Causes of red eye
There are many different causes of a red eye. After taking a full history and thoroughly examining the eyes, a management plan can be made.
Inflammation of the iris and ciliary body
- Previous uveitis
- Seronegative arthropathy, especially HLA B27 positive patients
- Herpes zoster ophthalmicus
- Young or middle aged patients
- Pain worse when reading
- Reduced visual acuity
- Pupil may be small and irregular (due to posterior synechiae - adhesions of iris to the lens)
- On using slit lamp, anterior chamber may show:
- cells (moving, white specks)
- hypopyon - pus in anterior chamber
- flare (looking through frosted glass)
- keratic precipitates may be seen at the back of the cornea
- Treat underlying cause if found.
- Topical steroids
- Mydriatics to prevent synechaie being formed which can cause acute glaucoma.
Acute angle closure glaucoma
Due to occlusion of the angle where aqueous fluid is normally drained, therefore leading to a sudden increase in intraocular pressure.
- Usually in patients over 50 yrs
- Severe pain
- Red eye
- Haloes around lights
- Reduced visual acuity
- Fixed semidilated pupil not reactive to light
- Eye feels hard on palpation
- Hazy cornea
- Systemic symptoms- headache, nausea, vomiting
- Urgent ophthalmological referral to prevent visual loss
- IV acetazolamide 500mg
- Pilocarpine 4% topical to constrict pupil
- To restore normal aqueous flow, a hole needs to be made in the iris. This can be done with a laser (iridotomy) or surgically (iridectomy)
- Inflammation of white sclera itself
- Usually very painful; significantly more redness present compared to episcleritis
- Associated with other autoimmune conditions
- Visual acuity may be affected
- Management - may need immunosuppressants
- Complications - corneal ulceration, intraocular inflammation
- Inflammation of episclera
- Mild eye irritation and redness
- Normal visual acuity
- Management - usually self limiting, but steroids may help
- Corneal abrasion
- Contact lenses
- Exposure keratopathy (ie a patient with facial nerve palsy who is unable to close eyelids).
- Foreign body sensation
- Mild to moderate red eye
- Blurred vision
- Staining the cornea with fluorescein shows an area of corneal epithelial defect, and shows up yellow.
- Viral infection- Topical acyclovir
- Bacterial or fungal infection- Broad spectrum antibiotics
- Non-infectious ulcer- treat the cause.
Bright red blood between white sclera and conjunctiva. Usually benign
Can be caused by:
- Severe coughing or straining
- Blood disorders
- Diffuse area of bright red blood
- May be a foreign body
- No pain, blurred vision or photophobia
- Eye examination otherwise normal
- Exclude hypertension
- Check coagulation profile, especially if patient is on warfarin
- Reassure patients that it is benign and may take a few weeks to fade
ABC of Eyes. 4th edition.
Kennerley Banke's Clinical Ophthalmology. 4th ediition.
Image 1- Hypopyon in anterior uveitis taken from http://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_-lny8tU/s1600/ant+uveitis.jpg
Image 2- Acute angle closure glaucoma taken from http://www.medrounds.org/glaucoma-guide/2006/12/section-9-c-diagnosis-of-acute-angle.html
Image 3- Scleritis taken from http://eyepathologist.com/images/KL21711.jpg
Image 4- Episcleritis taken from http://www.gp-training.net/protocol/ophthalmology/redeye/episcl.jpg
Image 5- Corneal ulcer taken from http://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg
Image 6- Subconjunctival haemorrhage taken from http://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg