Common Causes of Red Eye

Pathophysiology
Lowest slide is an interpalpebral redness. Ciliary injections are much more deeper
and are more serious and must be looked out for first. Ciliary around the limbus,
conjunctival diffuse
Pathophysiology
Lower picture: Cornea has some sort of a crown around it, while the rest of the
conjunctiva looks fairly white
Clinical History
most important part is changes in vision
Conjunctival Inflammatory Reactions
Two basic types of conjunctival inflammatory reactions
Follicular Conjunctivitis
Sago like structures (smooth, rounded, nodules) are actually lymphoid
germinal centers
Anything that would incite inflammatory reactions would create
follicles
Adenoviral conjunctivitis is also known as sore eyes in laymans
terms
Papillary Conjunctivitis
Vascular (compared to follicular which is lymphoid)
Others?

Adenoviral Conjunctivitis
Most common cause of conjunctivitis in the Philippines
Epidemic Keratoconjunctivitis (EKC)
Sequelae of adenoviral conjunctivitis
Produces punctate lesions that hamper vision
Membranous Conjunctivitis
Gonococcal Keratoconjunctivitis
A hyper-acute type of conjunctivitis caused by N. gonorrhea
which is one of the few bacteria that can penetrate intact
epithelium
An urgent case, but treatment is very successful
Chlamydial Keratoconjunctivitis

More common STD, ocularly speaking

Very easy to treat, but the problem is that it colonizes the
pharynx, so treatment must be systemic
Looks like sore-eyes but has follicles on the upper back lid
Partner must also be treated
May ask for urinary problems then go to STD symptoms
Allergic Conjunctivitis (see 6 following types)
Hay-Fever Conjunctivitis
Most common is Type 1 aka Hay-Fever Conjunctivitis
In the Philippines, most common antigen is dust
Very easy to detect because the patient will complain of itching
Redness is more pink than red
There is chemosis or edema of the conjunctiva looks elevated,
eyelids are sticky
Atopic Keratoconjunctivitis
Has photophobia because of the higher degree of inflammation
Upper papillae become very prominent and scrape on the
cornea when you blink, causing scarring, neovascularization,
and neovascularization a common pathway to blindness
Vernal Conjunctivitis
More common in Asians
Cobblestone papillae
Giant Papillary Cconjuntivitis
More of a type 4 hypersensitivity
Patients usually shift to glasses or turn to LASIK procedures
Pterygium
Stimulus is thought to be a dry spot preceding the head of the
cornea. As elevated hypovascular structure arises, it causes
dryness around it and stimulates cells to cover it so that it
advances. Common to people with chronic exposure to sunlight.
Phylctenulosis
Typically patients will have a history of TB infection

Basically an abscess
Leading cause of blindness that covers the pupil and creates an
opaque scar to cause vision problems

Episcleritis
Slightly red, slightly tender, redness of the eyes
A general term for something that is happening the scleral
tissue
Subconjunctival Hemorrhage
Painless, no history of trauma
Most benign of the conditions we are discussing
Patients typically have a history of valsalva (i.e. constipation),
etc etc (di lang Valsalva)

Causes in the Cornea for Redness (KERATITIS)

Bacterial Keratitis (most common)
Streptococcus pneumonia currently use the 4 th gen fluoroquinolones
because they are very active against g- agents
Pseudomonas aeruginosa can penetrate the cornea within 4-8 hours. Have
to act quickly because of the virulence. Secretes collagenases and causes actual
melting of the cornea, making it very dangerous. Differentiated from pneumonia
because there are no distinct borders. Treatment is also 4 th gen fluoroquinolones.
Fungal Keratitis no sure cure. Typically, the patient has a history of being hit
by any vegetable material (e.g. mud, leaf, branchesvegetables). Very hard to
eradicate once it has established in the cornea. Only natamycin is proven to work
and it only works on yeast types. We do not have drugs for the other forms of fungi.
Herpes Simplex Keratitis quite common, viral type. Classical dendritic lesion
on fluorescein stain. Become map-like or causes geographic ulcers once the virus
spreads from center to periphery. Can resolve by itself.
Corneal Abrasion mechanical. Causes a lot of redness, pain, photophobia,
and tearing because the cornea is a very sensitive organ with a lot of nerve
endings. Typical story is waking up in the morning with sudden pain on one eye. Aim
of treatament is just to stabilize the eye, usually with a contact lens that acts as a
bandage. If the basement (aka Bowmans) membrane is also affected, you will have
recurrent abrasions and must be treated later on with keratectomy or lasers

Glaucoma
Acute Angle Closure Glaucoma severe pain, severe redness, severe
decrease of vision, with possible nausea and vomiting. Eyes will be stone hard.

Uveitis
Acute Anterior Uveitis less common cause of red eye. Pain is very mild and
is more like a heaviness. Vision may or may not be affected at all. Patient complains
of photophobia because the ciliary bodies are cramped. Cells and protein buildup
seen on anterior chamber upon slit-lamp examination. Keratic precipitates are cells
with pigments attached to them and become stuck in anterior chamber

Dry Eye Disease

More a problem of ocular surface than absence of tears
Used to be more common in female elderly but is now happening to everyone
most likely due to the more prevalent use of screens (e.g. tablets, computers,
television)
Anti-histamines, diuretics, and some drugs are common causes of dry eye
DEWS Drye Eye Workshop Algorithm grades patients 1-4 based on symptoms
and depending on the grade can give guidelines on treatment

ALGORITHM
First thing to ask is pain
YES? r/o that shit in the slide
NO? luh sige na nga madali lang naman pala yung algorithm