1. Acute unilateral red eye
Dr. Anthony Hall MD, FRANZCO

2. differential diagnosis of the unilateral red eye
Eyelid
Conjunctiva
Conjunctivitis
Cornea
Corneal foreign body/ulcer
Infectious keratitis
Sclera
Anterior chamber
Iritis
Angle closure glaucoma
Orbit

3. Eyelid

4. Acute lid problems
Chalazion
Preseptal cellulitis

5. Chalazion Obstructed and infected and inflamed meibomian gland
Unilateral, unifocal lid swelling

6. Chalazion – initial treatment
Topical antibiotics
+ oral if associated cellulitis
Hot compresses
If fails then surgery

7. Chalazion – surgical treatment
Lid everted
Chalazion incised form tarsal surface

8. Preseptal cellulitis Acutely unwell Swollen, tender red eyelid
No orbital signs
No proptosis, visual loss, movement problems

9. Orbital vs preseptal cellulitis
The orbital septum divides the eyelid from the orbit

10. Conjunctiva

11. Conjunctivitis Viral Watery discharge URTI Allergic Itch
Stringy discharge
Atopic patient
Usually bilateral!!

12. Viral conjunctivitis URTI Acute pain, redness, and watery discharge
Normal pupil
Normal VA
Normal cornea
Management

13. Allergic conjunctivitis
Atopy
Sub-acute irritation, itch, redness, and stringy discharge
Normal pupil
Normal VA
Normal cornea

14. Subconjunctival haemorrhage

15. Cornea

16. Keratitis Suspect if Corneal fluorescein stain (dendritic)
Focal corneal swelling
Past history HSV/VZV
Contact lens wear
Post trauma
                                

17. Keratitis management
HSV
Topical aciclovir till epithelium healed

18. Keratitis management
Bacterial
Intensive topical antibiotics

19. Corneal foreign body/ulcer
Suspect if
History of grinding etc
Fluorescein staining
Corneal/subtarsal foreign body
Always evert eyelid

20. Management of corneal FB
Topical LA
Remove fb with 23 G needle
Oc Chloro and pad 24 hrs

21. Underlying cornea is clear - iris details are seen
Corneal ulcer
Without Fluorescein: 
Underlying cornea is clear - iris details are seen

22. Fluorescein with or without cobalt blue filter

23. Anterior chamber

24. Trauma Hyphaema or corneal abrasion may follow trauma
In this setting beware of
Keratitis
Perforation

25. Iritis (acute anterior uveitis)
Inflammation confined primarily to the iris and anterior chamber
Resolving totally within three months
(not associated with other significant anterior or posterior segment pathology)

26. Iritis - symptoms
pain
redness
photophobia
epiphora

27. Iritis - signs ciliary flush small irregular pupil AC cells and flare
keratic precipitates
hypopyon
iris nodules
spill over vitritis

29. Iritis - aetiology

30. B 27 related diseases Ankylosing spondylitis Psoriatic arthritis
Reiters syndrome (reactive arthritis)
Inflammatory bowel disease associated arthropathy

31. Sarcoidosis Multisystem granulomatous disease 90% lung 90% lymph node
25-50% joint involvement
25% skin
25% eye

32. Syphilis Primary 4-6 weeks of ulcer Secondary 2-4 months
Skin rash and lymphadenopathy
Eye and CNS involvement
Latent/tertiary
CVS and CNS

33. Viral Suspect if History of simplex or zoster Chronic course
Iris changes
High pressure
Keratitis (old or new)

34. Investigation of AAU Most important Clinical History Family history
Examination
Less important
HLA B 27
Sarcoidosis
CXR
ACE
Syphilis serology

35. Principles of management of Iritis
Determine the underlying cause
Control the inflammation
Detect and control ocular complications of
the inflammation
the treatment

36. How to control the inflammation
Adequate high potency topical steroids
Sub conjunctival steroids
Oral steroids
Aggressive dilation
Regular and close review

37. Acute angle closure glaucoma
Unusual
Severe pain
Profound visual loss
Cloudy cornea
Fixed mid position pupil
Treatment
iridotomy

42. Orbital disease

43. Orbital cellulitis Pre septal Orbital Acute lid swelling
No chemosis, visual loss or eye movement disorder
Secondary to trauma, chalazia, lacrimal sac disease
Orbital
Lid swelling
Chemosis, visual loss, eye movement abnormalities
Secondary to sinus disease

44. Pre septal
Orbital

45. Treatment Pre septal Orbital Antibiotics Image Drain sinus disease
Drain orbital disease

46. Key steps in the diagnosis of the unilateral red eye
History
Ocular
Previous episodes
CL wear
Trauma
Systemic
Auto-immune disease
Recent URTI
Examination VA
Cornea
Pupil
Conjunctiva