1. Juan S. Lopez, MD UP-PGH, UST, St. Luke’s, EAMC
The RED EYE
Juan S. Lopez, MD
UP-PGH, UST, St. Luke’s, EAMC

2. Complaints of “red eye” Differentiation of redness of the globe
Forms of redness:
• Subconjunctival hemorrhage
• Vascular congestion

3. Subconjunctival hemorrhage
• Common eye disorder
• Occurs in any age group
• Rupture of conjunctival
blood vessel
• Sudden onset, bright red
• Alarming to the patient
• Usually in one eye, rare
bilateral
• Not asso. w/ any intraocular hemorrhage
• May occur spontaneously

4. Subconjunctival hemorrhage
• Forceful coughing, sneezing, rubbing, straining, lifting or pushing heavy objects, BP
• If recurrent R/O blood dyscracia or HPN
• Rx: › Reassurance not blinding, only external
› CMC 5-10 mins. tid 1st 24 hrs.
› WMC tid daily thereafter until cleared up
If recurrent:
› Ascorbic acid (Vit C) 500mg bid
› Medical workup & management
• Hemmorhage absorbs in 1-2 weeks

5. Vascular congestion • Hyperemia of conjunctival vessels
• External surface inflammation
• Intraocular inflammation

6. Hyperemia of conjunctival vessels
• Most common cause of
red eyes
• Smoke, smog, other
irritants
• Topical vasoconstrictors,
cold compresses helpful

7. “All red eyes are not pink eye” - a useful maxim
The physician must be alert for the more
serious causes of red eye which are
potentially blinding such as external
surface and intraocular inflammations.

8. External Surface Inflammations
• Episcleritis • Acute Conjunctivitis
• Scleritis • Acute Keratitis

9. Episcleritis • Inflammation of the episclera • Usually unilateral
• Cause unknown,
hypersensitivity rxns
• Assoc. w/ certain
systemic diseases
• Localized redness & swelling of episclera
• Mild pain, tenderness, tearing
• Rx: topical steroid or NSAID drops

10. Scleritis • Inflammation of the sclera, relatively rare
• Assoc. w/ systemic
diseases (TB, RhA)
• Unilateral or bilateral
• Severe pain, tenderness
• Intense scleral swelling
& deep congestion
• Recurrent, underlying
choroid visible, rupture
• Rx: steroids, NSAID,
immunosuppressives

11. Acute Conjunctivitis • Extremely common
• Watery to mucoid, mucopurulent or purulent discharge
• Clear vision, fb sensation, itching, no pain
• Diffuse redness, clear cornea, normal pupil
size & IOP

12. Acute Conjunctivitis
Types
• Allergic
• Bacterial
• Viral
• Chemical

13. Allergic Conjunctivitis
• Redness, itching, tearing
• Lid swelling, conj. edema
or chemosis, pale conj.
congestion
• Pollens, weeds, dust, etc.
• Recurrences are common
• Rx:
› Antihistamine/vaso-
constrictor, mild steroid/
antibiotic drops
› Oral antihistamines
› Cold compresses

14. Bacterial Conjunctivitis
• Acute onset, unilateral or bilateral
• Redness, mucopurulent or purulent discharge
• Lids swollen, stuck in a.m. w/ discharge
• Mild to severe
• Rx: appropriate topical antibiotic drops,
and/or oral antibiotics

15. Bacterial Conjunctivitis
• Gonorrheal STD
• Pneumococcal - URTI
• Hemophilus URTI
• Chlamydia STD
• Staphylococcal - Blepharitis
• Moraxella Blepharitis

16. Bacterial Conjunctivitis
Gonorrheal Conjunctivitis - Hyperacute, purulent discharge
corneal melting perforation

17. Bacterial Conjunctivitis
1. Pneumococcal Conjunctivitis
- Acute Catarrhal Conjunctivitis
- Mucopurulent dischagre
2. Hemophilus sp. Conjunctivitis
- Acute, Subacute
- Mucopurulent discharge

18. Bacterial Conjunctivitis
Chlamydia Conjunctivitis - Chronic, mucopurulent discharge
Staphylococcal Blepharo Moraxella Blepharo-
conjunctivitis conjunctivitis

19. Viral Conjunctivitis • Very common
• Referred to by general public as “sore eyes”
• Easily spread, epidemic form
• Usually bilateral
• Mild to severe
• Redness, lid swelling, tearing
• Watery, mucoid or mucopurulent discharge
• Asso. w/ fever, sorethroat

