The Red EyeMarc A. Booth, M.D.10 April 2013

ObjectivesObtain a pertinent history for patients presenting with a red eye Formulate a differential diagnosis for a patient with a red eye based on history and examKnow when to begin therapy versus refer/defer management Identify patients with red eye problems which require immediate referral to an ophthalmologist for treatment

Pre-Lecture Quiz Question 1Which is/are in the differential diagnosis for red eye?A) ConjunctivitisB) ScleritisC) Ocular foreign bodyD) Angle Closure GlaucomaE) All of the Above

Pre-Lecture Quiz Question 2Which is not associated with acute viral conjunctivitis?A) Mucoid or serous dischargeB) Preauricular adenopathyC) PhotophobiaD) Palpebral (conjunctival) papillae E) Blurry vision

Pre-Lecture Quiz Question 3Which is not associated with pre-orbital/pre-septal cellulitis?A) Decreased visual acuityB) Lid erythema and edemaC) PtosisD) FeverE) Full ocular motility

Pre-Lecture Quiz Question 4Which of the following has no role in treating HSV epithelial keratitis?A) Superficial debridementB) Topical ganciclovir (Zirgan)C) Topical steroids (Pred Acetate)D) Oral Antivirals (acyclovir)E) Topical trifluridine (Viroptic)

The Red EyeInfectiousPreseptal CellulitisAnterior to orbital septum globe and orbit not involvedS.aureus likely if traumaticEyelid swollen, red, ptosis, pain, mild feverNo change: vision, pupil, motility, proptosisD/Dx: Orbital cellulitis, idiopathic orbital inflammation, abscess, dacryoadenitis, dacryocystitis, rhabdomyosarcoma (peds)rapid, painful, progressive. 7yr old boy

The Red EyeInfectiousPreseptal CellulitisHistory: sinus surgery/disease, traumaExam: External, Va, EOM, pupils.Ancillary tests: Orbital CT, CBC, blood cx.Treatment: Oral vs IV antibiotics IV, compliance, septic patient

The Red EyeInfectiousDacryocystitis ------------->

Rhabdo

Preseptal --------------------->

The Red Eye InfectiousPreseptal vs Orbital CellulitisOrbital (septal): similar to preseptalKEY SIGNS: decreased visual acuity, afferent pupillary defect, limited ocular motility, proptosisMost commonly secondary to ethmoidal sinusitis

Beware of Mucormycosis with DM

The Red EyeInflammatoryChalazionGraves Disease

The Red EyeInflammatoryChalazionObstruction and inflammation of meibomian gland with leakage of sebum into surrounding tissue and resultant lipogranuloma formationHordeolum is secondary to an acute bacterial infection Painful red lump on eyelidTreat with warm compresses, incise after 4-6 weeksIf multiple, recurrent, unresponsive to treatment beware of possible sebaceous carcinoma

The Red EyeInflammatoryGraves DiseaseVariabilityAsymptomatic to NLP Frozen Globe Observation to orbital/muscle/lid surgeryLid retraction is most common signFemale predilection (5-8:1)FBS, decreased vision (acuity or color), motility disturbanceOrbital CT to assess EOMs, IMSLO

The Red EyeInflammatoryGraves DiseaseUnilateral

Bilateral

Skin and Adnexal Disorders InfectiousPreseptal CellulitisHistory: sinus surgery/disease, traumaExam: External, Va, EOM, pupils.Ancillary tests: Orbital CT, CBC, blood cx.Treatment: Oral vs IV antibiotics IV, compliance, septic patient

Post-Lecture Quiz Question 1Which is/are in the differential diagnosis for red eye?A) ConjunctivitisB) ScleritisC) Ocular foreign bodyD) Angle Closure GlaucomaE) All of the Above

Post-Lecture Quiz Question 2Which is not associated with acute viral conjunctivitis?A) Mucoid or serous dischargeB) Preauricular adenopathyC) PhotophobiaD) Palpebral (conjunctival) papillae E) Blurry vision

Post-Lecture Quiz Question 3Which is not associated with pre-orbital/pre-septal cellulitis?A) Decreased visual acuityB) Lid erythema and edemaC) PtosisD) FeverE) Full ocular motility

Post-Lecture Quiz Question 4Which of the following has no role in treating HSV epithelial keratitis?A) Superficial debridementB) Topical ganciclovir (Zirgan)C) Topical steroids (Pred Acetate)D) Oral Antivirals (acyclovir)E) Topical trifluridine (Viroptic)