RED EYE, a Differential Diagnosis

M. F. Al Fayez, MD, FRCS

RED EYE DISORDERS:NON VISION-THREATENING

Blepharitis

Hordeolum

Chalazion

Conjunctivitis

Subconjunctival hemorrhage

Dry eyes

Corneal abrasions (most)

RED EYE DISORDERS:VISION-THREATENING

Orbital cellulitis Scleritis Corneal infections Hyphema iritis Acute glaucoma

RED EYE: POSSIBLE CAUSES

Trauma Chemicals Infection Allergy Systemic conditions

RED EYE: HISTORY

• Trauma, CL wear or previous eye surgery

• One or Both Eyes

• Pain or Photophobia vs Discomfort

• Reduced or Blurred Vision that does not clear on blinking

RED EYE: CAUSE AND EFFECT

Symptom:

Itching

Scratchiness,burning

Localized lidtenderness

Cause:

Allergy

Lid, conjunctival, Corneal disorders “ including foreign body”, trichiasis, dry eye

Hordeolum, chalazion

RED EYE: CAUSE AND EFFECT (cont'd)

Symptom:

Deep, intense pain

Photophobia

Halo vision

Cause:

Corneal abrasions,scleritis, iritis, acuteglaucoma, sinusitis, etc.

Corneal abrasions,iritis, acute glaucoma

Corneal edema(acute glaucoma,contact lens overwear)

CONJUNCTIVITIS

Causes: bacteria, viruses, allergies, tear deficiency

Pattern: palpebral or diffuse

CONJUNCTIVITIS: DISCHARGE

Discharge:

Purulent

Clear Stringy, white mucus

*Preauricular lymphadenopathy signals viral infection.

Cause:

Bacteria

Viruses*

Allergies

BACTERIAL CONJUNCTIVITIS:COMMON CAUSES

Staphylococcus

Streptococcus

Haemophilus

BACTERIAL CONJUNCTIVITIS:TREATMENT

Topical antibiotic qid x 4 days

Warm compresses

Refer if not markedly improved in 4 days

VIRAL CONJUNCTIVITIS

Watery discharge

Highly contagious

Palpable preauricular lymph node

URI, sore throat, fever common

If pain, photophobia, or decreased vision, refer.

ALLERGIC CONJUNCTIVITIS

• Associated conditions: hay fever, asthma, eczema

• Contact allergy: chemicals, cosmetics

• Treatrnent: topical antihistamines, artificial tears to relieve itching

Refer refractory cases.

NEONATAL CONJUNCTIVITIS:CAUSES

• Chemical (silver nitrate)

• Bacteria (N gonorrhoeae, Staphylococcus, Streptococcus)

• Chlamydia

• Viruses (herpes)

• Systemic chlamydial infection

TRACHOMA

• Leading Cause of blindness worldwide

• Caused by serotypes A-C Clamydia

trachomatis

• Traeted with topical and systemic

tetracyclines

TEARS

• Possess lubricating and bacteriostatic

properties• Essential for maintaining a healthy cornea and conjunctiva

Dry eye (keratoconjunctivitis sicca) is a tear deficiency state

TEAR DEFICIENCY STATES:SYMPTOMS

• Burning

• Foreign-body sensation

• Reflex tearing

TEAR DEFICIENCY STATES:ASSOCIATED CONDITIONS

• Blepharitis

• Aging

• Rheumatoid arthritis

• Stevens-Johnson syndrome

• Systemic medications; e.g.

DRY EYES: TREATMENT

• Artificial tears

• Lubricating ointment hs

• Punctal occlusion

EXPOSURE KERATITIS

• Due to incomplete lid closure

• Manage with lubricating solutions/ointments

• Tape lids shut at night

• Do not patch

• Refer severe cases

INFLAMED PINGUECULAAND PTERYGIUM:

MANAGEMENT

Artificial tears & Topical vasoconstrictors

if severe, refer

Corneal infections, scleritis, iritis, and acute glaucoma should be

recognized and referred

EPISCERITIS & SCLERITIS

• Redness and tenderness (more in scleritis)

• Localized or diffuse

• Etiology:

Often idiopathicMay be assciated with rheumatoid arthritis and other autoimmune disorders

Should be recognised and referred

ACUTE CORNEAL DISORDERS:SYMPTOMS

• Pain

• Photophobia

• Blurred vision

IRITIS

Sx/Sx

• Circumcorneal redness

• Pain

• Photophobia

• Decreased vision

• Miotic pupil

Recognize and refer.

SYSTEMIC ASSOCIATIONS

Arthritis: Ankylosing spondylitis

Reiter’s syndrome

Psoriatic arthritis

Juvenile rheumatoid arthritis

Non infectious: Sarcoidosis

Behcet’s disease

Vogt Koyanagi Harada syndrome

Systemic infections: AIDS, acq. Syphilis, T.B. & Leprosy

Parasitic infections: Toxoplasmosis Toxocariasis

COMMON RED EYE DISORDERS:TREATMENT INDICATED

• Hordeolum

• Chalazion

• Blepharitis

• Conjunctivitis

• Subconjunctival hemorrhage

• Dry eyes

• Corneal abrasions (most)

VISION-THREATENING RED EYESX/SX: REFERRAL REQUIRED

• Decreased vision

• Ocular pain

• Photophobia

• Circumcorneal redness

• Corneal edema

• Corneal ulcers/dendrites

• Abnormal pupil

• Proptosis

• Elevated IOP

VISION-THREATENING RED EYE DISORDERS: URGENT REFERRAL

• Orbital cellulitis

• Episcleritis / scleritis

• Chemical injury

• Corneal infection

• Hyphema

• Iritis

• Acute glaucoma