RED EYE

DR GODSWILL AMECHI NNAJIMBBS, FWACP, FMCGP, FCA, MBA, MPH

Epidemiology of red eye in Nigeria• 14.8% of ophthalmic patients• Male > Females• 63% of patients are below 20 years of age• Common causes of red eyes (Nigerian Teaching hosp) include;• Allergic conjunctivitis – 40%• microbial conjunctivitis – 17%• Corneal ulcer - 11%• Inflammed Pterygium - 11%

• Most causes of red eye are treatable

Causes of red eye

• Red eye is caused by dilated scleral blood vessels.• Infectious causes such as bacteria or

viruses.• Non-infectious, e.g. Allergy, chemical

irritation, underlying inflammatory diseases, or trauma.

Causes of red eye• Dust or other particles in the eye• Allergy (pollen, pest dander, dust, chemicals, contact lens solution)• Infection• Injury• Blepharitis• Conjunctivitis• Eye dryness (dry eye syndrome)• Excessive exposure sun • Corneal scratches: Injuries caused by sand, dust, or overuse of contact lenses• Corneal ulcer• Uveitis: Inflammation of the uvea, (iris, ciliary body, and choroid). Cause may be

unknown, an autoimmune disorder, infection, or exposure to toxins. In iritis - only the iris is inflamed.• Acute glaucoma

Common causes of red eye in children• Bacterial conjunctivitis• Neonatal conjunctivitis• Blepharitis • Burns• Child abuse• Corneal abrasion• Eczema• Episcleritis• Eye allergy• Iritis• Keratitis• Measles • Meibomitis • Stevens-Johnson syndrome• Sub-conjuntival haemorrhage

Common symptoms associated with red eyes• Eye pain, • Itching/ irritation/ no irritation• Photophobia/ sensitivity to light• Watering/ tearing• Eye discharge• Swollen eyes• Visual disturbances – blurring of vision/ impaired vision

AetiologySub-conjuntival haemorrhage commonly due to sudden increase in pressure e.g. violent sneezing, straining or coughing resulting in ruptured capillaries within the bulbar conjunctiva.

Symptoms:- red eye, no pain, no discharge, no change in vision

Causes

• Elevated BP/ anticoagulant drugs

• Rubbing the eyes

• Viral infection

• Some eye surgeries

• Child birth/newborn infants

Physical Exam

Bright red, dense bloody patch, alarming but of little significance

Exam & Tests

BP, Visual acuity and visual field tests, funduscopy

Conjunctivitis

• Most common eye infection (contagious) • Different types of conjunctivitis include;• Allergic conjunctivitis – commonest cause of red eye• Viral (commonest especially in school children)• Bacterial

Allergy • Substances provoking allergy include;• Pollen, • pet dander, • dust, • certain chemicals in make-up, • contact lens solutionsSubstances provoke the immune system and ultimately leading to release of histamine resulting in dilation of blood vessels in the conjunctiva leading to redness and waterying of the eyes.Rx – avoiding known allergens, use of antihistamine eye drops for prevention

Dry eye syndrome• Insufficient or poor quality tear glad resulting in inadequate

lubrication and nourishment of the eyes. • Chronic dry eyes may lead to irritated and inflamed eyes.• Rx - artificial tears-eye drops

Contact lenses• Improper caring of contact lenses• Keratitis or fungal eye infection may occur with contact lenses use• Tight fitting contact lenses can worsen dry eyes syndrome (by reducing

normal tear production – reduction in oxygen reaching cornea and reduction of normal tear flow production)

• Prevention – keep lenses clean and disinfected, regular check-up, use of gas permeable lenses and daily disposable lenses.

Computer vision syndrome

• Starring at computer screen for a long time (blinking less while working on computers result in poor production and circulation of tear.

