Red EyeRed Eye

Abdulrahman Al-MuammarAbdulrahman Al-Muammar

College of MedicineCollege of Medicine

King Saud UniversityKing Saud University

IntrodutionIntrodution

RelevanceRelevanceRed EyeRed Eye• Frequent presentation to GPFrequent presentation to GP• Must be able to differentiate between serious Must be able to differentiate between serious

vision threatening conditions and simple benign vision threatening conditions and simple benign conditionsconditions

BasicsBasicsRed EyeRed Eye

– Refers to hyperemia of the superficially visible Refers to hyperemia of the superficially visible vessels of the conjunctiva, episclera, or the scleravessels of the conjunctiva, episclera, or the sclera

– Caused by disorders of these structures themselves, Caused by disorders of these structures themselves, or of adjacent structures like the eyelids, cornea, iris, or of adjacent structures like the eyelids, cornea, iris, and ciliary bodyand ciliary body

Differential diagnosis of red eyeDifferential diagnosis of red eye

ConjunctivalConjunctivalBlepharoconjunctivitisBlepharoconjunctivitisBacterial conjunctivitisBacterial conjunctivitisViral conjunctivitisViral conjunctivitisChlamydial conjunctivitisChlamydial conjunctivitisAllergic conjunctivitisAllergic conjunctivitisToxic/chemical reactionToxic/chemical reactionDry eyeDry eyePinguecula/pteyrgiumPinguecula/pteyrgium

Lid diseasesLid diseasesClalazionClalazionStyStyAbnormal lid functionAbnormal lid function

Corneal diseaseCorneal diseaseAbrasionAbrasionUlcerUlcer

Foreign bodyForeign body

DacryoadenitisDacryoadenitisDacryocystitisDacryocystitisMasquerade syndromeMasquerade syndromeCarotid and dural fistulaCarotid and dural fistulaAcute angle glaucomaAcute angle glaucomaAnterior uveitisAnterior uveitisEpiscleritis/scleritisEpiscleritis/scleritisSubconjunctival hemorrhageSubconjunctival hemorrhageFactitiousFactitious

BlepharitisBlepharitis

Adults > childrenAdults > children

Inflammation of the lid marginInflammation of the lid margin

Frequently associated with styesFrequently associated with styes

Meibomian gland dysfunctionMeibomian gland dysfunction

Lid hygiene, topical antibiotics, and lubricants are the Lid hygiene, topical antibiotics, and lubricants are the mainstays of treatmentmainstays of treatment

Bacterial ConjunctivitisBacterial ConjunctivitisBoth adults and childrenBoth adults and childrenTearing, foreign body sensation, burning, stinging Tearing, foreign body sensation, burning, stinging and photophobiaand photophobiaMucopurulent or purulent dischargeMucopurulent or purulent dischargeLid and conjunctiva maybe edematousLid and conjunctiva maybe edematousStreptococcus pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Haemophilus influenzae, and staphylococcus aureus and epidermidisand staphylococcus aureus and epidermidisConjunctival swab for cultureConjunctival swab for cultureTopical broad spectrum antibioticsTopical broad spectrum antibiotics

Viral ConjunctivitisViral ConjunctivitisAcute, watery red eye with soreness, foreign body sensation Acute, watery red eye with soreness, foreign body sensation and photophobiaand photophobia

Conjunctiva is often intensely hyperaemic and there maybe Conjunctiva is often intensely hyperaemic and there maybe follicles, haemorrhages, inflammatory membranes and a follicles, haemorrhages, inflammatory membranes and a pre-auricular nodepre-auricular node

The most common cause is an adenoviral infectionThe most common cause is an adenoviral infection

No specific therapy but cold compresses are helpfulNo specific therapy but cold compresses are helpful

Allergic ConjunctivitisAllergic ConjunctivitisEncompasses a spectrum of clinical conditionEncompasses a spectrum of clinical conditionAll associated with the hallmark symptom of itchingAll associated with the hallmark symptom of itchingThere is often a history of rhinitis, asthma and family history There is often a history of rhinitis, asthma and family history of atopyof atopySigns may include mildly red eyes, watery discharge, Signs may include mildly red eyes, watery discharge, chemosis, papillary hypertrophy and giant papillaechemosis, papillary hypertrophy and giant papillaeTreatment consist of cold compresses, antihistamines, Treatment consist of cold compresses, antihistamines, nonsteroidals, mast cells stabilizers, topical corticosteroids nonsteroidals, mast cells stabilizers, topical corticosteroids and cyclosporineand cyclosporine

