Red Eye Conditions Flashcards
What is episcleritis?
Inflammation of the eipiscleral vessels - vascular connective tissue layer that lies between the sclera and conjunctiva
Usually benign
Generally 1/3 associated with systemic conditions such as RA, IBD, AS, systemic lupus erythemetous
Espiscleritis - Symptoms
Acute onset Typically unilateral red eye, bilateral in 25-50% of cases - sectoral but can be diffuse Mild ache or burning sensation Sometimes tender on palpatio Commonly recurrent - over 1-3 months Occasional watering
Episcleritis - Signs
Hyperaemia from dilated scleral veins
Blanch with vasoconstrictors - Phenylephrine 2.5%
Simple (80%) - sectoral or diffuse redness
Nodular (20%) - mild elevation of conjunctiva with injection
Typically no AC reaction
No effect on VA
Usually, no corneal or palpebral involvement
Episcleritis - Management
Usually self-limiting in 7 to 10 days
Reassurance that condition does not progress to more serious ocular condition
Cold compresses
Advise patient to return or seek further help if symptoms persist
If discomfort, artificial tears for 1 to 2 weeks are necessary
In more severe cases, patient may need mild topical steroid (in nodular type) 
What is Subconjunctival haemorrhage?
Bleeding of conjunctival vessels into the subconjunctival space
What causes subconjunctival haemorrhage?
Idiopathic Valsalva manoeuvre Trauma Drugs including warfarin/steroids/NSAID Hypertension
Subconjunctival haemorrhage - Presentation
If posterior margin cannot be seen, think about intercranial haemorrhage or fracture of orbit
- listen out for headaches or trauma in H&S - look out for proptosis or periorbital bruising
Can spread or change colour
Usually resolves within two weeks
Subconjunctival haemorrhage - Management
Self-limiting
Topical lubricant for mild discomfort
Discourage aspirin/NSAID as they make bleed worse or take longer to resolve
CT if trauma
Refer if persistent or recurrent and simultaneous bilateral as this is more concerning
What is scleritis?
Potentially severe inflammatory disease of the sclera which is bilateral in 50% of cases
Scleritis - Predisposing factors
Age between 40 to 60 years
Male to female - 2:3 ratio
May be idiopathic but 1/3 cases associated to systemic inflammatory disease of which scleritis may be the first presentation (RA, vasculitides, IBD, AS)
4 to 10% scleritis infectious in origin (Herpes zoster opthalmicus, pseudomonas & other bacterial infections, fungal and protozoal infections, syphils, sarcoidoisis, TB)
Trauma and surgery - Surgery induced necrotising scleritis (SINS) is a rare complication of ocular surgery including cataract, scleral buckling, pterygiectomy and is often associated with this infection, especially by pseudomonas

Scleritis - Signs
Moderate to severe pain Gradual onset May disturb sleep Tenderness of globe Epiphora Visual loss Previous history of scleritis
Anterior scleritis
90% of cases
Non-necrotising - 75% of cases
Necrotising - 15% of cases
Non-necrotising anterior scleritis
Usually unilateral
Hyperaemia of superficial and deep episcleral veins which do not bleach with Phenylephrine
Tenderness of globe
When inflammation resolved choroidal pigment may show through thin sclera as blue/black colouration
Approximately 60% of use and 40% nodular
Necrotising anterior scleritis
Most severe form which may occur in the absence of pain
75% will eventually have visual impairment
Avascular patches lead to scleral melting with ectais and choroidal herniation
Posterior scleritis
10% of cases
Involves sclera posterior to ora serrata
Eye may be white
Ophthalmoscopy may show executive retinal detachment, macula oedema, optic disc oedema, but also may show no abnormality
Scleritis - Management
Same day emergency referral
Acute allergic conjunctivitis
A self-limiting reaction to an allergen that comes into contact with the content either provoking an immediate IgE mediated response
Common in children
Allergens include grass pollen,animal dander
Allergic conjunctivitis - Predisposing factors
History of allergic disease
Can also occur without search history
Allergic conjunctivitis - symptoms
Sudden eyelid swelling
Ocular itching
Maybe unilateral if a direct contact response
Allergic conjunctivitis - signs
Lid oedema and erythema Conjunctival chemosis which may bulge lid margin or limbus Watery or mucoid discharge - mild Usually no papillae No corneal involvement
Allergic conjunctivitis - management
Reassure patient that most cases resolve spontaneously within a few hours
Advise against eye rubbing as this can cause mechanical mast cell degranulation
Cool compress may give symptomatic relief
Ocular lubricants drops and/or topical antihistamines may provide symptomatic relief
If recurrent prescribed prophylactic topical masst cell stabilisier 
Bacterial conjunctivitis
Self-limiting bacterial infection of the conjuring Tiber typically by a Staphylococcus species, streptococcus pneumoniae, Haemophilus influenzae (especially in children)
Bacterial conjunctivitis - predisposing factors
Contamination of the conjunctival surface
Superficial trauma
Contact lens wear
Secondary to viral conjunctivitis
Diabetes or other disease compromising the immune system
Steroids - Systemic or topical compromising ocular resistance to infection
Blepharitis or other chronic ocular inflammation
Bacterial conjunctivitis - Signs
Lid crusting
Purulent or mucopurulent discharge conjunctivitis Hyperaemia maximal in fornices
Tarsal conjunctiva may show put mild papillary reaction
Cornea usually no involvement - if cornea significantly involved consider possibility of gonococcal infection
Pre-auricular lymphadenopathy usually absent
