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

• • Causes

    • Hayfever

  • Management

    • Antihistamines

    • Mast cell stabilisers (Cromoglycate - Opticron)

      • cromolyn

      • More: http://www.igenericdrugs.com/?s=Opticron

      • cromolyn

      • More: http://www.igenericdrugs.com/?s=Opticron

    • Lubricants

    • Steroids

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