Acute Red Eye

Question 1

Key Questions to ask in acute red eye

Answer 1

1. Uni or Bilateral
2. pain/ photophobia?
3. Discharge
4. Vision affected?
5. Pupil affected

Question 2

severe and non severe causes of acute red eye

Answer 2

Severe: Acute glaucoma, acute iritis, corneal ulcers

Non-Severe: Episcleritis, conjunctivitis, spontaneous conjunctival haem

Question 3

conjunctivitis - C / CF / T

Answer 3

Allergic or Non allergic/infective

CF - Allergic (chronic issue, itching, burning, watery sticky discharge)

Infective (bilateral, discharge esp in bact, red, follicles in viral, VERY contagious if viral) Acuity is UNaffected

T - often self-limiting, if prolonged :
allergic = anti-hist drops
bact = antibiotic eye drops (chloramphenicol)
other = steroid drops??

Question 4

corneal abrasion / ulcer C / PC and o/e / I / Comp / T

Answer 4

abrasion = epithelial breach without keratitis treated with chloramphenicol +/- cycloplegia

ulcer = bacterial / herpetic / protozoal/ fungal/ vasculitis
PC - painful, photophobic, watering
o/e - if bacterial - visible corneal opacity
I - FLUORESCEIN
comp - scarring or visual loss

T - get expert help urgently

Question 5

anterior uveitis - CF / I / C / T

Answer 5

CF - acute pain, photophobia, blurred, lacrimation, redness, small pupil
(always enquire about systemic conditions)

I - talbots test - pain on pupil convergence / slit lamp = white precipitates on back of cornea + cells in anterior chamber

C - MANY MANY
T - refer to ophthalmology - steroids (pred drops) + pupil dilation (cyclopentdate)

Question 6

Trauma - results in

Answer 6

sub tarsal foreign body, corneal abrasion, chemical injury

Question 7

iritis - PC / I / T

Answer 7

PC - pupil strange shape, painful, photophobic, ciliary injection, cells and flare

I - no need to investigate

T -

Question 8

Acute Glaucoma - ? / CF / T / C

Answer 8

? - blocked drainage of aqueous from the anterior chamber via canal of schlemm –> increased intra oc pressure

CF - Pain, Visual loss, corneal haze, redness, fixed semi dilated pupil, eye feels hard (+/- other: N+V)

T -

• topical cholinergic agonist (pilocarpine)
• carbonic anhydrase inhib/top B blocker (acetazolamide / timolol)
• laser iriditomy after acute attack resolves (when press down)

+/- analgesia +/- anti emetic

C - prim or secondary (other eye dis= thick cataract lens, ectopic lens, DM retinop) or drugs