Download - The Red Eye
The Red Eye
Introduction
• Relevance– Red Eye
• Frequent presentation to GP• Must be able to differentiate between serious vision
threatening conditions and simple benign conditions
Differential diagnosis of red eye• Conjunctival
– Blepharoconjunctivitis– Bacterial conjunctivitis– Viral conjunctivitis– Chlamydial conjunctivitis– Allergic conjunctivitis– Toxic/chemical reaction– Dry eye– Pinguecula/pteyrgium– Subconjunctival hemorrhage
• Lid diseases– Clalazion– Sty– Abnormal lid function
• Corneal disease– Abrasion– Ulcer
• Foreign body• Trauma
• Dacryoadenitis• Dacryocystitis• Masquerade syndrome• Carotid and dural fistula• Acute angle glaucoma• Anterior uveitis• Episcleritis/scleritis• Factitious
Blepharitis• Adults > children• Inflammation of the lid margin• Frequently associated with styes• Meibomian gland dysfunction• Lid hygiene, topical antibiotics, and lubricants are the
mainstays of treatment
Bacterial Conjunctivitis• Both adults and children• Tearing, foreign body sensation, burning, stinging and
photophobia• Mucopurulent or purulent discharge• Lid and conjunctiva maybe edematous• Streptococcus pneumoniae, Haemophilus influenzae, and
staphylococcus aureus and epidermidis• Conjunctival swab for culture• Topical broad spectrum antibiotics
Viral Conjunctivitis– Acute, watery red eye with soreness, foreign
body sensation and photophobia– Conjunctiva is often intensely hyperaemic
and there maybe follicles, haemorrhages, inflammatory membranes and a pre-auricular node
– The most common cause is an adenoviral infection
– No specific therapy but cold compresses are helpful
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Allergic Conjunctivitis– Encompasses a spectrum of clinical condition– All associated with the hallmark symptom of itching– There is often a history of rhinitis, asthma and family history of
atopy– Signs may include mildly red eyes, watery discharge, chemosis,
papillary hypertrophy and giant papillae– Treatment consist of cold compresses, antihistamines,
nonsteroidals, mast cells stabilizers, topical corticosteroids and cyclosporine
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Chlamydial Conjunctivitis
– Usually occur in sexually active individuals with or without an associated genital infection
– Conjunctivitis usually unilateral with tearing, foreign body sensation, lid crusting, conjunctival discharge and follicles
– There is often non-tender preauricular node– Treatments requires oral tetracycline or azithromycin
Conjunctivitis
FolliclesPapillae Purulent discharge
ChemosisRedness
Subconjunctival Haemorrhage
• Diffuse or localised area of blood under conjunctiva. Asymptomatic
• Idiopathic, trauma, cough, sneezing, aspirin, HT
• Resolves within 10-14 days
Dry Eye Syndrome
• Poor quality – Meibomian gland disease,Acne rosacea– Lid related– Vitamin A deficiency
• Poor quantity– KCS
• Sjogren Syndrome• Rheumatoid Arthritis
– Lacrimal disease ie, Sarcoidosis– Paralytic ie, VII CN palsy
Lid malposition
Pterygium
Corneal Abrasion
• Surface epithelium sloughed off. • Stains with fluorescein• Usually due to trauma• Pain, FB sensation, tearing, red eye
Foreign Body
Corneal Ulcer
• Infection– Bacterial: Adnexal infection, lid malposition,
dry eye, CL– Viral: HSV, HZO– Fungal:– Protozoan: Acanthamoeba in CL wearer
• Mechanical or trauma • Chemical: Alkali injuries are worse than acid
Episcleritis
• Superficial• Idiopathic, collagen
vascular disorder (RA)• Asymptomatic, mild
pain• Self-limiting or topical
treatment
Scleritis
• Deep • Idiopathic• Collagen vascular disease (RA,AS, SLE, Wegener,
PAN) • Zoster • Sarcoidosis• Dull, deep pain wakes patient at night• Systemic treatment with NSAI or Prednisolone if
severe
Uveitis
Anterior: acute recurrent and chronic
Posterior: vitritis, retinal vasculitis, retinitis, choroiditis
Panuveitis: anterior and posterior
Anterior uveitis (iritis)
• Photophobia, red eye, decreased vision• Idiopathic. Commonest• Associated to systemic disease
– Seronegative arthropathies:AS, IBD, Psoriatic arthritis, Reiter’s
– Autoimmune: Sarcoidosis, Behcets– Infection: Shingles, Toxoplasmosis, TB,
Syphillis, HIV
KPs
Fibrin
Posterior synechiae
Hypopyon
Ciliary flush
Flare
Acute Angle-closure Glaucoma
• Symptoms– Pain, headache,
nausea-vomiting– Redness, photophobia, – Reduced vision– Haloes around lights
Corneal oedema
Ciliary hyperaemiaDilated pupil
Red Eye Treatment Algorithm
• History– Trauma– Contact lens wearer– Severe pain/photophobia– Significant vision changes– History of prior ocular diseases
• Exam
- Visual loss– Abnormal pupil– Ocular tenderness– White corneal opacity– Increased intraocular pressure
YES
Refer urgently to ophthalmologist