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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
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Conjunctival
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Lid diseases
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Clalazion
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Abnormal lid function
Corneal disease
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Blepharoconjunctivitis
Bacterial conjunctivitis
Viral conjunctivitis
Chlamydial conjunctivitis
Allergic conjunctivitis
Toxic/chemical reaction
Dry eye
Pinguecula/pteyrgium
Subconjunctival hemorrhage
Abrasion
Ulcer
Foreign body
Trauma
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Dacryoadenitis
Dacryocystitis
Masquerade syndrome
Carotid and dural fistula
Acute angle glaucoma
Anterior uveitis
Episcleritis/scleritis
Factitious
Blepharitis
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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 preauricular 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
Follicles
Papillae
Redness
Chemosis
Purulent discharge
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
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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
Ciliary flush
Posterior synechiae
Fibrin
Flare
Hypopyon
KPs
Acute Angle-closure Glaucoma
• Symptoms
– Pain, headache,
nausea-vomiting
– Redness, photophobia,
– Reduced vision
Ciliary hyperaemia
– Haloes around lights
Corneal oedema
Dilated pupil
Red Eye Treatment Algorithm
• History
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Trauma
Contact lens wearer
Severe pain/photophobia
Significant vision changes
History of prior ocular diseases
• Exam
- Visual loss
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Abnormal pupil
Ocular tenderness
White corneal opacity
Increased intraocular pressure
YES
Refer urgently to
ophthalmologist