Differential Diagnosis of the Red Eye - Semantic Scholar · Differential diagnosis of the red eye...
Transcript of Differential Diagnosis of the Red Eye - Semantic Scholar · Differential diagnosis of the red eye...
The red eye
HSVKeratitis
Anterior Uveitis
Sub-conjunctivalhaemorrhage
Corneal Ulcer
Episcleritis
Scleritis
Acute angle closure
glaucoma
Conjunctivitis
Red eye
History
• Symptoms• Duration of symptoms• Contact lens wearer• Previous History of red eye• History of trauma• Contact with red eyes• Medical history – recent URTI, AS, IBD• Medications• Age
Examination
• Look at eye systematically from outer structures to inner
structures
• Some conditions are obvious by torch or naked eye
• Think how symptoms fit
• Do not assume all red eyes are acute glaucoma
For each condition look at
• Visual acuity• Pain• Discharge or watering• Hyperaemia• Cornea• AC• Iris• Pupils• Pupillary response to light• IOP
Sub conjunctival haemorrhage
Visual acuity Normal
Pain Mild irritation but may be aymptomatic
Discharge/ watering
Not usually
Hyperaemia Deep red area under conj. Often sectorial
Cornea Clear
AC Deep and quiet
Iris Normal
Pupils Normal
Pupillary response
Normal
IOP Normal
Conjunctivitis
Visual acuity Usually normal
Pain Burning, itching, irritation
Discharge/ watering
Mucous or mucopurulent
Hyperaemia Superficial and diffuse of conj and eyelids
Cornea Usually clear but punctate staining at times
AC Deep and quiet
Iris normal
Pupils normal
Pupillary response
normal
IOP normal
Episcleritis
Visual acuity Usually normal
Pain Sometimes irritation
Discharge/ watering
No
Hyperaemia Sectorial redness- engorgement of episcleral vessels
Cornea Clear
AC Deep and quiet
Iris Normal
Pupils Normal
Pupillary response
Normal
IOP Normal
Scleritis
Visual acuity May have insidious decrease
Pain Severe and boring pain.Tender to touch
Discharge/watering
No
Hyperaemia Intensive injection of scleral, episcleral and conjunctival vessels. May have bluish hue
Cornea May have peripheral keratitis
AC May have inflammatory cells
Iris Usually normal
Pupils Usually normal
Pupil response Usually normal
IOP Normal but may be elevated
HSV Keratitis
Visual acuity May be reduced
Pain Pain – mild to moderate
Discharge/ watering
Lacrimation
Hyperaemia Mild to moderate injection
Cornea Area of corneal ulceration with fluorescein staining
AC Deep and usually quiet
Iris Normal
Pupils Normal
Pupillary response
Normal
IOP Normal (usually)
Corneal ulcer
Visual acuity May be markedly reduced
Pain Can be severe
Discharge/ watering
May be purulent
Hyperaemia Diffuse
Cornea Infiltrate with overlying epithelial defect
AC Deep. May have inflammatory cells/hypopyon
Iris normal
Pupils Usually normal
Pupillary response
Usually normal
IOP Usually normal
The Uveal Tract
• Middle layer of the globe
• Iris, ciliary body and choroid
• Vascular layer of globe
Acute anterior uveitis
Visual acuity May be decreased
Pain Moderately severe ache and photophobia
Discharge/watering
Lacrimation
Hyperaemia Circum corneal
Cornea Transparent precipitates may be present posterior surface
AC Normal depth/ white blood cells
Iris May appear muddy coloured
Pupils Often small and irregular
Pupillary response
Sluggish reaction to light
IOP May be normal or ↓
or occ.↑
Anatomy and physiology
• Produced in ciliary body • Ultrafiltrate of plasma • Posterior chamber-
through pupil - to Anterior Chamber- to angle of A/C - Trabecular meshwork - Canal of Schleem - Episceral vessels
• 2 µl per minute
Acute angle closure glaucoma
Visual acuity Markedly reduced 6/60 and below
Pain Severe with headache, nausea, vomiting
Discharge/watering
lacrimation
Hyperaemia Marked circumcorneal and episcleral
Cornea May be cloudy
AC Shallow or flat
Iris May be difficult to see
Pupils Semi dilated fixed
Pupillary response
Non reactive or minimal reaction
IOP Very high over 40 mmHg
The red eye
AACG
AAU Subconjunctival haemorrhage
Corneal ulcer
Conjunctivitis
Episcleritis
ScleritisHSV keratitis
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Finally
Remember
• History
• Symptoms described
• Predisposing factors
• Trauma
• Medical conditions
• Age
• Eye examination
LogarithimRed Eye
Pain?
Ophthalmic referral Blurred vision
Discharge
Watery Itching/burningPurulent
Ophthalmic referral
Allergic conjunctivitisDry eye
Blepharitis
EpiscleritisDry eye, topical Drug toxicity andother conditions
Bacterial Conjunctivitis
Viral or AllergicConjunctivitis
Itching?
Allergic or viral conjunctivitis
Viral conjunctivitis
Uveitis, AACG,Keratitis, Scleritis
Yes
YesNo
Yes
No
Yes
YesNo