The Red Eye

The Red Eye

·        Never use steroids in an undiagnosed red eye (can worsen ulcers, etc)

·        Diagnostic Tree:

o   Uniocular:

§  No Pain, vision normal: subconjunctival haemorrhage, episcleritis, pterygium, conjunctivitis

§  Pain and normal vision: if no corneal staining: Anterior uveitis, scleritis, HZO.  If corneal

§  scarring: HSV, marginal ulcer

§  Pain and vision reduced: If no corneal staining: severe uveitis, angle closure glaucoma,

§  secondary glaucoma.  If corneal staining: HSV, Bacterial keratitis, HZO

o  Binocular:

§  No pain, good vision: bacterial, viral or allergic conjunctivitis

§  Pain, vision good or poor: viral or chlamydial keratoconjunctivitis

·        Subconjunctival bleed:  self limiting unless severely hypertensive or coagulopathy

·        Conjunctivitis:

o  Initially unilateral, may ® bilateral due to cross infection

o  Feeling of surface grittiness

o  Causes:

§  Infective:

§  Allergic: eg eczema, allergy to protein deposits on poorly cleaned soft contacts

§  Chemical/mechanical

o  Baby: 1 month with pussy discharge ® urgent referral (?blocked and infected lacrimal duct)

o  Never pad a discharging eye

·        Blepheritis

o  = Lid inflammation

o  Eyelash „dandruff‟

o  Meibomian gland dysfunction: usually staph infection. 30ish glands under they eyelid normally secrete lipid to cover tear film

o  Clean with saline or bicarbonate solution 

·        Chalazion: Red nodule in the lid. Due to obstruction and infection of a Meibomian gland. Microscopically granulomatous inflammation (basically a burst sebaceous gland)

·        Corneal Ulcer:  See HSV infections below.

·        Keratitis:

o  Corneal inflammatory disease

o  Symptoms: deeper, aching pain

o   Aetiology: infective, contact lens, staph hypersensitivity, exposure keratopathy (eg 7^th nerve palsy)

o  Signs: speckled light reflex Þ corneal oedema 

·        Shingles affecting face: refer within 7 – 10 days to check for intra-ocular complications. Pain is due to trigeminal neuralgia

·        Iritis:

o  Frontal headache, photophobia, not watering.  Usually unilateral

o  White cells and fibrous exudate in anterior aqueous.  May be white cells at bottom of cornea

o  Usually autoimmune: Ankylosing Spondylitis, Crohn‟s. Treat with steroids, and dilating drops to keep iris mobile

o  Rarely infective (eg Tb)

·        Episcleritis:

o  = Localised inflammation of sclera. Treatment: topical NSAIDs

o  Acute onset, mild pain, young adults, usually sectorial, no corneal signs

o  Cf Scleritis: pain, VA decreased, tender, sectorial or diffuse, corneal signs

·        Pterygium:

o  Conjunctival overgrowth growing over cornea.  Age related changes due to sun exposure

o  Refer if enlarging and vascularised.  Differential: squamous cell carcinoma.

o  Pinguecula: White epibulbar nodule similar to pterygium

·        Acute Glaucoma