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The red eye

The red eye. The red eye. Aim to distinguish acute emergency from less urgent Vision affected? Pain? Unilateral/bilateral? Distinguish conjunctival injection from ciliary flush. The red eye. Acute conjunctivitis <3 weeks Red eye Discharge Watery, mucoid, purulent Irritation

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The red eye

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  1. The red eye

  2. The red eye • Aim to distinguish acute emergency from less urgent • Vision affected? • Pain? • Unilateral/bilateral? • Distinguish conjunctival injection from ciliary flush

  3. The red eye • Acute conjunctivitis • <3 weeks • Red eye • Discharge • Watery, mucoid, purulent • Irritation • Cornea clear • Vision good • Swab for culture+sensitivity • clean + topical antibiotic chloramphenicol

  4. The red eye • Acute conjunctivitis • Papillae • Non specific • Except Giant papillae • atopic disease • Fb • Follicles • Physiologic in children • Chlamydia,adenovirus,herpes simplex, molluscum, drug toxicity, trachoma

  5. The red eye • Bacterial conjunctivitis • Less common than viral • Conjunctival inflammation • Purulent discharge • Usually self limiting • Occasionally sight threatening • Gonococcal • Swab: Neonate,immunodeficient Severe cases Unresponsive cases

  6. The red eye • Keratitis • Inflammation of cornea • Infection • Bacteria • Virus • Fungus • Protozoa • Dry Eye • Toxicity • Trauma • Chemical • Mechanical • UV light (arc eye) • loss of transparency • Reduced acuity • +/-pain

  7. The red eye • Corneal ulcer • Emergency • scrape for Gram stain and culture • Intensive topical antibiotics • Fluoroquinolone • Fortified gentamicin and cefuroxime

  8. The red eye • Corneal foreign body • Remove • Topical antibiotic • UV keratitis • History of welding • Cycloplegic + patch

  9. The red eye • Uveitis • Inflammation of iris, ciliary body, choroid • Anterior uveitis • Pain • Sensitivity to light • Blurring • Ciliary flush • Deep AC • Clear cornea • But keratic precipitates • AC flare and cells • Irregular shape of pupil

  10. The red eye • Uveitis • Topical steroid • Prednisolone 1% • Cycloplegia • Often recurrent • Chronic cases need investigation

  11. The red eye • Herpes simplex keratitis • Discomfort • Watering • Photophobia • Ciliary flush • Dendritic pattern of fluorescein staining • Reduced corneal sensation • Recurrent disease

  12. The red eye • Herpes simplex keratitis • Topical aciclovir • +/- debridement with sterile swab • Do NOT use steroid in epithelial disease • HSV can also affect stroma and endothelium which require steroid but these require close supervision

  13. The red eye • Herpes zoster ophthalmicus • Reactivation of latent infection of trigeminal ganglion with varicella-zoster virus • Older age group • Can be triggered by malignancy, HIV, immunosuppression

  14. The red eye • Herpes zoster ophthalmicus • Prodromal fever, malaise • Rash in dermatome • Vesicular, becoming crusty • Painful (maychronic) • Inflammation can affect ALL parts of eye • Lids, cornea, sclera, AC, uvea, optic nerve, cranial nerves • Can result in corneal opacity, new vessels

  15. The red eye • Herpes Zoster ophthalmicus • Oral aciclovir 800mg x5 daily for 10 days starting WITHIN 72 hrs of onset • Topical ACV not indicated • Topical steroids and cycloplegia for stromal keratitis and uveitis • Need very slow taper • Respect this condition!

  16. The red eye • Acute glaucoma • Pain • Blurring of vision • High IOP • Ciliary flush • Hazy cornea • Mid-dilated pupil • Shallow anterior chamber

  17. The red eye • Acute glaucoma • Timolol 0.5% • Pilocarpine 1%-2% • Q15 minutes x3 • Prednisolone • Oral/iv Diamox • Beware CCF, renal disease • When acute attack broken perform laser or surgical iridotomy

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