Red Eye: Conjunctivitis, Cellulitis, Bacterial Keratitis, Anterior Uveitis, Episcleritis, Scleritis ☺️

Question 1

Conjunctivitis

• types and features of each
• general presentation
• diagnosis
• management

Answer 1

Sore, gritty, red eye, discharge
Bacterial - purulent, eyes stuck together in the morning
Viral - watery, recent URTI, preauricular LN
Allergic - itchy

Clinical diagnosis

Self limiting but ABx often given for rapid resolution

• don’t use contacts
• topical ABx - chloramphenicol/fusidic acid if pregnant

Question 2

Complications and things to consider in conjunctivitis

Answer 2

If discharge purulent and prolonged => swab for chlamydia, gonorrhea
-If in neonate => opthalmia neonatorum

Chlamydia - doxy or azithromycin
Gonorrhea - ceftriaxone

Question 3

Cellulitis

• types and features of each
• general presentation
• key investigation
• management

Answer 3

Red around eyelid

Preseptal - inflammation of anterior septum

• recent insect bite, break in skin
• no significant severe pain, tenderness, swelling, fever

Orbital - inflammation of posterior septum

• recent sinusitis
• SEVERE REDNESS AROUND EYELID,
• SEVERE PAIN, VISUAL CHANGES
• HEADACHE, FEVER

CT sinus and orbits with contrast

Broad spec ABx until causative organism found

Question 4

Bacterial keratitis

• pathophysiology, main cause
• causative organisms
• presentation
• investigations
• management

Answer 4

Bacterial infection of the cornea via abrasions- MAIN INFECTION IN CONTACT LENS USERS (Pseudomonas)
-staph, strep

Red eye, PAIN
Photophobia and feeling of something in eye - corneal injury constantly irritating trigeminal => tears
Visual changes - cloudy cornea

EMERGENCY - corneal and contact scrapings for culture => topical ABx
-fluorecein dye - assess for abrasions

Question 5

Anterior uveitis/iritis

• pathophysiology, associated conditions
• presentation
• management

Answer 5

Inflammation of iris and ciliary body
HLA B27 - AS, reactive, IBD, Behcet, sarcoid

Acute pain, red eye
Photophobia + lacrimation
Ciliary flush
Visual acuity => blurry, impaired
Small, irregular pupil
Fluid level in ant chamber

URGENT EYE REVIEW

• cycloplegics - dilates pupil to relieve pain, photophobia (atropine, cyclopentolate)
• steroid eye drops

Question 6

Episcleritis vs scleritis

• pathophysiology
• differentiating between the 2
• investigations
• management

Answer 6

Red painful eye

Episcleritis - benign common self limiting inflammation of superficial layer of eye
-often idiopathic, lasts a week
Supportive - NSAIDs , eye drops

Scleritis - full thickness inflammation of sclera which needs systemic treatment
-often associated with other inflammatory diseases
Systemic steroids
NSAIDs
ABx

Phenylephrine only blanches vessel in ES
Slit lamp - detect intraocular inflammationn in scleritis