RED EYE, a Differential Diagnosis

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RED EYE, a Differential Diagnosis

• M. F. Al Fayez, MD, FRCS

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RED EYE DISORDERSNON VISION-THREATENING

• Blepharitis
• Hordeolum
• Chalazion
• Conjunctivitis
• Subconjunctival hemorrhage
• Dry eyes
• Corneal abrasions (most)

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RED EYE DISORDERSVISION-THREATENING

• Orbital cellulitis
• Scleritis
• Corneal infections
• Hyphema
• iritis
• Acute glaucoma

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RED EYE POSSIBLE CAUSES

• Trauma
• Chemicals
• Infection
• Allergy
• Systemic conditions

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RED EYE HISTORY

• Trauma, CL wear or previous eye surgery
• One or Both Eyes
• Pain or Photophobia vs Discomfort
• Reduced or Blurred Vision that does not
• clear on blinking

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RED EYE CAUSE AND EFFECT
Cause Allergy Lid, conjunctival, Corneal
disorders including foreign body, trichiasis,
dry eye Hordeolum, chalazion

• Symptom
• Itching
• Scratchiness,
• burning
• Localized lid
• tenderness

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RED EYE CAUSE AND EFFECT (cont'd)
Cause Corneal abrasions, scleritis, iritis,
acute glaucoma, sinusitis, etc. Corneal
abrasions, iritis, acute glaucoma Corneal
edema (acute glaucoma, contact lens overwear)

• Symptom
• Deep, intense pain
• Photophobia
• Halo vision

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CONJUNCTIVITIS
Causes bacteria, viruses,
allergies, tear deficiency Pattern
palpebral or diffuse
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CONJUNCTIVITIS DISCHARGE
Discharge Purulent Clear Stringy, white
mucus Preauricular lymphadenopathy signals
viral infection.
Cause Bacteria Viruses Allergies
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BACTERIAL CONJUNCTIVITISCOMMON CAUSES
Staphylococcus Streptococcus Haemophilus
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BACTERIAL CONJUNCTIVITISTREATMENT
Topical antibiotic qid x 4 days Warm
compresses Refer if not markedly improved in 4
days
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VIRAL CONJUNCTIVITIS
Watery discharge Highly contagious Palpable
preauricular lymph node URI, sore throat, fever
common If pain, photophobia, or decreased
vision, refer.
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ALLERGIC CONJUNCTIVITIS
Associated conditions hay fever, asthma,
eczema Contact allergy chemicals,
cosmetics Treatrnent topical antihistamines,
artificial tears to relieve itching Refer
refractory cases.
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NEONATAL CONJUNCTIVITISCAUSES
Chemical (silver nitrate) Bacteria (N
gonorrhoeae, Staphylococcus,
Streptococcus) Chlamydia Viruses
(herpes) Systemic chlamydial infection
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TRACHOMA

• Leading Cause of blindness worldwide
• Caused by serotypes A-C Clamydia
• trachomatis
• Traeted with topical and systemic
• tetracyclines

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TEARS

• Possess lubricating and bacteriostatic
• properties
• Essential for maintaining a healthy
• cornea and conjunctiva
• Dry eye (keratoconjunctivitis sicca) is a
• tear deficiency state

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TEAR DEFICIENCY STATESSYMPTOMS
Burning Foreign-body sensation Reflex
tearing
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TEAR DEFICIENCY STATESASSOCIATED CONDITIONS

• Blepharitis
• Aging
• Rheumatoid arthritis
• Stevens-Johnson syndrome
• Systemic medications e.g.

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DRY EYES TREATMENT
Artificial tears Lubricating ointment hs
Punctal occlusion
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EXPOSURE KERATITIS
Due to incomplete lid closure Manage with
lubricating solutions/ointments Tape lids shut
at night Do not patch Refer severe cases
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INFLAMED PINGUECULAAND PTERYGIUM MANAGEMENT

• Artificial tears Topical vasoconstrictors
• if severe, refer

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Corneal infections, scleritis, iritis, and acute
glaucoma should be recognized and referred
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EPISCERITIS SCLERITIS

• Redness and tenderness (more in scleritis)
• Localized or diffuse
• Etiology
• Often idiopathic
• May be assciated with rheumatoid arthritis and
  other autoimmune disorders
• Should be recognised and referred

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ACUTE CORNEAL DISORDERSSYMPTOMS
Pain Photophobia Blurred vision
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IRITIS
Sx/Sx Circumcorneal redness Pain
Photophobia Decreased vision Miotic
pupil Recognize and refer.
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SYSTEMIC ASSOCIATIONS

• Arthritis Ankylosing spondylitis
• Reiters syndrome
• Psoriatic arthritis
• Juvenile rheumatoid arthritis
• Non infectious Sarcoidosis
• Behcets disease
• Vogt Koyanagi Harada syndrome
• Systemic infections AIDS, acq. Syphilis, T.B.
  Leprosy
• Parasitic infections Toxoplasmosis
• Toxocariasis

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COMMON RED EYE DISORDERSTREATMENT INDICATED

• Hordeolum
• Chalazion
• Blepharitis
• Conjunctivitis
• Subconjunctival hemorrhage
• Dry eyes
• Corneal abrasions (most)

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VISION-THREATENING RED EYESX/SX REFERRAL
REQUIRED

• Decreased vision
• Ocular pain
• Photophobia
• Circumcorneal redness
• Corneal edema
• Corneal ulcers/dendrites
• Abnormal pupil
• Proptosis
• Elevated IOP

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VISION-THREATENING RED EYE DISORDERS URGENT
REFERRAL

• Orbital cellulitis
• Episcleritis / scleritis
• Chemical injury
• Corneal infection
• Hyphema
• Iritis
• Acute glaucoma