CDA - Red Eye

Question 1

What are your DDx and Dx?
25 year old male
* PC: Woke with eyes stuck together this
morning. Not much pain but some burning
discomfort, no itching, no headaches, no
photophobia,
* FH: Nil relevant
* GH: Nil relevant
* POH: Nil relevant
* Meds: Nil relevant
* VA: OD 6/7.5 OS 6/6
* SL: as shown. Some matting of lashes.
Blood vessels can be moved with a cotton
bud (with anaesthesia). Some conjunctival
swelling and tarsal papillae. AC no cells or
flare. Cornea NaFl NAD
* OD & OS Posterior Pole NAD

Answer 1

Acute bacterial conjunctivitis

• Onset this morning
• the oedamatous conjunctival vessels can be moved
• Lids stuck together
• Papillae on lids
• no itch, pain (uveitis, scleritis, keratitis)
• AC is D and Q (no uveitis, scleritis, keratitis)
• no watery discharge (viral)
• normal VA (nil involvement with posterior pole)
• no systemic involvement (inflammatory, viral)

Question 2

What are your DDx and Dx?
* 45 year old male
* PC: Red OD last 8 days, initially noticed
by his wife. Mild irritation, FB sensation
last 4 days. No change in vision, no
discharge
* FH: Diabetes and diabetic retinopathy
* GH: Good, no meds
* POH: Occasional intermittent ocular
redness (OU), past ~20 years
* VA: OD 6/6 OS 6/6
* SL: OD as shown, lids and conjunctiva
clear otherwise. Cornea clear, fundus
clear, AC quiet. OS NAD.
* IOP: 17mmHg OU

Answer 2

Episcleritis (sectoral + nodular)
- mild discomfort and long duration (not uveitis, scleritis)
- Sectoral hyperaemia
- Associated with recurrence
- No itch, pain, AC/ corneal involvement
- no discharge
- IOP is normal
- no cells or flares

Question 3

What are your DDx and Dx?
* 45 year old female
* PC: Red OS last 3 days. Very painful,
photophobia, epiphora.
* FH: NAD
* GH: sore shoulders and hands
* POH: Nil
* VA: OD 6/6 OS 6/7.5
* SL: OS as shown, deep red eye. No blanching
of vessels with low dose Phenylephrine. Lids
clear, cornea clear, fundus clear, AC possibly
a few cells. OD NAD.
* IOP: 17mmHg OU

Answer 3

Scleritis
- Painful, few days of onset, epiphora and photophobia
- Diffuse redness and colour is deep red/ purple
- Cannot blanch with 2.5% phenyl
- AC involvement
- is not uveitis because uveitis has circumlimbal redness
- is not keratitis because cornea is clear

Question 4

What are your DDx and Dx?
* 45 year old female
* PC: Red OS last 3 days (symptoms worsening).
Very painful, photophobia, epiphora.
* FH: Rheumatoid Arthritis
* GH: Nil
* POH: Occasional sore eyes like this over past
25 years. Doctor gave antibiotics and it
cleared up over a month or so.
* VA: OD 6/6 OS 6/9
* SL: OS as shown, irregular pupil, circumlimbal
redness especially temporally, lots of cells and
flare in AC. OD NAD.
* IOP: OD 17mmHg, OS 22mmHg

Answer 4

Acute Anterior Uveitis (~iritis)
- Really painful, photophobia, epiphora
- Circumlimbal redness and AC (cells and flares)
- not episcleritis and conjunctivitis due to AC
- Assocaited with recurrence
- No itch, corneal involvement
- no mucopurulent dischage (bacterial)
- Epiphora due to CNV involvement
- slightly reduced VA
- Systemic involvement in history (joint in pain may indicate scleritis, uveitis)
- IOP slightly high (possibility of angle closure)

Question 5

DDx and Dx?
* 25 year old female
* PC: Both eyes itchy, burning, sore. Really
uncomfortable wearing soft contact lenses.
* FH: myopia
* GH: Nil
* POH: wearing soft Cl for past 10 years.
Mainly monthly disposable. “Can get 7-8
weeks before they become uncomfortable”
* VA: OD 6/6 OS 6/6
* SL: OS shown, diffuse bulbar conjunctival
redness, no AC reaction. OD very similar.
* IOP: 17mmHg OU

Answer 5

Giant papillary conjunctivitis
- itchy, sore, inflammed lids with large papilae
- CL overwear (red flag)
- not follicles (virus)
- nil purulent discharge (bacterial)
- normal/ slightly reduced VA
- nil systemic involvement in history