The red eye

Tim Manners MRCGP FRCOphthConsultant Ophthalmologist

equipment

• Snellen chart• Pinhole• Daylight• Fluorescein• Illuminated magnifier (auriscope head)• Paper clip• Proxymetacaine minims

What do you do?

What do you do?

• Ask a few questions• Have a look• Ask more if necessary• Find your eye things• Look again.

questions

questions

• One eye or both• Painful / itchy / scratchy• Trauma• How long• Contact lenses• Stuck together• History of same or same in others/family• Associated URTI• Any treatment

1st look

– How old– One or both– Acuity affected– Pattern of redness in daylight– Pupil-reactive? shape? – Cornea- bright or cloudy– Look for foreign body

2nd look

• Fluorescein-stains corneal injury(abrasion, fb, herpes. All unilateral)

• Local anaesthetic-is pain relieved?• Magnifier-lumps on palpebral conjunctiva and good

look at cornea• Evert lid if fb suspected (wipe)• Feel for pre auric lmyph nodes

conjunctivitis

• Viral• Bacterial• chlamydial• allergic

viral

– Watery– Unilateral then bilateral– Often with urti and preauric nodes– May be trivial to severe– May need referral if painful– May last weeks– sometimes epidemic

bacterial

– Usually bilateral– Sticky in am– Not usually painful– Self limiting, lasts days.– Treat with chloro, or fucidin in children

allergic

– Itchy– Seasonal or perennial– Hay fever– Chronic severe types may need steroids esp in

children/teenagers– sensitised to drops or preservatives

Corneal causes

• Abrasion• Foreign body• Corneal ulcer

• Contact lenses, herpetic

• Other rarer causes• Look for cloudy cornea• Any corneal cause needs slit lamp exam to confirm

herpetic

– Simplex usually corneal except as primary infection and commonly recurrent

– Zoster causes immune mediated intra ocular inflammation 2-any weeks after infection

– Signs of uveitis– Corneal denervation– Raised iop common

blepharitis

• Itching• burning• mild pain• fb sensation• tearing or dry• crusting• recurrent and variable

uveitis

– Usually unilateral or asymmetric– Painful, unrelieved by local– Circumcorneal injection– Recurrent– May be systemic associations

• HLA B27. Sarcoid etc– Needs referral

• Only indication in 1care for steroids if recurrent before slit lamp examination

episcleritis

• Sectorial or diffuse• Usually asymptomatic other than redness• Self limiting

scleritis

– Immune mediated- complex deposition– Needs systemic Ix and Rx– Painful and usually bilateral– Try nsaids, then steroids then others

Acute glaucoma

• 60s-80s, in winter• Degree of pain• Fixed pupil, mid dilated• Variable injection

Before Rx any red eye

• Exclude foreign body• exclude corneal problem• exclude uveitis,scleritis, acute glaucoma

– history, degree of pain, lack of discharge,laterality, examination.

• NO OTHER PROBLEM WOULD SUFFER FROM A COURSE OF ANTIBIOTIC DROPS.