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

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

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

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

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