Diagnoes Red Eye Flashcards
DDX Conjunctivitis: Diffuse conjunctival hyperemia, +/- chemosis and ocular discharge, No corneal disease and eye otherwise normal
- KCS
- Infectious disease (chlamydophilla or herpes)
- Mechanical/Chemical Irritants (FB)
- Stress
Diagnostics Conjunctivitis
STT
Fluoroscein Stain Test
Swab and Culture
DDX Superficial Keratitis/Keratoconjunctivitis: conjunctival hyperemia, long-branching corneal vessels (superficial - location and direction may indicate disease type)
- Non-ulcerative superficial keratitis (KCS, exposure, abherrant hairs/entropion, immune-mediated keratitis, pannus, CSK - chronic superficial keratitis)
- Superficial corneal ulceration (look for underlying disease)
Diagnostics Superficial Keratitis/Keratoconjunctivitis
Good physical
STT
Fluoroscein
DDX Stromal Keratitis: conjunctival hyperemia, vessels straighter, hedge-like (location may help determine cause)
- non-ulcerative stromal keratitis (primary corneal disease; secondary to glaucoma or uveitis)
- Deep ulcer/laceration
Diagnostics Stromal Keratitis
Check Pressure (high gluacoma, low uveitis)
STT
Fluoroscein
Pupil size (large/mydriasis glaucoma, small/miosis uveitis)
Superficial, branching corneal neovascularization
Superficial corneal disease
Deep, hedge-like corneal neovascularization
Deep stromal or intraocular
LOCATION Ulcerative keratitis: horizontal, equatorial ulcer
Trouble blinking
LOCATION Ulcerative keratitis: Third eyelid associated ulcer
FB under the 3rd eyelid
LOCATION Ulcerative Keratitis: lateral bottom lid ulcer
Entropion with trichiasis
LOCATION Ulcerative Keratitis: upper lid ulcer
Ectopic cilia
DDX Intraocular disease: episcleral injection, +/- conjunctival hyperemia, +/- 360˚ Deep corneal vessels
- Uveitis (most common)
2. Glaucoma
Diagnostics Intraocular disease
Check pressure (low uveitis, high glaucoma)
Pupil Size (small uveitis, big glaucoma)
History (past problems with pressure)
Signs of inflammation (uveitis)
DDX Subconjunctival hemorrhage: free blood with no distinct pattern beneath conjunctiva, obscures view of episcleral vessels and sclera
- coagulation disorder or vasculitis
- proptosis
- trauma
- strangulation
Diagnostics subconjunctival hemorrhage
History and PE
Bloodwork (cbc/chem/ua and Coag profile)
Fluoroscein
DDX Intraocular hemorrhage (hyphema): diffuse redness mixed with aqueous humor (recent) or a dark settled clot (resolving)
- Intraocular Mass/Neoplasia
- Uveitis
- retinal detachment
- high BP/hypertension
- Coaguation disorder/vasculitis (warfarin and vWF)
- Trauma (blunt or sharp, rapid decompression)
- hyperviscosity syndromes (multiple myeloma and BM neoplasia, FIP in cats)
- platelet disorders
- congenital/genetic defects (collie eye, color dilute Aussie and mini dachsunds, uveal cyst and pigmentary uveitis in goldens)
- chronic glaucoma
Diagnostics Intraocular hemorrhage
Bloodwork (cbc/chem/ua and Coag Profile)
Ultrasound (can see hiding structures)
Blood pressure
What are the most important immediate rule outs of the red eye?
- Corneal Ulcer (Fluoroscein stain)
- Dry Eye (STT)
- Glaucoma (increased pressure, big pupil)
- Uveitis (dec. pressure, small pupil, hypopion, flare, synechia)
Intraocular disease
episcleral injection, conjunctival hyperemia, deep 360 degree neovascularization, hyphema
extraocular/corneal disease
conjunctival hyperemia, corneal neovascularization
ocular manifestation of systemic disease
Subconjunctival or intraocular hemorrhage, conjunctival hyperemia, retinal hemorrhages on fundic exam, hyphema
