Ophthalmology

      Red eye

        Px:
          Type of redness: diffuse ; subconjunctival hemorrhage ; ciliary flush
          Visual acuity:
          Flourescein:
          Discharge:
          Opacity:
          Anterior chamber: angle closure ; hypopyon ; hyphema
          Pupils:
          Proptosis:
          Pressure:

        DDx:
        S&S bact conj viral conj allerg conj acute glaucoma acute iridocyclitis keratitis
        pain - - - +++ ++ ++
        itching - - +++ - - -
        halos - - - ++ - -
        ciliary flush - - - + + +
        discharge + + + - - +/-
        corneal opacity - - - + - +
        periauricular LN - + - - - -
        abnormal pupil - - - + + +/-
        shallow ant chamber - - - + - -

      Chalazion

        A chalazion is noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.

        Tx: Hot compresses for 5 to 10 min 2 or 3 times a day can be used to hasten resolution of chalazia and external hordeola.

        Incision and curettage or intrachalazion corticosteroid therapy (0.05 to 0.2 mL triamcinolone 25 mg/mL) may be indicated if chalazia are large, unsightly, and persist for more than several weeks despite conservative therapy.

      Hordeolum

        A hordeolum, or stye, is an acute, localized, pyogenic (usually staphylococcal) infection or abscess of the eyelid that may be external or internal. Most hordeola are external and result from obstruction and infection of an eyelash follicle and adjacent glands of Zeis or Moll's glands. Follicle obstruction may be associated with blepharitis.
        An internal hordeolum, which is very rare, results from infection of a meibomian gland. Sometimes cellulitis accompanies hordeola.

        Tx: Incision with a sharp, fine-tipped blade. Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg po qid) are indicated when cellulitis accompanies a hordeolum.