The red eyeThe red eye

The red eyeThe red eye

– Aim to distinguish Aim to distinguish acute emergency from acute emergency from less urgentless urgent

Vision affected?Vision affected?

Pain?Pain?

Unilateral/bilateral?Unilateral/bilateral?

Distinguish conjunctival Distinguish conjunctival injection from ciliary injection from ciliary flushflush

The red eyeThe red eye– Acute conjunctivitisAcute conjunctivitis

– <3 weeks<3 weeks

Red eyeRed eye

DischargeDischarge– Watery, mucoid, purulentWatery, mucoid, purulent

IrritationIrritation– Cornea clearCornea clear– Vision goodVision good

Swab for Swab for culture+sensitivityculture+sensitivity

clean + topical antibioticclean + topical antibioticchloramphenicolchloramphenicol

The red eyeThe red eye

Acute conjunctivitisAcute conjunctivitis– PapillaePapillae

Non specificNon specific– Except Giant papillaeExcept Giant papillae

atopic diseaseatopic disease

FbFb

– FolliclesFolliclesPhysiologic in childrenPhysiologic in children

Chlamydia,adenovirus,Chlamydia,adenovirus,herpes simplex, herpes simplex, molluscum,molluscum,

drug toxicity, trachomadrug toxicity, trachoma

The red eyeThe red eyeBacterial conjunctivitisBacterial conjunctivitis

– Less common than viralLess common than viral

Conjunctival inflammationConjunctival inflammation

Purulent dischargePurulent discharge

– Usually self limitingUsually self limiting– Occasionally sight Occasionally sight

threateningthreatening

GonococcalGonococcal

Swab:Swab:Neonate,immunodeficientNeonate,immunodeficient

Severe casesSevere cases

Unresponsive casesUnresponsive cases

The red eyeThe red eye– KeratitisKeratitis

Inflammation of corneaInflammation of cornea– InfectionInfection

BacteriaBacteriaVirusVirusFungusFungusProtozoaProtozoa

– Dry EyeDry Eye– ToxicityToxicity– TraumaTrauma

ChemicalChemicalMechanicalMechanicalUV light (arc eye)UV light (arc eye)

loss of transparencyloss of transparency– Reduced acuityReduced acuity– +/-pain+/-pain

The red eyeThe red eyeCorneal ulcerCorneal ulcer– EmergencyEmergency

scrape for Gram stain scrape for Gram stain and cultureand culture

Intensive topical Intensive topical antibioticsantibiotics

– FluoroquinoloneFluoroquinolone

– Fortified gentamicin Fortified gentamicin and cefuroximeand cefuroxime

The red eyeThe red eyeCorneal foreign bodyCorneal foreign body

RemoveRemove

Topical antibioticTopical antibiotic

UV keratitisUV keratitisHistory of weldingHistory of welding

Cycloplegic + patchCycloplegic + patch

The red eyeThe red eye– UveitisUveitis

Inflammation of iris, ciliary Inflammation of iris, ciliary body, choroidbody, choroid

Anterior uveitisAnterior uveitis– PainPain– Sensitivity to lightSensitivity to light– BlurringBlurring– Ciliary flushCiliary flush

Deep ACDeep ACClear corneaClear cornea

– But keratic precipitatesBut keratic precipitates

AC flare and cellsAC flare and cellsIrregular shape of pupilIrregular shape of pupil

The red eyeThe red eye– UveitisUveitis

Topical steroidTopical steroid– Prednisolone 1%Prednisolone 1%

CycloplegiaCycloplegia

– Often recurrentOften recurrent

– Chronic cases need Chronic cases need investigation investigation

The red eyeThe red eyeHerpes simplex Herpes simplex keratitiskeratitis

DiscomfortDiscomfortWateringWateringPhotophobiaPhotophobiaCiliary flushCiliary flush

Dendritic pattern of Dendritic pattern of fluorescein stainingfluorescein stainingReduced corneal Reduced corneal sensationsensation

– Recurrent diseaseRecurrent disease

The red eyeThe red eye– Herpes simplex keratitisHerpes simplex keratitis

Topical aciclovirTopical aciclovir

+/- debridement with +/- debridement with sterile swabsterile swab

Do NOT use steroid in Do NOT use steroid in epithelial diseaseepithelial disease

– HSV can also affect HSV can also affect stroma and endothelium stroma and endothelium which require steroid but which require steroid but these require close these require close supervisionsupervision

The red eyeThe red eyeHerpes zoster Herpes zoster ophthalmicusophthalmicus

Reactivation of latent Reactivation of latent infection of trigeminal infection of trigeminal ganglion with varicella-ganglion with varicella-zoster viruszoster virus

Older age groupOlder age group

Can be triggered by Can be triggered by malignancy, HIV, malignancy, HIV, immunosuppressionimmunosuppression

The red eyeThe red eye– Herpes zoster Herpes zoster

ophthalmicusophthalmicusProdromal fever, malaiseProdromal fever, malaise

Rash in dermatomeRash in dermatome– Vesicular, becoming Vesicular, becoming

crustycrusty

Painful (mayPainful (maychronic)chronic)

Inflammation can affect Inflammation can affect ALL parts of eyeALL parts of eye

– Lids, cornea, sclera, AC, Lids, cornea, sclera, AC, uvea, optic nerve, uvea, optic nerve, cranial nervescranial nerves

– Can result in corneal Can result in corneal opacity, new vesselsopacity, new vessels

The red eyeThe red eye– Herpes Zoster Herpes Zoster

ophthalmicusophthalmicus– Oral aciclovir 800mg Oral aciclovir 800mg

x5 daily for 10 days x5 daily for 10 days starting WITHIN 72 starting WITHIN 72 hrs of onsethrs of onset

– Topical ACV not Topical ACV not indicatedindicated

– Topical steroids and Topical steroids and cycloplegia for cycloplegia for stromal keratitis and stromal keratitis and uveitisuveitis

Need very slow Need very slow tapertaper

– Respect this Respect this condition!condition!

The red eyeThe red eyeAcute glaucomaAcute glaucoma

PainPain

Blurring of visionBlurring of vision

High IOPHigh IOP

Ciliary flushCiliary flush

Hazy corneaHazy cornea

Mid-dilated pupilMid-dilated pupil

Shallow anterior Shallow anterior chamberchamber

The red eyeThe red eyeAcute glaucomaAcute glaucoma

Timolol 0.5%Timolol 0.5%

Pilocarpine 1%-2%Pilocarpine 1%-2%– Q15 minutes x3Q15 minutes x3

PrednisolonePrednisolone

Oral/iv DiamoxOral/iv Diamox– Beware CCF, renal Beware CCF, renal

diseasedisease

– When acute attack When acute attack broken perform laser broken perform laser or surgical iridotomyor surgical iridotomy