Red Eye Flashcards
What is the most common cause of red eye?
Red eye is a common presentation in primary care and is a sign of inflammation.
Most cases will be due to relatively benign problems. The most common cause of red eye presenting in a primary care setting is conjunctivitis.
A small proportion of cases are serious and need urgent treatment.
What are the common causes of red eye?
Conjunctivitis Blepharitis Glaucoma Uveitis Iritis Scleritis Episcleritis Corneal abrasion Foreign body Keratitis Chemical burn
What do you ask in the hx of a px presenting with red eye?
History:
- Time and speed of onset
- Ocular symptoms (e.g. pain, photophobia, blurred vision, discharge)
- Systemic symptoms (headaches, nausea and rash on the forehead)
- Symptoms affecting the other eye
- Specifically enquire about trauma, however minor it appears to have been
- Recent contact with infectious illness (herpes simplex, conjunctivitis)
Past ocular hx:
- Any other episodes
- Ophthalmic surgery
- Lazy eye
- Contact lenses
- Using any eye drops
General health issues
- Systemic medication
- Any recent changes to medications
- Allergies
Social hx:
- Determine whether the eye condition is affecting activities of daily living.
- Establish whether there is an immediate management problem
- Ask whether the patient drove to the surgery. Establish whether they are fit to drive away again.
What do you examine in a px presenting with a red eye?
Essential to record the VA in both eyes
If no ocular causes emerge, consider potential systemic causes.
Scleritis and episcleritis are associated with connective tissue diseases such as RA, gout, syphilis, sarcoidosis and HTN.
What are the causes of acute painful red eye?
Acute angle-closure glaucoma Keratitis Acute anterior uveitis Trauma- foreign body or corneal abrasion Endophthalmitis Scleritis
What are the causes of acute non-painful red eye?
Conjunctivitis
Episcleritis
Subconjunctival haemorrhage
What are the causes of non-acute red eye?
Acne rosacea Canaliculitis Blepharitis Lagophthalmos Floppy eyelid syndrome Trichiasis Inflamed Pinguecula Stevens-Johnson syndrome
What is inflamed pinguecula?
A pingueculum is a common, innocuous lesion seen as a cluster of yellow-white deposits (usually in a triangular formation with the base adjacent to the cornea), arranged temporally or nasally to the cornea.
It results from degenerative change in the sclera from environmental irritants, including sunlight.
If it becomes inflamed (pingueculitis), it becomes red and may be elevated, sore or ulcerated.
What is the management of a red eye?
Urgent referral for potentially serious problems.
Which features are suggestive of a serious condition which may warrant urgent referral in a px of red eye?
Moderate-to-severe eye pain or photophobia.
Marked unilateral redness. The greater the redness, the more likely it is that the cause is serious.
Ciliary injection, which is not always obvious, is suggestive of inflammation of deeper structures. It is indicated by redness and dilated blood vessels that can be seen between the sclera and the iris.
Reduced VA.
Photophobia or seeing coloured haloes around point sources of light.
Copious purulent discharge (particularly in neonates).
Corneal involvement.
Known or suspected eye trauma.
Recent ocular surgery.
Pupillary distortion or abnormal reaction.
Herpes simplex or herpes zoster.
Recurrent episodes.
Proptosis.
Contact lens wear.
What is conjunctivitis?
This is the inflammation of the conjunctiva.
Associated corneal involvement give rise to keratoconjunctivitis.
Eyelid involvement suggests blepharoconjunctivitis.
It can be classified as infectious or non-infectious, and as acute, chronic, or recurrent.
It can affect any age group. There is no gender, ethnic or social preponderance.
What is the presentation of conjunctivitis?
Red eye, which is usually generalised, often bilateral.
Irritation, grittiness and discomfort are typical; significant pain suggests alternative diagnoses.
Discharge, which may be watery, mucoid, stickly or purulent.
Photophobia is not typical.
VA should be unaltered.
Signs include:
Conjunctival chemosis
Conjunctival injection with dilated conjunctival vessels
Follicles or papillae
Corneal involvement (this occurs rarely): oedema, neovascularisation and punctate epithelial erosions.
What are follicles?
Follicles are round collections of lymphocytes, most prominent in the inferior fornix, which appear as small, dome-shaped nodules, pale at the top and without prominent central vessels, although blood vessels may overlie them.
They are typically seen in conjunctivitis caused by viruses, atypical bacteria and toxins, including some topical medications (especially brimonidine).
What is a papillae?
Papillae have a cobblestone appearance of flattened nodules with central vascular cores, appearing red on the surface and pale at the base.
They are most commonly associated with an allergic immune response, as in vernal and atopic keratoconjunctivitis, or as a response to a foreign body such as a contact lens. Papillae coat the tarsal surface of the upper eyelid and may reach large size (giant papillary conjunctivitis).
How do you assess conjunctivitis?
Ask about:
- Recent upper respiratory tract illness.
- Recent infectious contacts, particularly to other cases of conjunctivitis.
- Morning discharge and stickiness, as the patient is likely to have cleaned this away.
- Spectacle or contact lens wear (and lens hygiene).
- Chemical exposure (including occupational exposure).
- Medication.
- Ultraviolet light exposure (including sunlamps and welding lamps).
- Any history of foreign body or eye trauma.
What do you do in the exam for conjunctivitis?
Exam:
- Wear gloves if suspecting adenoviral infection - this is extremely contagious (clean all equipment after use).
- Look for evidence of generalised malaise and preauricular lymph nodes.
- Check visual acuity.
- External eye: assess for evidence of orbital cellulitis, blepharitis, herpetic rash or nasolacrimal blockage.
- Conjunctiva: look at the pattern of congestion, discharge and for the presence of follicles or papillae.
- Papillae
- Follicles
- Cornea: note whether there is evidence of corneal involvement. Staining is an essential part of the examination.
- Fundoscopy: this is necessary if you are unsure about the diagnosis. Look for clouding of the anterior chamber.
