RED EYE a Differential Diagnosis M F Al

RED EYE, a Differential Diagnosis M. F. Al Fayez, MD, FRCS

RED EYE DISORDERS: NON VISION-THREATENING § Blepharitis § Hordeolum § Chalazion § Conjunctivitis § Subconjunctival hemorrhage § Dry eyes § Corneal abrasions (most)

RED EYE DISORDERS: VISION-THREATENING § Orbital cellulitis § Scleritis § Corneal infections § Hyphema § iritis § Acute glaucoma

RED EYE: POSSIBLE CAUSES § Trauma § Chemicals § Infection § Allergy § Systemic conditions

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

RED EYE: CAUSE AND EFFECT Symptom: Cause: Itching Allergy Scratchiness, burning Lid, conjunctival, Corneal disorders “ including foreign body”, trichiasis, dry eye Localized lid tenderness Hordeolum, chalazion

RED EYE: CAUSE AND EFFECT (cont'd) Symptom: Cause: Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, contact lens overwear)

CONJUNCTIVITIS Causes: bacteria, viruses, allergies, tear deficiency Pattern: palpebral or diffuse

CONJUNCTIVITIS: DISCHARGE Discharge: Cause: Purulent Bacteria Clear Viruses* Stringy, white mucus Allergies *Preauricular lymphadenopathy signals viral infection.

BACTERIAL CONJUNCTIVITIS: COMMON CAUSES Staphylococcus Streptococcus Haemophilus

BACTERIAL CONJUNCTIVITIS: TREATMENT Topical antibiotic qid x 4 days Warm compresses Refer if not markedly improved in 4 days

VIRAL CONJUNCTIVITIS Watery discharge Highly contagious Palpable preauricular lymph node URI, sore throat, fever common If pain, photophobia, or decreased vision, refer.

ALLERGIC CONJUNCTIVITIS • Associated conditions: hay fever, asthma, eczema • Contact allergy: chemicals, cosmetics • Treatrnent: topical antihistamines, artificial tears to relieve itching Refer refractory cases.

NEONATAL CONJUNCTIVITIS: CAUSES • Chemical (silver nitrate) • Bacteria (N gonorrhoeae, Staphylococcus, Streptococcus) • Chlamydia • Viruses (herpes) • Systemic chlamydial infection

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

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

TEAR DEFICIENCY STATES: SYMPTOMS • Burning • Foreign-body sensation • Reflex tearing

TEAR DEFICIENCY STATES: ASSOCIATED CONDITIONS • Blepharitis • Aging • Rheumatoid arthritis • Stevens-Johnson syndrome • Systemic medications; e. g.

DRY EYES: TREATMENT • Artificial tears • Lubricating ointment hs • Punctal occlusion

EXPOSURE KERATITIS • Due to incomplete lid closure • Manage with lubricating solutions/ointments • Tape lids shut at night • Do not patch • Refer severe cases

INFLAMED PINGUECULA AND PTERYGIUM: MANAGEMENT Artificial tears & Topical vasoconstrictors § if severe, refer

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

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

ACUTE CORNEAL DISORDERS: SYMPTOMS • Pain • Photophobia • Blurred vision

IRITIS Sx/Sx • Circumcorneal redness • Pain • Photophobia • Decreased vision • Miotic pupil Recognize and refer.

SYSTEMIC ASSOCIATIONS Arthritis: Ankylosing spondylitis Reiter’s syndrome Psoriatic arthritis Juvenile rheumatoid arthritis Non infectious: Sarcoidosis Behcet’s disease Vogt Koyanagi Harada syndrome Systemic infections: AIDS, acq. Syphilis, T. B. & Leprosy Parasitic infections: Toxoplasmosis Toxocariasis

COMMON RED EYE DISORDERS: TREATMENT INDICATED • Hordeolum • Chalazion • Blepharitis • Conjunctivitis • Subconjunctival hemorrhage • Dry eyes • Corneal abrasions (most)

VISION-THREATENING RED EYE SX/SX: REFERRAL REQUIRED • Decreased vision • Ocular pain • Photophobia • Circumcorneal redness • Corneal edema • Corneal ulcers/dendrites • Abnormal pupil • Proptosis • Elevated IOP

VISION-THREATENING RED EYE DISORDERS: URGENT REFERRAL • Orbital cellulitis • Episcleritis / scleritis • Chemical injury • Corneal infection • Hyphema • Iritis • Acute glaucoma