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