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The Infected Red Eye
Simon Taylor MA PhD FRCOphthClinical Senior Lecturer & Consultant Ophthalmologist
Affected ocular structures
Conjunctiva Cornea Intraocular contents Lids and orbit
Symptoms and signs
SYMPTOMS
Pain Watering Redness Photophobia Diplopia Poor vision
SIGNS
Reduced visual acuity Lid swelling/redness Conjunctival
swelling/injection Corneal ulceration Hypopyon
Restricted eye movements
Relative afferent pupillary defect
Fever
Bacterial conjunctivitis
Very common Bilateral Redness Grittiness Morning stickiness Normal visual
acuity Staph &
Streptococcus
Severe conjunctivitis
HAEMORRHAGIC
Enterovirus 70 Highly contagious Self-limiting
GONOCOCCAL
Hyperacute onset Profuse creamy pus Periocular oedema
Viral Conjunctivitis
Adenovirus Acute onset Bilateral in 60% Watering, redness,
discomfort, photophobia
Follicular response Very contagious
Neonatal Conjunctivitis
5-14 days after birth
Mainly chlamydial Could be
gonococcal Purulent discharge Papillary reaction Sup. corneal
pannus Conjunctival
scarring
Corneal infections Contact lens wear
Bacterial Acanthamoeba
Gardening injury or Organic FB Bacterial Fungal
Wooden foreign body
scedosporium
Corneal infetions
Elderly, diabetic, use of expired eyedrops
Use of contact lenses
History of foreign body/trauma
Ask about cold sores Marginal
ulcer
Dendritic ulcers
Viral in origin Pain & Watering Photophobia Treat with Oc.
Aciclovir
Dendritic ulcers
Dendritic ulceration
AVOID STEROIDS!
Crystalline keratopathy
Viridans streptococci
Exogenous endophthalmitis
Following any intraocular procedure Cataract surgery Intravitreal injection
Pain, eyelid swelling, reduced vision and vitritis are all compelling signs
Endogenous endophthalmitis
BACTERIAL FUNGAL
Dacryocystitis
Lacrimal Sac Abscess
Acute or chronic Secondary to
blockage of nasolacrimal duct
Watering & discharge
Red, tense, painful swelling
Orbital cellulitis
Systemically unwell
Restricted eye movements
Optic nerve compromise Colour vision RAPD Distance acuity