7/27/2019 4 26 the Acute Red Eye

1/17

THE ACUTE RED EYETHE ACUTE RED EYE

7/27/2019 4 26 the Acute Red Eye

2/17

History: Trauma? Contact lens use?History: Trauma? Contact lens use?

Previous surgery? Ocular self-medication?Previous surgery? Ocular self-medication?

Is it one eye or both?

Is it painful or sensitive to light rather thanunconfortable?

Is the vision blurred to an extent that is doesnt

clear on blinking?

7/27/2019 4 26 the Acute Red Eye

3/17

ONE EYE, NO PAIN, GOOD VISIONONE EYE, NO PAIN, GOOD VISION

Spontaneous subconjunctival haemorrhage

Episcleritis (irritation rather than pain )

Pterygia

PapillomataInfective conjunctivitis(in its early stage)

Acute dacryocystitis

Molluscum contagiosumCarotico - Cavernous Sinus fistula

Haemorrhagic teleangiectasia

Sickle cell disease

7/27/2019 4 26 the Acute Red Eye

4/17

ONE EYE, PAIN, GOOD VISIONONE EYE, PAIN, GOOD VISION

With corneal staining

Herpes simplex keratitis

Marginal ulceration

Exposure keratitis (from lagophthalmos)Moorens ulcer

Without corneal stainingAnterior uveitis (iritis)

Scleritis (nodular, diffuse, necrotizing)

Herpes zoster ophthalmicus

7/27/2019 4 26 the Acute Red Eye

5/17

ONE EYE, PAIN, REDUCED VISIONONE EYE, PAIN, REDUCED VISION

With corneal staining:

Herpes simplex: dendritic ulcer

(geographic ulcer, corneal perforation)

Acute keratitis (from bacteria, fungi )

Herpes zoster ophthalmicus

7/27/2019 4 26 the Acute Red Eye

6/17

Without corneal stainingAnterior uveitis (secondary corneal oedema)

Sympathetic ophthalmia

Acute angle closure glaucoma

Rubeotic glaucomaDisciform keratitis

Phacolytic glaucoma

Metastatic endophthalmitis (HIV positive status

Candida endophthalmitisSeptic foci elsewher in the body)

Preseptal cellulitis

Orbital cellulitis

Acute gonococcal conjunctivitis

ONE EYE, PAIN, REDUCED VISIONONE EYE, PAIN, REDUCED VISION

7/27/2019 4 26 the Acute Red Eye

7/17

BOTH EYES, NO PAIN,BOTH EYES, NO PAIN,

GOOD VISIONGOOD VISION

Acute bacterial conjunctivitisViral conjunctivitis

Acute allergic conjunctivitis

Iatrogen conjunctivitis

7/27/2019 4 26 the Acute Red Eye

8/17

BOTH EYES, PAIN, WITH ORBOTH EYES, PAIN, WITH OR

WITHOUT VISION EFFECTEDWITHOUT VISION EFFECTED

Viral keratoconjunctivitis (Photophobia - APC.)

Adult inclusion conjunctivitis (Chlamidial inf.)Vernal catarrh

Erythema multiforme (Stevens-Johnson sy)

ARC eye (after exposure to an arc welding flash)

7/27/2019 4 26 the Acute Red Eye

9/17

Red eye(s) following the use of contactRed eye(s) following the use of contact

lenseslenses

Overwear

Inadequate cleaning

Sensitivity to the cleaning solutions

Symptoms: diffusely red eyes with punctate keratopathy

discomfort with itching

excessive mucus

blurring of vision

small sterile corneal ulcers

Amoebic keratitis

Symptoms: painful watery eye

central corneal clouding

epithelial defect

7/27/2019 4 26 the Acute Red Eye

10/17

RED EYE following ocular surgeryRED EYE following ocular surgery

Cataract surgeryirritation from sutures

localised redness around the wound site

endophthalmitischronic uveitis

late corneal decompensation

Glaucoma surgerybleb infection

Retinal detachment surgery extruding explant

Corneal graft surgery graft rejection

7/27/2019 4 26 the Acute Red Eye

11/17

CHRONIC OCULAR UNEASECHRONIC OCULAR UNEASE

AND ASSOCIATED HEADACHEAND ASSOCIATED HEADACHE

7/27/2019 4 26 the Acute Red Eye

12/17

ACHING EYESACHING EYES

Optical causes

Refractive errors:Uncorrected astigmatic errors

Hypermetropia (Reading vision!)

Myopia (Undercorrected/overcorrected)

Extraocular muscle balance (strong latent squints)Non-optical causes:

Debility

Systemic viral infection (extraocularmuscle myositis)

Infections (mononucleosis)

Dry eye sy.

7/27/2019 4 26 the Acute Red Eye

13/17

HEAD AND EYE ACHEHEAD AND EYE ACHE

Chronic exess alcohol ingestions (toxic

amblyopia)

Drugs (nifedipine)

Raised intracranial pressure (BIH)

Chronic paranasal sinus disease

Cranial arteritisHerpes zoster (in its prodromal phase)

7/27/2019 4 26 the Acute Red Eye

14/17

SORE FEELINGSORE FEELING

Dry eye syndrome Sjgrens sy

Ocular pemphigoid

Superior limbic keratitis

Chronic eyedrop usageChronic blepharitisStaphylococcal blepharitis

Seborrheic blepharitis

Ocular rosaceaOther causes: Post rival keratoconjunctivitis

Corneal epithelial dystrophies

7/27/2019 4 26 the Acute Red Eye

15/17

Monocular sore feeling

exlude :

Intermittent entropion

Ingrowing lash(es)

Chronic foreign body

Molluscum contagiosum

Postoperative problems

Recurrent erosion / abrasionsy.

7/27/2019 4 26 the Acute Red Eye

16/17

TWITCHES FEELINGTWITCHES FEELING

Lid twitching

Sign of stress in the patient

Facial dystonia (recovery from VII. nerve palsy)

Globe twitching

Nystagmus: involuntary, rhythmical oscillation of the eye(s)present in any or all positions of gaze

Intermittent eye twitching (stress)

Rhithmical uniocular torsional nystagmoid-type movementsuperior oblique myokymia

Intrusory oscillations (disease if the midbrain and/orcerebellum)

7/27/2019 4 26 the Acute Red Eye

17/17

EYES WATER

Epiphora

Restricted lacrimal drainageDelayed opening of the nasolacrimal duct

Medial ectropion: poorly fitting spectacles

VII. nerve palsy

injudicious lid surgery

Punctal occlusion

Canalicular occlusion

Nasolacrimal duct obstructionFunctional blockage

Reflex tearing (symptom of many acute

and chronic ocular conditions)