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