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10/21/2015 Red Eye Ophthalmology | Fastbleep
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Ophthalmology ArticlesRevision Notes/ Biology Notes/ Ophthalmology
Red EyeWritten by: Sana Rasool from Manchester University,
History
Examination
10/21/2015 Red Eye Ophthalmology | Fastbleep
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Inflammation of the iris and ciliary body
Risk factors:
Previous uveitisSeronegative arthropathy, especially
HLA B27 positive patientsHerpes zoster ophthalmicusSyphilisTb
Clinical features:
Young or middle aged patientsPain worse when readingPhotophobiaReduced visual acuity
On examination:
Pupil may be small and irregular (dueto posterior synechiae adhesions of iristo the lens)
On using slit lamp, anterior chambermay show:
cells (moving, white specks)hypopyon pus in anterior
chamber
Causes of red eye
There are many different causes of a red eye. After taking a full history and thoroughlyexamining the eyes, a management plan can be made.
Anterior uveitis
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flare (looking through frostedglass)
keratic precipitates may be seen at theback of the cornea
Management:
Treat underlying cause if found.Topical steroidsMydriatics to prevent synechaie being
formed which can cause acute glaucoma.
Due to occlusion of the angle where aqueousfluid is normally drained, therefore leading to asudden increase in intraocular pressure.
Clinical features:
Usually in patients over 50 yrs
Severe pain
Red eye
Haloes around lights
Reduced visual acuity
Fixed semidilated pupil not reactive tolight
Eye feels hard on palpation
Hazy cornea
Systemic symptoms headache,nausea, vomiting
Management:
Urgent ophthalmological referral toprevent visual loss
IV acetazolamide 500mg
Pilocarpine 4% topical to constrict pupil
To restore normal aqueous flow, a holeneeds to be made in the iris. This can bedone with a laser (iridotomy) or surgically(iridectomy)
Inflammation of white sclera itself
Acute angle closure glaucoma
Scleritis
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Usually very painful; significantly moreredness present compared to episcleritis
Associated with other autoimmuneconditions
Visual acuity may be affectedManagement may need
immunosuppressantsComplications corneal ulceration,
intraocular inflammation
Inflammation of episclera
Mild eye irritation and redness
Normal visual acuity
Management usually self limiting, butsteroids may help
Causes
InfectionCorneal abrasionContact lensesExposure keratopathy (ie a patient with
facial nerve palsy who is unable to closeeyelids).
Clinical Features
PainForeign body sensationMild to moderate red eyeBlurred vision Photophobia
Examination
Staining the cornea with fluoresceinshows an area of corneal epithelial defect,and shows up yellow.
Management
Viral infection Topical acyclovir
Episcleritis
Corneal ulceration
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Bacterial or fungal infection Broadspectrum antibiotics
Noninfectious ulcer treat the cause.
Bright red blood between white sclera andconjunctiva. Usually benign
Can be caused by:
Severe coughing or straining
Hypertension
Blood disorders
Idiopathic
Clinical features:
Diffuse area of bright red blood
May be a foreign body
No pain, blurred vision or photophobia
Eye examination otherwise normal
Management:
Exclude hypertension
Check coagulation profile, especially ifpatient is on warfarin
Reassure patients that it is benign andmay take a few weeks to fade
Subconjunctival haemorrhage
Conjunctivitis
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References
ABC of Eyes. 4th edition.
Kennerley Banke's Clinical Ophthalmology. 4th ediition.
Image 1 Hypopyon in anterior uveitis taken fromhttp://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_lny8tU/s1600/ant+uveitis.jpg (http://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_lny8tU/s1600/ant+uveitis.jpg)
Image 2 Acute angle closure glaucoma taken from http://www.medrounds.org/glaucomaguide/2006/12/section9cdiagnosisofacuteangle.html (http://www.medrounds.org/glaucomaguide/2006/12/section9cdiagnosisofacuteangle.html)
Image 3 Scleritis taken from http://eyepathologist.com/images/KL21711.jpg(http://eyepathologist.com/images/KL21711.jpg)
Image 4 Episcleritis taken from http://www.gptraining.net/protocol/ophthalmology/redeye/episcl.jpg (http://www.gptraining.net/protocol/ophthalmology/redeye/episcl.jpg)
Image 5 Corneal ulcer taken fromhttp://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg(http://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg)
Image 6 Subconjunctival haemorrhage taken fromhttp://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg(http://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg)
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