Red Eye

Waleed alrashed

Introduction

• Frequent presentation to GP
  • Must be able to differentiate between serious vision-threatening conditions and simple benign conditions

Red Eye

• Refers to hyperemia of the superficially visible vessels of the conjunctiva, episclera, or the sclera
• Caused by disorders of these structures themselves, or of adjacent structures like the eyelids, cornea, iris, and ciliary body

Differential diagnosis of red eye

• Conjunctival

  • Blepharoconjunctivitis
  • Bacterial conjunctivitis
  • Viral conjunctivitis
  • Chlamydial conjunctivitis
  • Allergic conjunctivitis
  • Toxic/chemical reaction
  • Dry eye

• Lid diseases

  • Stye
  • Abnormal lid function

• Corneal disease

  • Abrasion
  • Ulcer

• Foreign body

• Carotid and Dural cavernous sinus fistula

• Acute angle glaucoma

• Anterior uveitis

• Episcleritis/scleritis

• Subconjunctival hemorrhage

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 may be edematous
• Streptococcus pneumoniae, Hemophilus 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 hyperemic, and there may be follicles, hemorrhages, inflammatory membranes, and a pre-auricular node
• The most common cause is an adenoviral infection
• No specific therapy but cold compresses are helpful

Allergic Conjunctivitis

• Encompasses a spectrum of clinical conditions
• All associated with the hallmark symptom of itchingz
• There is often a history of rhinitis, asthma, eczema, and family history of atopy
• Signs may include mildly red eyes, watery discharge, chemosis, papillary hypertrophy, and giant papillae
• Treatment consists of cold compresses, antihistamines, nonsteroidals, mast cell stabilizers, and in severe cases, topical corticosteroids and cyclosporine

Chlamydial Conjunctivitis

• Usually occurs 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 a non-tender preauricular node
• Treatment requires oral tetracycline or azithromycin

---

Iritis

Episcleritis

• Episcleritis
  • Can be localized (sectorial) or diffuse redness
  • Often asymptomatic
  • Usually self-limited
  • Treatment: topical or systemic NSAIDs

htn, gout - no sequele

ScleritisZ

• Pain which may be severe with tenderness, tearing, and photophobia
• May be localized, diffuse, or associated with nodules
• Can result in scleral necrosis (scleromalacia perforans)
• 30 to 60% may have an associated systemic disease
  • RA …
• May need systemic steroid and immunosuppressive agents

nodular scleritis

Subconjunctival Hemorrhage

• Usually asymptomatic/ self limited
• Blood underneath the conjunctiva, often in a sector of the eye
• Etiology
  1. Valsalva (coughing or straining)
  2. Traumatic
  3. Hypertension
  4. Bleeding disorder
  5. Idiopathic
  6. Postoperative
  7. Anticoagulants

Red Eye Treatment Algorithm urgency

• History
  • Trauma
  • Contact lens wearer
  • Severe pain/photophobia
  • Significant vision changes
  • History of prior ocular diseases
• Exam
  • Abnormal pupil
  • Ocular tenderness
  • White corneal opacity
  • Increased intraocular pressure

YES
Refer urgently to ophthalmologist

Is it conjunctivitis?

• History

  • Itching
  • Exposure to person with red eye
  • URTI
  • Discharge with morning crusting
  • Exposure to drugs

• Signs

  • Discharge what types
  • Lid and conjunctival edema
  • Conjunctival redness
  • Preauricular lymph node
  • Facial or eyelid vesicles