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The Red Eye

The Red Eye. Marc A. Booth, M.D. 10 April 2013. Objectives. Obtain a pertinent history for patients presenting with a red eye Formulate a differential diagnosis for a patient with a red eye based on history and exam Know when to begin therapy versus refer/defer management

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The Red Eye

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  1. The Red Eye Marc A. Booth, M.D. 10 April 2013

  2. Objectives • Obtain a pertinent history for patients presenting with a red eye • Formulate a differential diagnosis for a patient with a red eye based on history and exam • Know when to begin therapy versus refer/defer management • Identify patients with red eye problems which require immediate referral to an ophthalmologist for treatment

  3. Which is/are in the differential diagnosis for red eye? A) Conjunctivitis B) Scleritis C) Ocular foreign body D) Angle Closure Glaucoma E) All of the Above Pre-Lecture Quiz Question 1

  4. Pre-Lecture Quiz Question 2 • Which is not associated with acute viral conjunctivitis? • A) Mucoid or serous discharge • B) Preauricular adenopathy • C) Photophobia • D) Palpebral (conjunctival) papillae • E) Blurry vision

  5. Pre-Lecture Quiz Question 3 • Which is not associated with pre-orbital/pre-septal cellulitis? • A) Decreased visual acuity • B) Lid erythema and edema • C) Ptosis • D) Fever • E) Full ocular motility

  6. Pre-Lecture Quiz Question 4 • Which of the following has no role in treating HSV epithelial keratitis? • A) Superficial debridement • B) Topical ganciclovir (Zirgan) • C) Topical steroids (Pred Acetate) • D) Oral Antivirals (acyclovir) • E) Topical trifluridine (Viroptic)

  7. The Red Eye • Infectious • Preseptal Cellulitis • Anterior to orbital septum • globe and orbit not involved • S.aureus likely if traumatic • Eyelid swollen, red, ptosis, pain, mild fever • No change: vision, pupil, motility, proptosis • D/Dx: Orbital cellulitis, idiopathic orbital inflammation, abscess, dacryoadenitis, dacryocystitis, • rhabdomyosarcoma (peds) • rapid, painful, progressive. 7yr old boy

  8. The Red Eye • Infectious • Preseptal Cellulitis • History: sinus surgery/disease, trauma • Exam: External, Va, EOM, pupils. • Ancillary tests: Orbital CT, CBC, blood cx. • Treatment: Oral vs IV antibiotics • <5yr old, 48 hour po not improved --> IV, compliance, septic patient

  9. The Red Eye • Infectious • Dacryocystitis -------------> • Rhabdo • Preseptal --------------------->

  10. The Red Eye • Infectious • Preseptal vs Orbital Cellulitis • Orbital (septal): similar to preseptal • KEY SIGNS: decreased visual acuity, afferent pupillary defect, limited ocular motility, proptosis • Most commonly secondary to ethmoidal sinusitis • Beware of Mucormycosis with DM

  11. The Red Eye • Inflammatory • Chalazion • Graves Disease

  12. The Red Eye • Inflammatory • Chalazion • Obstruction and inflammation of meibomian gland with leakage of sebum into surrounding tissue and resultant lipogranuloma formation • “Hordeolum” is secondary to an acute bacterial infection • Painful red lump on eyelid • Treat with warm compresses, incise after 4-6 weeks • If multiple, recurrent, unresponsive to treatment beware of possible sebaceous carcinoma

  13. The Red Eye • Inflammatory • Graves Disease • Variability • Asymptomatic to NLP Frozen Globe • Observation to orbital/muscle/lid surgery • Lid retraction is most common sign • Female predilection (5-8:1) • FBS, decreased vision (acuity or color), motility disturbance • Orbital CT to assess EOMs, IMSLO

  14. The Red Eye • Inflammatory • Graves Disease • Unilateral • Bilateral

  15. Skin and Adnexal Disorders • Infectious • Preseptal Cellulitis • History: sinus surgery/disease, trauma • Exam: External, Va, EOM, pupils. • Ancillary tests: Orbital CT, CBC, blood cx. • Treatment: Oral vs IV antibiotics • <5yr old, 48 hour po not improved --> IV, compliance, septic patient

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