RED EYE

2 The Red Eye Differential Diagnosis

3 Differential Diagnosis of “red eye” ConjunctivaPupilCornea Anterior Chamber Intra Ocular Pressure Subconjucntival hemorrhage Bright Red NormalNormalNormalNormal Conjunctivitis Injected vessels, Discharge NormalNormalNormalNormal Iritis Injected around cornea Small fixed irregular pupilNormalTurgidDeepNormal Acute glaucoma Entire eye red Fixed dilated pupil HazyShallowHigh

4 Conjunctivitis Follicles Papillae Purulent discharge Chemosis Redness

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8 Subconjunctival Haemorrhage Diffuse or localised area of blood under conjunctiva. Asymptomatic Diffuse or localised area of blood under conjunctiva. Asymptomatic Idiopathic, trauma, cough, sneezing, aspirin, HT Idiopathic, trauma, cough, sneezing, aspirin, HT Resolves within days Resolves within days

9 Dry Eye Syndrome Poor quality Poor quality  Meibomian gland disease,Acne rosacea  Lid related  Vitamin A deficiency Poor quantity Poor quantity  Kerato Conjunctivitis Sicca Sjogren Syndrome Sjogren Syndrome Rheumatoid Arthritis Rheumatoid Arthritis  Lachrymal disease ie, Sarcoidosis  Paralytic ie, VII CN palsy

10 Corneal Abrasion Surface epithelium sloughed off. Surface epithelium sloughed off. Stains with fluorescein Stains with fluorescein Usually due to trauma Usually due to trauma Pain, FB sensation, tearing, red eye Pain, FB sensation, tearing, red eye

11 Corneal Ulcer Infection Infection  Bacterial: Adnexal infection, lid malposition, dry eye, CL  Viral: HSV, HZO  Fungal:  Protozoan: Acanthamoeba in CL wearer Mechanical or trauma Mechanical or trauma Chemical: Alkali injuries are worse than acid Chemical: Alkali injuries are worse than acid

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13 Episcleritis Superficial Superficial Idiopathic, collagen vascular disorder (RA) Idiopathic, collagen vascular disorder (RA) Asymptomatic, mild pain Asymptomatic, mild pain Self-limiting or topical treatment Self-limiting or topical treatment

14 Scleritis Deep Deep Idiopathic Idiopathic Collagen vascular disease (RA,AS, SLE, Wegener, PAN) Collagen vascular disease (RA,AS, SLE, Wegener, PAN) Zoster Zoster Sarcoidosis Sarcoidosis Dull, deep pain wakes patient at night Dull, deep pain wakes patient at night Systemic treatment with NSAI or Prednisolone if severe Systemic treatment with NSAI or Prednisolone if severe

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17 Uveitis Anterior:acute recurrent and chronic Posterior: vitritis, retinal vasculitis, retinitis, choroiditis Panuveitis:anterior and posterior

18 Anterior uveitis (iritis) Photophobia, red eye, decreased vision Photophobia, red eye, decreased vision Idiopathic. Commonest Idiopathic. Commonest Associated to systemic disease Associated to systemic disease  Seronegative arthropathies:AS, IBD, Psoriatic arthritis, Reiter’s  Autoimmune: Sarcoidosis, Behcets  Infection: Shingles, Toxoplasmosis, TB, Syphillis, HIV

19 KPs Fibrin Posterior synechiae Hypopyon Ciliary flush Flare

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21 Acute Angle-closure Glaucoma Symptoms Symptoms  Pain, headache, nausea-vomiting  Redness, photophobia,  Reduced vision  Haloes around lights Corneal oedema Ciliary hyperaemia Dilated pupil

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23 GLAUCOMA

24 CATARACT

25 CATARACT