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RED EYE
Prof. Dr. Ilgaz YALVAÇ
RED EYE
 One of the most common ophthalmologic conditions in the
primary care setting
 Inflammation of almost any part of the eye, including the
lacrimal glands and eyelids, or faulty tear film can lead to
red eye
 Primary care physicians often effectively manage red eye,
although knowing when to refer patients to an
ophthalmologist is crucial
What is RED EYE?
It is the cardinal sign of ocular inflammation
Conjunctivitis is the most common cause of red
eye
Signs and symptoms are discharge, redness,
pain, photophobia, itching, and visual changes
It can be diagnosed through a detailed patient
history and careful eye examination, and
treatment is based on the underlying etiology.
Recognizing the need for emergent referral to an
ophthalmologist is key in the primary care
management of red eye
RED EYE
(Non-Vision Threatening Disorders)
Subconjunctival hemorrhage
Conjunctivitis
Dry Eye Syndrome
Blepharitis
Corneal Abrasion
Pterygium/Pingueculum
Subconjunctival Haemorrhage
 Diffuse or localised area of blood under conjunctiva
 Asymptomatic
 Idiopathic
 Trauma
 Cough
 Sneezing
 Aspirin
 Systemic Hypertension
 Resolves within 10-14 days
Subconjuntival Hemorrhage with Chemosis
Keep conjunctiva moist
Subconjunctival air!
Posterior petechial
hemorrhages
Think
embolic
disease
Conjunctivitis
Follicles
Papillae
Redness
Chemosis
Purulent discharge
Blepharo-conjunctivitis
Acne Rosacea Blepharo-Conjunctivitis
Conjunctivitis
Allergic Conjunctivitis
(Polytrim)
Dry Eye Syndrome
 Poor quality
 Meibomian gland disease ie, Acne Rosacea
 Lid related
 Vitamin A deficiency
 Poor quantity
 Keratoconjunctivitis Sicca
 Sjogren Syndrome
 Rheumatoid Arthritis
 Lacrimal disease ie, Sarcoidosis
 Paralytic ie, VII CN palsy
Computer Vision Syndrome
Red, burning and tired eyes with staring at a computer
screen for too long.
Blink less when working at a computer, which dries out the
surface of eye.
Taking frequent breaks while working at a computer,
modifying your workstation.
Lubricating eye drops to keep eyes moist.
Blepharitis
Subacute
Chronic
External hordeolum
Internal hordeolum
Corneal Abrasion
Surface epithelium sloughed off
Stains with fluorescein
Usually due to trauma
Pain
FB sensation
Tearing
Red eye
Pterygium
Active
Dormant
Pingueculum (inflammed)
RED EYE
(Vision Threatening Disorders)
Episcleritis / Scleritis
Corneal Ulcers
Iritis ( Anterior Uveitis)
Angle-Closure Glaucoma
Preseptal & Orbital Cellulitis
Endophthalmitis
Trauma
Episcleritis
Superficial
Idiopathic
Collagen vascular disorder
(Romatoid Artritis)
Asymptomatic, mild pain
Self-limiting or topical treatment
Corneal Ulcer
Infection
 Bacterial: Adnexal infection, lid malposition, dry eye, CL
 Viral: Herpes Simplex, Herpes Zoster
 Fungal:
 Protozoan: Acanthamoeba in CL wearer
Mechanical or trauma
Chemical: Alkali worse than acid
Corneal Ulcer

Viral Dendritic Keratitis
Corneal Ulcer

Viral Dendritic Keratitis
HSV-1
H. Zoster
Iritis (Anterior Uveitis)
Photophobia, red eye, decreased vision
Idiopathic Commonest
Associated to systemic disease
Seronegative arthropathies: AS, IBD, Psoriatic arthritis,
Reiter’s
Autoimmune: Sarcoidosis, Behcet’s Disease
Infection: Herpes, Toxoplasmosis, TB, Syphillis, HIV
Ciliary flush
Posterior synechiae
Fibrin
Flare
Hypopyon
KPs
Acute Angle-Closure Glaucoma
Symptoms
Pain
Headache
Nausea-Vomiting
Ciliary hyperaemia
Dilated pupil
Redness
Photophobia
Corneal oedema
Reduced vision
Haloes around lights
Acute Angle-Closure Glaucoma
Onset over 50
Severe eye pain
Blurred vision
Red eye
Headache/Nausea
Corneal edema
Mid-dilated, fixed pupilla
“Glaukomflecken”
Iris atrophy
Severe AC inflammation
Preseptal cellulitis
Orbital Cellulitis

Severe pain

Proptosis

Limited EOMs

Conjunctival
congestion

Diabetic?
Orbital Cellulitis
Frontal, ethmoid, maxillary and orbital
abscesses
Endophthalmitis

Severe pain

Photophobia

Poor vision

Recent intra-ocular surgery
Differential Diagnosis
Conjunctiva
Pupil
Cornea
Anterior
chamber
IOP
Subconjunctival
Haemorrhage
Bright red
Normal
Normal
Normal
Normal
Conjunctivitis
Injected
vessels,
fornices.
Discharge
Normal
Normal
Normal
Normal
Iritis
Injected
around cornea
Small,
fixed,
irregular
Normal,
KPs
Turgid,
deep
Normal
Acute glaucoma
Entire eye red
Fixed,
dilated,
oval
Hazy
Shallow
High
Refer to an Ophthalmologist
Red Eye with
 Severe pain
 Patient has vision loss
 Copious purulent discharge
 Corneal involvement
 Traumatic eye injury
 Recent ocular surgery
 Distorted pupilla
 Herpes infection
 Recurrent infections