P year‎ > ‎Specialties‎ > ‎

13.03.05 Red eye

Worrying signs
  • Loss of vision
  • Severe pain
  • Contact lens wearer
  • Long time
  • Recent trauma/surgery
  • Corneal haziness/hypopyon
  • Purulent discharge


Classification

  • Allergy
  • Trauma
  • Infection
  • Inflammation
    • Iritis
    • Episcleritis
    • Scleritis
  • Glaucoma
    • Acute angle closure
  • Subconjunctival haemorrhage


Keratoconjunctivitis


Cellulitis

  • Preseptal
    • Eye normal, Lid swollen
    • Eye movements + vision normal
  • Orbital
    • More serious
    • Can be dangerous in young kids
    • Tracks back => Meningitis/Cerebral abscess
    • => IV ABx


Conjunctivitis

  • Adenovirus
  • Easily spread to other eye/people
  • Red flags - Suggesting bacterial rather than viral aetiology
    • Atypical Hx
    • Pus
    • Contact lens
    • > 1 week


Keratitis

  • = Corneal inflammation
  • Aetiology
    • Fungal
      • Common in tropics
    • Bacterial
      • Pseudomonas
    • Viral
      • Herpes => Dendritic ulcer (can change cornea shape)


Scleritis

  • Episcleritis is common and relatively benign
  • True scleritis
    • Serious and very painful
    • Association with systemic symptoms (Wegener's, RA)


Iritis/Anterior uveitis

  • Visual loss / photophobia
  • Throbbing pain
  • Cellularity


Endophthalmitis

  • Inflammation of occular cavity
  • Extremely serious complicaiton of eye surgery
    • 0.1% of cataract operations


Acute angle-closure glaucoma

  • Intraoccular pressure rises from normal (12-20 mm Hg) to >70 mm Hg
  • +ve feedback
    • Pupil sticks to lens
    • No drainage => Pressure rise
    • Angle pushed closed
  • Management
    • Pilocarpine (parasympathomimetic => miosis pulls pupil off)
    • Timolol (beta antagonist => less aqueous humour production)
    • Acetazolamide (=> less aqueous humour production)
    • Laser a hole in the iris


Subconjunctival haemorrhage

  • From trauma, straining, vomiting
  • Looks bad but harmless


Notes
  • Episclera = Outer sclera
  • Orbital floor #
    • Prophylactic ABx
    • Risk of orbital cellulitis
    • Don't blow nose
  • Antigen deposition can leave white post-infective spots, which can interfere with vision
  • Hypopion is collection of WBCs/pus in lower part of anterior chamber
  • Uvea = Iris, ciliary body, choroid
  • Chloramphenicol is the go-to drug for eyes, but doesn't hit everything e.g. E. coli from dirty contact lenses
Comments