Red Eye 1

Question 1

Red Eye (RE), no pain, no vision 
loss (Va = Visual acuity)

Answer 1

Conjunctivitis

Question 2

Conjunctivitis

Answer 2

Pt frequently complains of:
!  Redness, itching,and foreign body (FB) sensation with
discharge ranging from watery to hyperpurulent!
!  Must be differentiated from corneal abrasion, iritis, acute
glaucoma, and corneal infection

Majority of cases are the result of a viral infection
!  Starts unilateral becomes bilateral!
!  Most common cause is adenovirus!
!  Transmission by direct contact with infected individual!
!  Inferior palpebral conjunctival lymphoid follicles seen on
slit lamp exam.

Majority of cases are the result of a viral infection!
! Preauricular lymphadenopathy may be present
and Hx of URI is common!
! Visual acuity may decrease by immune infiltration
of the cornea!
! Self limiting disease and Rx aimed at Pt comfort!
! Cool compresses may be used!
! Pt’s advised to wash hands frequently!
! Pt’s contagious for 1-2 wks!

! Minority of cases (<5%) are the result of a
bacterial infection!
!  Infection with staphylococcus appears as chronic mild
mucoid discharge and crusting !
!  May be associated with chronic blepharitis or dacryocystitis!
!  Acute bacterial conjunctivitis caused by Haemophilus or
Streptococcus may be seen in epidemic and isolated
forms!
!  Transmission from infected individuals or fomites!
!  Moderate purulent discharge is common!
!  May see mild edema of the conjunctiva (chemosis) and
lid

Question 3

Allergic Conjunctivitis

Answer 3

! Patient has a red eye (vasodilation of scleral
vessels), no vision change, an itchy watery
eye, (foreign body sensation)!
! Most common cause is hayfever!
!  If patient has this and rhinitis it is called allergic
rhinoconjunctivitis!
! Rx, avoid allergins, cold compresses,
antihistamine (topically or systemic), eye
wash with artificial tears or 1% boric acid
(ophthalmic) [Soothing Collyrium for Fresh
eyes Eye Wash by Bausch & Lomb] !

Question 4

Dacryocystitis

Answer 4

! Inflammation of the lacrimal sac
! Usually caused by obstruction of 
nasolacrimal duct with subsequent 
infection!
! Unilateral!
! Treatment: warm compresses, topical 
& systemic antibiotics, incision for pus 
drainage if abscess present, after acute 
inflammation subsides, consider 
dacrocystorhinostom

! Inflammation of lacrimal gland
! Symptoms: swelling, redness, may have 
pain, tearing, discharge with acute 
infection (Staphylococcus, N. 
gonorrheae, mumps, EBV)!
! Findings: enlarged lacrimal gland, 
tenderness, fever, preauricular 
lymphadenopathy, restricted ocular 
motility!

Diagnosis: CT scan, consider culture
! Treatment: systemic antibiotics,
incision & drainage or excision!

Question 5

Red Eye, pain, variable vision change!

Answer 5

! Keratoconjunctivitis sicca

Question 6

! Keratoconjunctivitis sicca

Answer 6

Dry eye syndrome, adult women, 95%!
!  Deficiency in any of the tear film layers!
!  Symptoms!
!  Gritty FB sensation, burning, dryness, photphobia, decreased
Va!

! Sjogren’s syndrome-immune destruction of exocrine
glands, particularly salivary & lacrimal!
!  1o Sjogren’s syndrome occurs w/o systemic CT disorder!
!  2o Sjogren’s syndrome occurs w/ a systemic CT disorder,
most commonly RA, also w/ SLE & Polymyositis!
!  Complications: !
!  Recurrent corneal erosion, keratitis (corneal inflam),
corneal opacification!
! Tx!
!  Artificial tears, humidifier, Abx onitment @ night & tape
eyelid closed!

Question 7

Red Eye (RE), pain (Pn), vision change!

Answer 7

Episcleritis

Scleritis

Question 8

Episcleritis

Answer 8

(RE, Pn, no change in Va)
! Inflammation of the episclera!
!  Thin layer of vascular elastic tissue overlaying the sclera is
called the episclera!

Inflammation of the episclera!
!  Thin layer of vascular elastic tissue overlaying the sclera is called
the episclera!
! Localized inflammation, bilateral 33%, unilateral 67%, young
adults!
! Associated with!
!   RA, Gout, Herpes Zoster Virus!
! Signs:!
! Sectoral 70% or diffuse 30% injection with mild or no discomfort, may have
chemosis, !
! Pathology: Nongranulomatous vascular dilatation, !
! Treatment: topical vasoconstrictor, mild topical steroid!
!  15% of pts will develop iritis!
!  R/o conjunctivitis by the localized redness and lack of conjunctival
involvement.!
!  Self limiting course of 10-14 d!

Question 9

Scleritis

Answer 9

the episclera!
! Scleritis - (RE, Pn, change in Va)!
! Inflammation of the sclera w/ or w/o inflammation of
the episclera!

Inflammation of the sclera !
!  98% anterior, 2% posterior!
!  More common in females, onset age 30-60 years!
! Epidemiology:!
!  Anterior form may be diffuse (40%), nodular (44%), or necrotizing
(14%) with or without inflammation!
!  More than 50% are bilateral!
!  Association with systemic disease in 50% of cases!
! Etiology:!
! CollegenVascular Disease in 30% of cases (Most commonly RA, AS, SLE, polyarteritis
nodosa, Wegener’s granulomatosis; !
!   Also herpes zoster virus (HZV), syphilis, TB, leprosy, gout porphyria!
! Symptoms:!
!  Redness, pain, photophobia, decreased Va