Dr.

Motasem Al-latayfeh, MD
Consultant Ophthalmologist
Hashemite University
 It is necessary to perform a systematic
exam to determine the involved ocular
structure
 In general, the red eye will be caused by an
②
① infection (viral / bacterial) or inflammation
③
(allergic / autoimmune) of a particular
structure
 An acute elevation of intraocular pressure
(acute glaucoma) is a rare cause of red eye,
but must not be missed to
itnsnallyainfnll
 A “Red Eye” may be due to an abnormality of a

number of ocular structures, including:
eyelid
Adnexa: support & Protect/ term used to describe the external structure
on


lacrimal system
→

◦ →omdtheeye-
(i.e. inflamed lids and periorbital region)
-

-
orbit
◦ Lid disorders
◦ Lacrimal system inflammatory conditions
◦ Orbital disease
itself
 Globe: → mean the eye

◦ Conjunctival / scleral disorders

◦ Corneal disease
◦ Uveitis
◦ Glaucoma
 Your objective in assessing a patient with
periocular or ocular inflammation is to use the
ocular history and physical examination to localize
the site of the abnormality and determine its
possible etiology
 Directed Ocular History
◦ Characterize the symptoms:
◦ Duration – hours, days, weeks
◦ Unilateral or bilateral
◦ Onset of symptoms – acute vs. chronic
◦ Precipitating event – trauma, contact lens usage
◦ Previous episodes of a similar problem
◦ Treatment to date
 General Danger Symptoms
◦ Decreased vision
◦ Severe ocular pain
◦ Coloured haloes

eephotophopia
 Associated symptoms and symptom complexes
◦ Itching, seasonal exacerbation, associated rhinitis = allergy
◦ Burning, foreign body sensation, tearing = blepharitis, dry
eye, retained foreign body, trichiasis
◦ Localized lid tenderness = hordeolum, chalazion
◦ Mucopurulent discharge, crusting = bacterial conjunctivitis
◦ Mucoid discharge, URTI, history of contacts, initially
unilateral then bilateral = viral conjunctivitis
◦ Intense pain = corneal ulcer, scleritis, iritis, acute glaucoma
◦ Nausea, vomiting, intense ocular pain, halos' in vision =
acute glaucoma
◦ Intense photophobia = uveitis, keratitis, corneal ulcer
 Directed Ocular Examination

◦ Record the visual acuity for distance, correction

◦ If decreased, use pinhole or near vision
◦ Examine the pupils for asymmetry (uveitis, acute
glaucoma), reactivity, relative afferent pupil defect
(RAPD) Shap
-
  External Ocular Examination

◦ Is there redness around (vs. in) the eye

◦ Localized lid redness = chalazion, hordeolum
◦ Localized periorbital inflammation =
5nF to lacrimal
.

gland
dacryoadenitis, dacryocystitis in to lacrimal sac
→ .

◦ Diffuse periorbital inflammation = orbital cellulitis

(

oinconjed.ir#d/Fornixial.eye1idedema-
 Slit Lamp Examination

◦ Lid margin – blepharitis?

◦ Conjunctiva – diffuse or sectoral redness?
◦ Limbal injection (corneal or iris involvement)?
◦ Conjunctivial follicles (viral conjunctivitis)
◦ Cornea – clear or opaque? Epithelial defect with
fluorescein? Abrasion vs. ulcer
◦ Anterior chamber – cells & flare? Narrow with
ACG?
- -

inflammation
◦ Iris
◦ Lens
 Clinical Features:

◦ Palpebral or diffuse redness

- -

◦ Purulent discharge when patient wean up

→ His eyelid connect
with each other / yellow to
◦ Papillae green .

◦ Edema of eyelids localized diffuse

→ or

-
some time start in one eye and then move to other eye .
clear Cornia / iris

normal limbless
"

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"

⇐H§aryFInsh
Palpi brat
or
a

injection.IS
 Common pathogens :

◦ Staphylococcus coagulase or non-coagulase

positive,
◦ Streptococcus
◦ Hemophilus influenzae,
◦ Pseudomonas sp. →
rarity
 Treatment:

◦ culture not mostly time

warm compresses
-

◦
◦ clean lids of discharge
◦ Topical antibiotic drops qid for 5-7 days and
ointment hs for 7-10 days
Specific type

-
affect the neonate / ophtbnlmianeonatornm conjunctivitis of the newborn

 Very serious infection caused by gonococcus

 May rapidly perforate the cornea if not treated →

 URGENT REFERRAL for intensive IV & topical

treatment
excessive amount of discharge
 Symptoms –

◦ itching,
◦ burning,
◦ redness;palpebral
I

◦ patient often has a viral URI and / or history of

contact with others affected similar condition
→
 Signs –

◦ mucoid / watery discharge,

◦ conjunctival follicles,
◦ preauricular lymph node palpable
◦ pseudomembrane Formation → deposition of exudative
→

material

µ
◦ subepithelial infiltrates bleed ↳ doesnt
idiÉtivities =

tissue
adhesion btw menbrain
and underlying
fine membroin → form → .

