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RED EYE Prof. Dr. Ilgaz YALVAÇ RED EYE One of the most common ophthalmologic conditions in the primary care setting Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial What is RED EYE? It is the cardinal sign of ocular inflammation Conjunctivitis is the most common cause of red eye Signs and symptoms are discharge, redness, pain, photophobia, itching, and visual changes It can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye RED EYE (Non-Vision Threatening Disorders) Subconjunctival hemorrhage Conjunctivitis Dry Eye Syndrome Blepharitis Corneal Abrasion Pterygium/Pingueculum Subconjunctival Haemorrhage Diffuse or localised area of blood under conjunctiva Asymptomatic Idiopathic Trauma Cough Sneezing Aspirin Systemic Hypertension Resolves within 10-14 days Subconjuntival Hemorrhage with Chemosis Keep conjunctiva moist Subconjunctival air! Posterior petechial hemorrhages Think embolic disease Conjunctivitis Follicles Papillae Redness Chemosis Purulent discharge Blepharo-conjunctivitis Acne Rosacea Blepharo-Conjunctivitis Conjunctivitis Allergic Conjunctivitis (Polytrim) Dry Eye Syndrome Poor quality Meibomian gland disease ie, Acne Rosacea Lid related Vitamin A deficiency Poor quantity Keratoconjunctivitis Sicca Sjogren Syndrome Rheumatoid Arthritis Lacrimal disease ie, Sarcoidosis Paralytic ie, VII CN palsy Computer Vision Syndrome Red, burning and tired eyes with staring at a computer screen for too long. Blink less when working at a computer, which dries out the surface of eye. Taking frequent breaks while working at a computer, modifying your workstation. Lubricating eye drops to keep eyes moist. Blepharitis Subacute Chronic External hordeolum Internal hordeolum Corneal Abrasion Surface epithelium sloughed off Stains with fluorescein Usually due to trauma Pain FB sensation Tearing Red eye Pterygium Active Dormant Pingueculum (inflammed) RED EYE (Vision Threatening Disorders) Episcleritis / Scleritis Corneal Ulcers Iritis ( Anterior Uveitis) Angle-Closure Glaucoma Preseptal & Orbital Cellulitis Endophthalmitis Trauma Episcleritis Superficial Idiopathic Collagen vascular disorder (Romatoid Artritis) Asymptomatic, mild pain Self-limiting or topical treatment Corneal Ulcer Infection Bacterial: Adnexal infection, lid malposition, dry eye, CL Viral: Herpes Simplex, Herpes Zoster Fungal: Protozoan: Acanthamoeba in CL wearer Mechanical or trauma Chemical: Alkali worse than acid Corneal Ulcer Viral Dendritic Keratitis Corneal Ulcer Viral Dendritic Keratitis HSV-1 H. Zoster Iritis (Anterior Uveitis) Photophobia, red eye, decreased vision Idiopathic Commonest Associated to systemic disease Seronegative arthropathies: AS, IBD, Psoriatic arthritis, Reiter’s Autoimmune: Sarcoidosis, Behcet’s Disease Infection: Herpes, Toxoplasmosis, TB, Syphillis, HIV Ciliary flush Posterior synechiae Fibrin Flare Hypopyon KPs Acute Angle-Closure Glaucoma Symptoms Pain Headache Nausea-Vomiting Ciliary hyperaemia Dilated pupil Redness Photophobia Corneal oedema Reduced vision Haloes around lights Acute Angle-Closure Glaucoma Onset over 50 Severe eye pain Blurred vision Red eye Headache/Nausea Corneal edema Mid-dilated, fixed pupilla “Glaukomflecken” Iris atrophy Severe AC inflammation Preseptal cellulitis Orbital Cellulitis Severe pain Proptosis Limited EOMs Conjunctival congestion Diabetic? Orbital Cellulitis Frontal, ethmoid, maxillary and orbital abscesses Endophthalmitis Severe pain Photophobia Poor vision Recent intra-ocular surgery Differential Diagnosis Conjunctiva Pupil Cornea Anterior chamber IOP Subconjunctival Haemorrhage Bright red Normal Normal Normal Normal Conjunctivitis Injected vessels, fornices. Discharge Normal Normal Normal Normal Iritis Injected around cornea Small, fixed, irregular Normal, KPs Turgid, deep Normal Acute glaucoma Entire eye red Fixed, dilated, oval Hazy Shallow High Refer to an Ophthalmologist Red Eye with Severe pain Patient has vision loss Copious purulent discharge Corneal involvement Traumatic eye injury Recent ocular surgery Distorted pupilla Herpes infection Recurrent infections