The Red Eye Flashcards
What are the common differential diagnoses for an acute red eye?
Conjunctivitis
Episcleritis
Subconjunctival haemorrhage (spontaneous when coughing or traumatic-is self resolving but bleeding disorder should be considered if repeated)
Trauma- corneal abrasion (positive fluorescin test) or foreign body
What are the site threatening causes of an acute red eye?
Keratitis (corneal infection)
Scleritis
Anterior uveitis
Acute angle closure glaucoma
What is conjunctivitis?
Inflammation of the conjunctiva, the clear moist membrane covering the exposed sclera and inner eyelids. Usually bilateral, but may start in one eye before spreading.
Describe viral conjunctivitis.
Is most commonly due to adenovirus
Presentation- Acute red eye Watery discharge. May dry to form yellow crust- this is NOT pus Mild foreign body sensation Associated viral URTICARIA
Management-
Supportive treatment with topical lubricant
Strict hand hygiene as highly contagious
Describe bacterial conjunctivitis.
Causes-
Staph or strep
Gonorrhoea or chlamydia can be the cause in concurrent STI, from hand transfer.
Presentation-
Acute red eye
Mucopurulent discharge leading to crusting and difficulty opening eyes in morning
Gonorrhoea may cause a severe manifestation requiring referral.
Management-
Chloramphenicol eye drops, though usually self resolves. Apply to both eyes even if unilateral to prevent amblyopia.
Do not wear contact lenses.
Describe allergic conjunctivitis.
Presentation-
Acute red eye plus or minus chemosis
Itchy, watery eyes
Usually seasonal (hay fever) or perennial (dust mites)
Management-
Antihistamines for rapid relief and long term control, oral (cetirizine) or topical (azelastine)
Topical mast cell stabiliser (sodium cromoglicate) is an alternative for long term control.
What is the pathophysiology of episcleritis?
Inflammation of the episclera, the thin vascular sheet between the conjunctiva and sclera.
Usually idiopathic, or secondary to RA, IBD, polyarteritis nodosa or sarcoidosis.
How does episcleritis present?
Acute red eye
Mild symptoms, perhaps with foreign body sensation.
Resolves in 1-2 weeks
How is episcleritis managed?
Topical lubricants
Oral NSAIDs
What is the pathophysiology of scleritis?
Inflammation of the sclera
50% linked to connective tissue disease- RA, GPA (Wegner’s). May be the presenting complaint.
How does scleritis present?
Severe, dull eye pain developing over days tender to touch.
Bluish red eye due to deep vascular engorgement.
Blurred vision, photophobia.
How is scleritis managed?
Rapid immunosuppression may be needed to preserve sight.
What is the pathophysiology of keratitis?
Inflammation of the cornea- can progress to ulceration
Cause can be bacterial occurring in contact lens wearer with inadequate lens care, or viral, usually herpes simplex.
How does keratitis present?
Acute red eye
Photophobia, severe pain, foreign body sensation
Purulent discharge and
