one part of area is
36:58getting involved what are the conditions
36:59you have a disclaritis you have
37:01scleritis and you have
37:05the differential features of a sectoral
37:08congestion with or without a nodule you
37:11can also have a sectoral hemorrhage in
37:13sub-conjunctival Hemorrhage okay
37:14remember that as well diffuse condition
37:16is typical of an acute conjunctivitis
37:18whereas you will see scenery condition
37:20in more deeper involvement like acute
37:22keratitis uveitis angular sugar glaucoma
37:25and case of scleritis
37:28there are a few other important
37:29algorithms also acute red dye with glare
37:32you will see acute array with glare in
37:34case of uveitis keratitis and foreign
37:36body when you have an involvement of
37:38cornea or when you have an intense AC
37:40reaction patient can have gla or
37:42photophobia is nothing but the painful
37:44sensitivity to light
37:46with systemic Association and recurrent
37:49episodes very characteristic in cases of
37:52uveitis scleritis and viral keratitis
37:55even viral keratitis especially in
37:56herpes lost infections the patients can
37:58have systemic involvement they can be an
38:00immunosuppression can be there they can
38:01have recurrent episodes in viral
38:03keratitis as well
38:06acute red eye with Hyperion is another
38:08important feature where you will see
38:10them you will see in uveitis the sterile
38:12hyperpillar you will see in acute
38:14keratives
38:15ulcer you will obtain acute end of
38:16thalamitis as well
38:19foreign
38:22which have not dealt much but this is
38:25crucial because when you see a bilateral
38:27acute red eye with proptosis with
38:29extracular movement restriction think of
38:31something more serious something more
38:33life threatening
38:34okay so in these patients especially
38:37patients who have an active thyroid
38:39disease that's going to be chemosis uh
38:41there's going to be congestion is going
38:42to be there and the patient can have
38:43proptosis with extracular muscle
38:45restriction cavernous sinus thrombosis
38:48again proctosis chemosis extraclamas
38:51restriction keratico cavernous fistula
38:53think of CCF in patient won't have this
38:56carb screws it's very characteristic of
38:58capital cabinets
39:01in case of orbital cellulitis the most
39:04common cause of orbital cellulitis in
39:06children is going to be a femoral
39:07sinusitis always look for the focal of
39:09infection in orbitals can be even a
39:11simple style leading onto a preceptor
39:13cellulitis then going for an orbitalitus
39:16orbital trauma like we discussed
39:17sometime back look for the signs so the
39:20key point is whenever you look at this
39:22acute red eye uh in orbital or admixyl
39:25pathologies with external restriction
39:26please please look for the pupillary
39:29reflexes look for rip
39:31optic neuropathy associated with it
39:35so now I've completed this video review
39:38on this mind map now this might be a
39:42standalone lecture for you so please
39:44watch this lecture and please watch this
39:46while you're reading the Mind map and
39:48please review this lecture as and when
39:50you want this is going to be a complete
39:52comprehensive uh take on this so thank
39:54you so much for for your patient
39:56listening hope you enjoy this effort
39:58thanks a lot take care bye

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