Acute Red Eye
The four main causes of acute red eye presenting to the ED are
Conjunctivitis
Inflammation outer eye
Iritis
Inflammation inner eye
Glaucoma
Aqueous outflow blockage
Keratitis
Corneal ulcer = combination of conjunctivitis and Iritis
Acute Conjunctivitis
Clinical
- Tarsal injection
- Discharge in AM, purulent
- Grittiness
- Mild photophobia
- Staph. aureus, pneumococcus, H. influ
- Rarely gonococci, chlamydia, adenovirus
- May be allergic
Management
- Toilet, Antibiotics (fucithalmic)
- Avoid pads, Dark glasses, Lubricant eyedrops
- Soln. of metal salts to decongest (given by ophthalmology staff)
- Steroids in allergic - (Ophthalmologist only)
- Chromoglycate or antihistamine drops - (ophthalmologist only)
Acute Iritis
Uveal tract = Iris, Ciliary body, Choroid
- Ant. uveitis = Iritis
- Pain = ciliary spasm and ooedema
- Red = engorgement blood vessels
- Post. uveitis = Choroiditis
- Painless
- Free from congestion
- Impaired vision
Aetiology of Acute Iritis
- Majority endogenous (Autoimmune disease or Focal sepsis or Sarcoidosis)
- Rarely exogenous (Through perforating wounds)
- Rarely sympathetic ophthalmitis
IrIrtis findings
- Ciliary injection
- Small pupil
- A normal pupil does not exclude iritis [BestBets]
- Exudate into anterior chamber
- Hypopyon (Usually KP ) & synechias
- Therapeutic atropine = festooning pupil
- Eyeball tender and painful
- Moderate photophobia
Acute glaucoma
Treatment Acute Glaucoma
- Immediate bright light to force meiosis
- Pilocarpine 4%
- Acetazolamide
- Analgesia, Pad, Heat
- Glycerol, Mannitol, Iridectomy
- Closed angle with bouts raised tension
- Emotion + fading light
- Severe pain
- Halos and dusky cornea
- Dilated oval fixed pupil
- Stony hard eyeball
Acute Keratitis (Corneal Ulcer)
Combination conjunctivitis and iritis
Conjunctivitis features
- Irritation
- Conjunctival injection
- Discharge
- Fluoresceine stain positive
Iritis features
- Boring pain
- Ciliary injection
- Reduced vision
- + / - hypopyon
Keratitis (Corneal Ulcers)
Treatment acute keratitis
- Combination of Px for conjunctivitis + iritis
- Antibiotics
- Atropine
- Pad
- Heat
- Acyclovir / idoxuridine - dendritic
- NO steroids
- Carbalization
- Tarsorrhaphy
Multiple small marginal
- Immune rxn to staph. protein
Large central
- Bacterial through abrasion - pneumococcus
- Corneal FB
- HSV dendritic
Central traumatic
- Facial N lesion
- Arc eye
- Blood flow changes
- Chronic iritis
- Vitamin A deficiency
Clinical features acute red eye
| Conjunctivitis | Iritis | Glaucoma | |
Pain |
Grittiness | Moderate / Severe | Severe +++ |
Discharge |
+/- Purulent | Reflex epiphora | |
Photophobia |
Mild | Severe | Moderate |
Cornea |
Clear | KP | Oedema |
Pupil |
Normal | Small Fixed, Irreg | Dilated, Fixed, Oval |
Iris |
Normal | Muddy | Grey - Green |
Tension |
Normal | Normal | High |
Red |
Tarsal | Central | Central |
Px |
Toilet, AB, Shades | Atropine, Heat, Steroids | Pilocarpine, Acetazol, Iridectomy |
Content by Dr Íomhar O' Sullivan 31/10/2003 Reviewed by Dr ÍOS 11/10/2004, 15/05/2005, 13/11/2006, 19/01/2007. Next review 91/01/2008.