• Prevention • Frequent breaks from work stations• Specially designed computer glasses• Lubricating eye drops to keep the eyes moist

Eye injury• Trauma• Cosmetic eyelid surgery (dilation of the blood vessels to the injured area

lead to redness) • Injury ranges from minor eye scratches (corneal abrasions) to deep

puncture wound.• Use of fluorescein dye for diagnosis• Rx - primary eye care provider• Puncture injury should be referred promptly for treatment by eye

specialists

Corneal ulcer• Corneal ulcer or ulcerative keratitis• Corneal Infection by virus, bacteria, fungus, chlamydia trachomatis• infective condition of the cornea involving disruption of its epithelial layer with

involvement of the corneal stroma• Children who have vitamin A deficiency are at high risk of corneal ulcers• Causes corneal ulcer include trauma, chemical injury, contact lens and infection

• Corneal healing by re-epithelialization for superficial ulcers and for deep ulcers mitosis , fibrosis, neovascularization and this may result in scarring• Immune-mediated eye disease resulting in ulcers at the border of the cornea

and sclera, e.g. Rheumatoid arthritis, rosacea, systemic sclerosis resulting in a special type of corneal ulcer called Mooren's ulcer. A circumferential crater like depression of the cornea, just inside the limbus, usually with an overhanging edge.

Symptoms and treatment of corneal ulcer

• Very painful – tearing, squinting, loss of vision, anterior uveitis, redness of the eyes, (miosis -small pupil, aqueuos flare,

DiagnosisSlit lampFluorescein dyeTreatment depends on findings• Antiviral - topical acyclovir ointment instilled at least five times a day.• Antibacteria- topical ointment or drops • topical cycloplegics e.g. atropine or homatropine• Conjunctival graft - conjunctival grafts or conjunctival flaps, soft contact lens• Vitamin A supplementation• Avoid topical cirticosteroid

Ocular herpes• Recurrent viral infection by type 1 herpes simplex virus (common cold

sores)• Sign and symptoms• Eye redness• Swollen eyes, pain, watery discharge• Photophobia

• Complications• Scarring of the cornea (if treatment is delayed)Rx - Corneal transplant to restore vision

Uveitisinflammation of the uvea tract

• Sign and symptoms• Inflammation of the iris,• Red eye• Photophobia• Visual disturbances – floaters and blurry vision

• Causes include • Eye infection• Eye injury or trauma• Systemic autoimmune disorder• Unknown in many cases

• Complications – loss of vision• Detached retina• Cataract• High ocular pressure

Glaucoma

• Signs and symptoms• Gradual and asymptomatic loss of vision• Sudden onset of painful, bright-red eyes associated with halos around lights,

loss of vision and nausea may signal acute angle-closure glaucoma• Acute angle-closure glaucoma – would require emergency attention to

prevent permanent loss of vision within hours if not relieved.

Whitening eye drops

• Used for treating red eyes can lead to vasoconstriction of conjuntival vessels• Rebound effect – rebound hyperemia• Chronic use can lead to dry eyes

• Cold and Flu• Red eyes in sinus infection or blocked sinuses associated with sneezing and

coughing•

Pregnancy• Hormonal changes in pregnancy – dry itchy and sensitivity to light• Alter shape of the cornea• Intolerance to contact lenses• Blurry vision• Changes are not permanent – resolves weeks to months after delivery.

Smoking • Smoking harms the eye• Increase the risk of • age –related macular degeneration (AMD),• Cataract and uveitis• Irritant to the eye• Dry red itchy eyes

• Marijuana can lead to red blood shot eyes (dilation of blood vessels on the eyes)• Excessive Alcohol use (lead to reduction of oxygen to RBC causing blood

vessels to clump together resulting to blood shot eyes

Work/environmental hazards

• Eye irritants/injurious items• Dry air, dust, smoke, and excessive sun exposure• Eye injuries by wind, e.g sand, wood fillings, metal and glass bits

• Prevention • use of safety glass (personal protective devices)

• Lack of Sleep• Puffy eyes and dark circles

Swimming

• Chlorine in swimming pools• Bacteria in rivers, lakes and other water sources

• Prevention- • Use of swimming goggles• Removing contact lenses before swimming