10/21/2015 Red Eye ­ Ophthalmology | Fastbleep

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Ophthalmology ArticlesRevision Notes/ Biology Notes/ Ophthalmology

Red EyeWritten by: Sana Rasool from Manchester University,

History

Examination

10/21/2015 Red Eye ­ Ophthalmology | Fastbleep

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Inflammation of the iris and ciliary body

Risk factors:

Previous uveitisSeronegative arthropathy, especially

HLA B27 positive patientsHerpes zoster ophthalmicusSyphilisTb

Clinical features:

Young or middle aged patientsPain worse when readingPhotophobiaReduced visual acuity

On examination:

Pupil may be small and irregular (dueto posterior synechiae ­ adhesions of iristo the lens)

On using slit lamp, anterior chambermay show:

cells (moving, white specks)hypopyon ­ pus in anterior

chamber

Causes of red eye

There are many different causes of a red eye. After taking a full history and thoroughlyexamining the eyes, a management plan can be made.

Anterior uveitis

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flare (looking through frostedglass)

keratic precipitates may be seen at theback of the cornea

Management:

Treat underlying cause if found.Topical steroidsMydriatics to prevent synechaie being

formed which can cause acute glaucoma.

Due to occlusion of the angle where aqueousfluid is normally drained, therefore leading to asudden increase in intraocular pressure.

Clinical features:

Usually in patients over 50 yrs

Severe pain

Red eye

Haloes around lights

Reduced visual acuity

Fixed semidilated pupil not reactive tolight

Eye feels hard on palpation

Hazy cornea

Systemic symptoms­ headache,nausea, vomiting

Management:

Urgent ophthalmological referral toprevent visual loss

IV acetazolamide 500mg

Pilocarpine 4% topical to constrict pupil

To restore normal aqueous flow, a holeneeds to be made in the iris. This can bedone with a laser (iridotomy) or surgically(iridectomy)

Inflammation of white sclera itself

Acute angle closure glaucoma

Scleritis

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Usually very painful; significantly moreredness present compared to episcleritis

Associated with other autoimmuneconditions

Visual acuity may be affectedManagement ­ may need

immunosuppressantsComplications ­ corneal ulceration,

intraocular inflammation

Inflammation of episclera

Mild eye irritation and redness

Normal visual acuity

Management ­ usually self limiting, butsteroids may help

Causes

InfectionCorneal abrasionContact lensesExposure keratopathy (ie a patient with

facial nerve palsy who is unable to closeeyelids).

Clinical Features

PainForeign body sensationMild to moderate red eyeBlurred vision Photophobia

Examination

Staining the cornea with fluoresceinshows an area of corneal epithelial defect,and shows up yellow.

Management

Viral infection­ Topical acyclovir

Episcleritis

Corneal ulceration

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Bacterial or fungal infection­ Broadspectrum antibiotics

Non­infectious ulcer­ treat the cause.

Bright red blood between white sclera andconjunctiva. Usually benign

Can be caused by:

Severe coughing or straining

Hypertension

Blood disorders

Idiopathic

Clinical features:

Diffuse area of bright red blood

May be a foreign body

No pain, blurred vision or photophobia

Eye examination otherwise normal

Management:

Exclude hypertension

Check coagulation profile, especially ifpatient is on warfarin

Reassure patients that it is benign andmay take a few weeks to fade

Subconjunctival haemorrhage

Conjunctivitis

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References

ABC of Eyes. 4th edition.

Kennerley Banke's Clinical Ophthalmology. 4th ediition.

Image 1­ Hypopyon in anterior uveitis taken fromhttp://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_­lny8tU/s1600/ant+uveitis.jpg (http://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_­lny8tU/s1600/ant+uveitis.jpg)

Image 2­ Acute angle closure glaucoma taken from http://www.medrounds.org/glaucoma­guide/2006/12/section­9­c­diagnosis­of­acute­angle.html (http://www.medrounds.org/glaucoma­guide/2006/12/section­9­c­diagnosis­of­acute­angle.html)

Image 3­ Scleritis taken from http://eyepathologist.com/images/KL21711.jpg(http://eyepathologist.com/images/KL21711.jpg)

Image 4­ Episcleritis taken from http://www.gp­training.net/protocol/ophthalmology/redeye/episcl.jpg (http://www.gp­training.net/protocol/ophthalmology/redeye/episcl.jpg)

Image 5­ Corneal ulcer taken fromhttp://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg(http://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg)

Image 6­ Subconjunctival haemorrhage taken fromhttp://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg(http://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg)

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