RED EYE. 2 The Red Eye Differential Diagnosis 3 Differential Diagnosis of “red eye”...

RED EYERED EYE

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The Red EyeDifferential Diagnosis

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Differential Diagnosis of “red eye”

ConjunctivaConjunctiva Pupil Pupil CorneaCornea Anterior Anterior ChamberChamber

Intra Intra Ocular Ocular PressurePressure

SubconjucntivSubconjucntival al hemorrhagehemorrhage

Bright RedBright Red NormalNormal NormalNormal NormalNormal NormalNormal

ConjunctivitisConjunctivitis Injected Injected vesselsvessels, , DischargeDischarge

NormalNormal NormalNormal NormalNormal NormalNormal

IritisIritis Injected Injected around around corneacornea

Small Small fixed fixed irregularirregular

pupilpupil

NormalNormal TurgidTurgid

DeepDeepNormalNormal

Acute Acute glaucomaglaucoma

Entire eye Entire eye redred

Fixed Fixed dilated dilated pupilpupil

HazyHazy ShallowShallow HighHigh

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Conjunctivitis

FolliclesPapillae Purulent discharge

ChemosisRedness

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Subconjunctival Haemorrhage

Diffuse or localised area of Diffuse or localised area of blood under conjunctiva. blood under conjunctiva. AsymptomaticAsymptomatic

Idiopathic, trauma, cough, Idiopathic, trauma, cough, sneezing, aspirin, HTsneezing, aspirin, HT

Resolves within 10-14 daysResolves within 10-14 days

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Dry Eye Syndrome

Poor quality Poor quality Meibomian gland disease,Acne rosaceaMeibomian gland disease,Acne rosacea Lid relatedLid related Vitamin A deficiencyVitamin A deficiency

Poor quantityPoor quantity Kerato Conjunctivitis SiccaKerato Conjunctivitis Sicca

Sjogren SyndromeSjogren Syndrome Rheumatoid ArthritisRheumatoid Arthritis

Lachrymal disease ie, SarcoidosisLachrymal disease ie, Sarcoidosis Paralytic ie, VII CN palsyParalytic ie, VII CN palsy

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Corneal Abrasion

Surface epithelium sloughed off. Surface epithelium sloughed off. Stains with fluoresceinStains with fluoresceinUsually due to traumaUsually due to traumaPain, FB sensation, tearing, red eyePain, FB sensation, tearing, red eye

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Corneal Ulcer

InfectionInfection Bacterial: Adnexal infection, lid malposition, Bacterial: Adnexal infection, lid malposition,

dry eye, CLdry eye, CL Viral: Viral: HSV, HZOHSV, HZO Fungal:Fungal: Protozoan: Protozoan: Acanthamoeba Acanthamoeba in CL wearerin CL wearer

Mechanical or traumaMechanical or trauma Chemical: Chemical: Alkali injuries are worse than acid Alkali injuries are worse than acid

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Episcleritis

SuperficialSuperficialIdiopathic, collagen Idiopathic, collagen

vascular disorder (RA)vascular disorder (RA)Asymptomatic, mild painAsymptomatic, mild painSelf-limiting or topical Self-limiting or topical

treatmenttreatment

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Scleritis

Deep Deep IdiopathicIdiopathicCollagen vascular disease (RA,AS, SLE, Wegener, PAN) Collagen vascular disease (RA,AS, SLE, Wegener, PAN) Zoster Zoster SarcoidosisSarcoidosisDull, deep pain wakes patient at nightDull, deep pain wakes patient at nightSystemic treatment with NSAI or Prednisolone if severeSystemic treatment with NSAI or Prednisolone if severe

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Uveitis

Anterior:Anterior: acute recurrent and chronicacute recurrent and chronic

Posterior: Posterior: vitritis, retinal vasculitis, vitritis, retinal vasculitis, retinitis, retinitis, choroiditischoroiditis

Panuveitis:Panuveitis: anterior and posterioranterior and posterior

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Anterior uveitis (iritis)

Photophobia, red eye, decreased visionPhotophobia, red eye, decreased visionIdiopathic. CommonestIdiopathic. CommonestAssociated to systemic diseaseAssociated to systemic disease

Seronegative arthropathies:AS, IBD, Psoriatic Seronegative arthropathies:AS, IBD, Psoriatic arthritis, Reiter’s arthritis, Reiter’s

Autoimmune: Sarcoidosis, BehcetsAutoimmune: Sarcoidosis, Behcets Infection: Shingles, Toxoplasmosis, TB, Infection: Shingles, Toxoplasmosis, TB,

Syphillis, HIVSyphillis, HIV

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KPs

Fibrin

Posterior synechiae

Hypopyon

Ciliary flush

Flare

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Acute Angle-closure Glaucoma

SymptomsSymptoms Pain, headache, Pain, headache,

nausea-vomitingnausea-vomiting Redness, Redness,

photophobia, photophobia, Reduced visionReduced vision Haloes around Haloes around

lightslights

Corneal oedema

Ciliary hyperaemiaDilated pupil

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GLAUCOMA

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CATARACT

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CATARACT