PGI Lourilaine Silva

Red eye is the cardinal sign of

ocular inflammation.
Benign
Conjunctivitis is the most
common cause of red eye.
Other common causes include
blepharitis, corneal abrasion,
foreign body, subconjunctival
hemorrhage, keratitis, iritis,
glaucoma, chemical burn, and
scleritis
Sign and symptoms:
eye discharge
redness
pain
photophobia
itching
visual changes
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Other Causes of Red Eye
Diagnosis of the Underlying Cause of Red Eye
A stye, or hordeolum, is an
acute, usually sterile,
inflammation of the glands or
hair follicles in the eyelid
Area of inflammation within the
eyelid secondary to obstruction
of meibomian gland or gland of
Zeiss
Categorized as external or
internal, according to where the
inflammation is located in the
eyelid
External hordeolum
This is a suppurative
inflammation of a Zeis
gland
In the early stages the
gland becomes swollen,
hard and painful, and
usually the whole edge of
the lid is oedematous.
External hordeolum
The pain is considerable
until the pus is removed.
Styes often occur in crops,
or may alternate with boils
on the neck, carbuncles, or
acne.
It is commonest in young
adults.
Internal hordeolum
An acute infection of a
meibomian gland produces
a swelling directed
internally toward the
conjunctiva.
Internal hordeolum
It is less common but the
inflammatory symptoms
are more violent than in an
external stye, because the
gland is larger and
embedded in dense fibrous
tissue.
Internal hordeolum
The pus appears as a
yellow spot shining through
the conjunctiva when the
lid is everted.
It may burst through the
duct or the conjunctiva
rarely through the skin
Chalazion is also known as a
tarsal ‘cyst’ or meibomian ‘cyst’.
Chronic inflammatory granuloma
of a meibomian gland
Chalazia are often multiple,
occurring in crops, and are more
common among adults than in
children
The glandular tissue is
replaced by granulations
containing giant cells, plasma
cells, histiocytes and
polymorphonuclear leucocytes
probably as a result of chronic
irritation.
Hard, painless swelling in
either lid, increasing very
gradually in size
The smaller chalazia are
difficult to see, but are readily
appreciated by passing the
finger over the skin.
The appearance is due to
alteration in the granulation
tissue, which becomes
converted into a jelly-like mass
Chalazia become smaller over
months
“Sore eyes”
Infectious or non-infectious
inflammation of the conjunctiva
Signs and symptoms:
“Red eye” (conjunctival hyperemia)
Discharge
Eyelids sticking or crusting (worse in
the morning)
FB sensation
<4 weeks duration
Conjunctivitis can be divided into infectious and noninfectious
causes
Viruses and bacteria are the most common infectious causes
Noninfectious conjunctivitis includes allergic, toxic, and
cicatricial conjunctivitis, as well as inflammation secondary to
immune-mediated diseases and neoplastic processes.
The disease can also be classified into acute, hyperacute, and
chronic according to the mode of onset and the severity of the
clinical response.
Furthermore, it can be either primary or secondary to systemic
diseases such as gonorrhea, chlamydia, graft-vs-host disease,
and Reiter syndrome, in which case systemic treatment is
warranted
Most common cause:
adenovirus
Signs & symptoms:
Itching, burning, tearing, gritty or FB
sensation
History of recent URTI or sick contact
Inferior palpebral conjunctivalfollicles
Tender palpable preauricular lymph
node
Often starts with one eye
theninvolves the fellow eye base later
on
Self-limiting
May give low dose steroid to address the inflammation
Fluorometholone eye drops TID, or
Tobramycin + Dexamethasone Q4 for 7 days
Frequent application of preservative free artificial tears
Reassure patients that medication is not needed because of its
viral cause
Frequent handwashing
Antihistamine as needed
Antibiotics if with secondary bacterial infection
Signs & symptoms
Itching, watery discharge
History of allergies
Usually, bilateral
Chemosis (fluid-like material
on the conjunctiva), red &
edematous eyelids,
conjunctival papillae,
No preauricular node
Eliminate the inciting agent
Temporary relief may be obtained by decongestant eye drops
(naphazoline)
Oral antihistamine
Loratadine or cetirizine
Olopatadine eye drops, 1 drop TID
Mast cell stabilizers (sodium cromoglycate, olopatadine, ketotifen)
NON GONOCCOCAL
Most common cause of acute
conjunctivitis
Usually caused by:
Staphylococcus aureus
Streptococcus
pneumoniae
Haemophilus spp.
Moraxella catarrhalis
Signs & symptoms:
Redness, FB sensation,
discharge
Itching is much less prominent
Purulent white-yellow discharge
of mild to moderate degree
Conjunctival papillae, chemosis
Preauricular node typically
absent but is often present in
gonococcal conjunctivitis
Topical drugs
‘broad-spectrum’ antibiotics such as chloramphenicol,
lomefloxacin, ofloxacin and ciprofloxacin in a frequency of four
to six times a day are prescribed empirically
Topical steroid medication to hasten resolution should not be used
in infectious conjunctivitis
Systemic medications are rarely required
Oral analgesic anti-inflammatory medication and/or antibiotics
are only indicated for systemic features such as pyrexia and
sore throat
Supportive management
The eyes should not be bandaged, as this prevents drainage
of the secretion
A sun-shade or dark goggles should be worn
The patient must keep his hands clean and no one else
should be allowed to use his towel, handkerchief, pillow or
other fomites
GONOCCOCAL
Severe purulent discharge,
hyperacute onset (within 12-24
hours from the time of contact
with the person who has
gonorrhea)
Conjunctival papillae, marked
chemosis, preauricular
adenopathy, eyelid swelling
GONOCCOCAL
The most important point in
diagnosis is the coincidence of
urethritis
The most important point in
prognosis is the involvement of the
cornea
Blindness
Diffuse haziness of the whole
cornea, with grey or yellow
spots near the center
Therapy is initiated based on the findings of intracellular Gram-
negative diplococci on conjunctival scraping and smear
examination or on clinical suspicion
The primary objective is to prevent or limit corneal involvement,
protect the other eye and eliminate any systemic reservoir of
infection
Topical therapy: The eye must be irrigated with warm saline and a
2-hourly intensive therapy given with antibiotic eyedrops (e.g.
ofloxacin, ciprofloxacin, gentamicin or tobramycin), orbacitracin
ointment 6 hourly.
Cycloplegics should be used in all cases involving the cornea
Systemic treatment with a single dose of 1 g ceftriaxone as an
intramuscular injection is usually adequate.
Consultation for skin and venereal disease
Patient’s sexual partner should be treated
If corneal involvement is present the patient should be hospitalized and
treated with an injection of 1 g ceftriaxone given intravenously every 12–24
hours
Treatment for any coexistent chlamydial infection is also
recommended.
Patients who are allergic to penicillin or cephalosporins should be
treated with tetracycline, particularly if there is coexistent infection
with Chlamydia trachomatis.