20. Viral Conjunctivitis • Adenoviruses usual etiology
› Most common cause of Membranous
conjunctivitis
› Pharyngoconjunctival Fever (PCF) - types 3,7
› Epidemic Keratoconjunctivitis ( EKC 25%)
- types 8, 19
• Enterovirus 70, Coxsackievirus A24
- rare epidemics
› Acute Hemorrhagic Conjunctivitis (AHC)
• No specific Rx, self limited, topical vaso-
constrictor, topical prophylactic antibiotic,
steroids avoided

21. Viral Conjunctivitis
Adenoviral PCF w/ Membrane
EKC Enterovirus AHC

22. Chemical Conjunctivitis
• Chemical burns are eye emergency
• Acids denature tissue protein immediately
• Alkalies penetrate tissues deeper & linger
• Pain, redness, photophobia, blepharospasm
• Lid & bulbar adhesion, corneal opacification
• Severe burns have poor prognosis
• Rx: › Immediate profuse irrigation w/ water or
saline solution at least for 1 hour
› Remove any solid material
› Cold compresses, analgesic, topical
antibiotic, pupillary dilation
› Surgery for remediable cases

23. Chemical Conjunctivitis
Localized conj. ischemia Diffuse conj. ischemia
Symblepharon, Corneal fibrovascualr membrane

24. Acute Microbial Keratitis (Corneal Ulcer)
• Common
• Diffuse redness
• Watery to purulent discharge
• Moderate to severe pain
• Vision usually blurred
• Corneal opacity, hypopyon
• Assoc. trauma
• Etiology: Bacterial, Viral, Fungal
• Corneal perforation, endophthalmitis
• Gram & giemsa stains, C/S
• Rx: topical, i.v. & oral antimicrobial agents, pupillary dilation, steroids contraindicated

25. Acute Microbial Keratitis
Common Bacterial agents
Pseudomonas Pneumococcus
Moraxella

26. Acute Microbial Keratitis Viral Agent
Herpes Simplex Virus (HSV) - recurrent, lifetime

27. Acute Microbial Keratitis Fungal Agents Common, filamentous Rare
Fusarium sp Dematiaceous (pigmented)
Aspergillus sp.

28. Acute Microbial Keratitis
Complications
Corneal perforation, Corneal opacification,
endophthalmitis, vascularization
phthisis bulbi

29. Intraocular Inflammations
• Acute Anterior Uveitis
• Acute Angle Closure Glaucoma

30. Acute Anterior Uveitis
• Inflammation of the iris & ciliary body
• Many causes, mostly unknown, few specific
• Common, recurrent
• Moderate to severe pain,
tenderness
• Blurred vision, photophobia
• Circumcorneal redness,
no discharge
• Clear cornea, irregular
small pupil, AC w/ fibrin
coagulum
• Normal IOP

31. Acute Anterior Uveitis
• Keratic precipitates,
aqueous flare & cells
• Posterior synechiae,
iris bombé, peripheral
anterior synechia Kps
Flare PS, Iris bombé

32. Acute Anterior Uveitis
• Complications: secondary
cataract, glaucoma
• Rx:
› Topical cycloplegics to
dilate pupil immediately
& prevent sequelae of
posterior synechiae
› Topical steroids to
resolve the inflammation

33. Acute Angle Closure Glaucoma
• Uncommon 10-15%
but an eye emergency
• Preexisting anatomic
narrowing of AC angle
• Occlusion of the angle Normal AC depth, angle
by peripheral iris
• Blocked aqueous outflow, IOP 60-80mm Hg (N=8-21mmHg)
Narrow occludable angle Closed angle

34. Acute Angle Closure Glaucoma
• Sudden severe pain,
redness, BOV, vomiting
• Shallow AC, steamy
cornea, middilated pupil
• Immediate Rx directed
at reducing IOP
• If delayed Rx & IOP mm Hg, permanent
severe optic nerve damage in hrs, visual
loss
• Medical Rx: topical miotics, beta blockers, & steroids; oral carbonic anhydrase inhibitors &
glycerol; i.v. mannitol
• Laser iridotomy or surgical peripheral iridec- tomy on involved eye, prophylactic on fellow
eye

35. THANK YOU