↳ difficult to beat
 Highly contagious, epidemics occur
 →
-osnbepithe
Adenovirus commonest cause social sign infiltration
.

 Initially one eye, with second eye affected a

few days later
 Rx artificial tears & cold compresses treatment
suppositive
→

 topical steroids sometimes used in severe

cases
to

 Gets worse for 4-7 days, then resolves over

next 2-3 weeks (contagious for 10-12
days)
 1-
Buffy eyelid in both eye → some mucoid discharge
u , , ,, / 9- both conjectiva is conjected
 Hypertrophy of the lymphoid tissue
◦

palpi boat conjectural injection → with follicle

Coronial involvement → sub epithelial infiltration

7
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① Adult chlamydial Keratoconjunctivitis:

◦ Adult chlamydial keratoconjunctivitis is a sexually
6- -
transmitted disease caused by the obligate intracellular
bacterium Chlamydia trachomatis serotypes D to K.
arlareobic
◦ Patients with chlamydial conjunctivitis are generally young
◦ At least 50% have a concomitant genital infection.
◦ Transmission is by autoinoculation from genital secretions
although eye-to-eye spread may occur rarely.
◦ Presention is with a subacute onset of unilateral or bilateral,
mucopurulent discharge.
◦ Unlike adenoviral infection, the conjunctivitis may persist
for 3-12 months if untreated>
◦ Signs include: edematous conjunctiva, mucopurulent
discharge, papillary then follicular reaction , non-tender
lymphadenopathy.
◦ Corneal involvement is uncommon
◦ Long-standing cases are characterized by conjunctival
scarring
follicularread.io#--*werpa1pibroalconjeotira
ACK
↳
 Treatment:
◦ Topical therapy is with tetracycline ointment four
times daily for 6 weeks.
◦ Systemic therapy can be with one of the
following:
 Doxycycline either 300 mg weekly for 3 weeks or 100 mg
daily for l-2 weeks.
 Tetracycline 250mg four times daily for 6 weeks.
 Erythromycin 250mg four times daily for 6 weeks if
tetracycline is inappropriate.
M
②

 Chlamydial infection is the most common

cause of neonatal conjunctivitis.
 It may be associated with systemic
chlamydial infection which may result in
otitis, rhinitis and pneumonitis.
 Because the infection is transmitted from
the mother during delivery it is important
that both parents are examined for
evidence of genital infection.
chlymed ink infection
-
so important to test both Percent of genital
  Presentation is usually between 5 and 19
days after birth.
 Signs include Papillary conjunctivitis with a
mucopurulent discharge .
 Treatment is with topical tetracycline and
yqstem oral erythromycin 25mg/kg body weight
twice daily for 14 days.
b-nffgfstechyeyel.IR discharge chhsmedialconjeetivitis
=
 Symptoms –
◦ itching, most important symptom
→

◦ Redness: perilimbal , bulbar or palpebral

◦ seasonal,
◦ atopic history,
◦ rhinitis
 Signs –

◦ chemosis,
◦ papillary reaction,
◦ Mucus
◦ Limbal thickening with white deposits
differs conjectival
with whitish
injection
steak discharge
-

Comncnsorigin
 Treatment –
◦ cool compresses,
◦ artificial tears,
◦ topical antihistamines/vasoconstrictors
◦ systemic antihistamines,
◦ topical mast cell stabilizers
 this reaction its only area of eonjectira its edematous .

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upper
tarsalofelevation
in the conjectivat
tissue
-

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degenerativecunses

 Pingueculum z④
◦ Change in conjunctiva due to wind, sun exposure,
increased vascularity
◦ confined to conjunctival tissue
◦ respond to irritants in environment (eg. smoke,
fumes) by becoming red, inflamed, and obvious
◦ Treatment: lubricant and/or vasoconstrictor
• not vascular but its surrounded by vascularity .
- ruffly its a triangular in
shop
limbus
with the base at the
and the apex away from

9 the
cornea
 Pterygium : fleshy e)astatic degeneration of the anjectiva .

◦ Blood vessel extension onto cornea

◦ Treatment
a. frequent use of artificial tears
b. sungoggles/sunglasses for outdoor wear (with
ultraviolet filter)
c. topical ophthalmic solutions with
e vasoconstrictors up to tid prn to alleviate redness
d. refer for possible removal if actively growing
pterygium or severe inflammation osmotically or

•
legion also triangular in shop but apex Honored the Cornia

and base at the limbus

 Subconjunctival Haemorrhage :
◦ blood beneath conjunctiva
◦ No pain, normal vision
◦ Traumatic or spontaneous
◦ Traumatic cases should be referred to rule out
other ocular injury
◦ Spontaneous may follow coughing, sneezing or
straining
◦ Spontaneous will resolve in about 10 days – but
should check CBC, INR/PTT & BP if recurrent
episodes
◦ . no treatment except time and reassurance