Chlamydial ConjunctivitisChlamydial Conjunctivitis

Usually occur in sexually active individuals with or Usually occur in sexually active individuals with or without an associated genital infectionwithout an associated genital infection

Conjunctivitis usually unilateral with tearing, Conjunctivitis usually unilateral with tearing, foreign body sensation, lid crusting, conjunctival foreign body sensation, lid crusting, conjunctival discharge and folliclesdischarge and follicles

There is often non-tender preauricular nodeThere is often non-tender preauricular node

Treatments requires oral tetracycline or Treatments requires oral tetracycline or azithromycinazithromycin

Dry EyeDry Eye

SymptomsSymptomsBurning or foreign body sensationBurning or foreign body sensationTearingTearingUsually bilateralUsually bilateral

EtiologyEtiologyIdiopathicIdiopathicCollagen vascular diseasesCollagen vascular diseasesConjunctival scarringConjunctival scarringInfiltration of the lacrimal glandInfiltration of the lacrimal glandVitamin A deficiencyVitamin A deficiency

TreatmentTreatmentArtificial tearsArtificial tears

Pterygium

EctropionEctropion

TrichiasisTrichiasis

Infectious keratitisInfectious keratitis

Corneal abrasion

HSV dendrites HSV dendrites

Foreign BodyForeign Body

Nasolacrimal ObstructionNasolacrimal ObstructionCan lead to DacryocystitisCan lead to Dacryocystitis

Pain, redness, and swelling over the innermost Pain, redness, and swelling over the innermost aspect of the lower eyelid, tearing, dischargeaspect of the lower eyelid, tearing, discharge

OrganismsOrganisms

Staphylococci, streptococci, and diphtheoidsStaphylococci, streptococci, and diphtheoids

TreatmentTreatment• Systemic antibioticsSystemic antibiotics• Surgical drainageSurgical drainage

Conjunctival tumorConjunctival tumor

IritisIritis

Episcleritis Episcleritis EpiscleritisEpiscleritis

Can be localized (sectorial) or diffuse rednessCan be localized (sectorial) or diffuse redness

Often asymptomaticOften asymptomatic

Usually self limitedUsually self limited

Treatment is topical or systemic NSAIDsTreatment is topical or systemic NSAIDs

ScleritisScleritisPain which maybe severe with tenderness, tearing Pain which maybe severe with tenderness, tearing and photophobiaand photophobia

Maybe localized, diffuse or associated with Maybe localized, diffuse or associated with nodulesnodules

Can result in scleral necrosis (scleromalacia Can result in scleral necrosis (scleromalacia perforance)perforance)

30 to 60 % may have an associated systemic 30 to 60 % may have an associated systemic diseasesdiseases

• RA ………RA ………

May need systemic steroidMay need systemic steroid

Subconjunctival Hemorrhage Subconjunctival Hemorrhage Usually asymptomaticUsually asymptomaticBlood underneath the conjunctiva, often in a sector of the eyeBlood underneath the conjunctiva, often in a sector of the eyeEtiologyEtiology

Valsalva (coughing or straining)Valsalva (coughing or straining)TraumaticTraumaticHypertensionHypertensionBleeding disorderBleeding disorderidiopathicidiopathic

Red Eye Treatment AlgorithmRed Eye Treatment Algorithm

• HistoryHistory– TraumaTrauma

– Contact lens wearerContact lens wearer

– Severe pain/photophobiaSevere pain/photophobia

– Significant vision changesSignificant vision changes

– History of prior ocular diseasesHistory of prior ocular diseases

• ExamExam– Abnormal pupilAbnormal pupil

– Ocular tendernessOcular tenderness

– White corneal opacityWhite corneal opacity

– Increased intraocular pressureIncreased intraocular pressure

YES

Refer urgently to ophthalmologist

Is it conjunctivitis?Is it conjunctivitis?

HistoryHistoryItchingItchingExposure to person Exposure to person with red eyewith red eyeURTIURTIPast history of Past history of conjunctivitisconjunctivitisDischarge with Discharge with morning crustingmorning crustingExposure to drugsExposure to drugs

SignsSignsDischargeDischargeLid and conjunctival Lid and conjunctival edemaedemaConjunctival rednessConjunctival rednessPreauricular lymph Preauricular lymph nodenodeFacial or eye lid Facial or eye lid vesiclesvesicles

Thank youThank you