Differential Causes of Red Eye

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Uveitis
The uvea is the pigmented middle layer of the eye (the outermost being the sclera and the innermost the retina). It is made up of the iris = ‘anterior’ = 90% ciliary body = ‘intermediate’ choroid = ‘posterior’ Uveitis refers to inflammation of the uvea. It is somewhat complex because the uvea is made up of so multiple constituent parts and so inflammation can be in any of these, as well as in other parts of the eye at the same time (e.g. retina). As a result the term “intraocular inflammation” is used to describe the spectrum of conditions. Causes: INFECTION by a virus herpes, fungus or parasite toxoplasmosis AUTOIMMUNITY SLE, MS, sarcoidosis TRAUMA to the eye or even the other eye in the past Symptoms: Redness diffuse or localised to limbus Visual Blurring Pain Dark Floating Spots Photophobia Pain Relief Glucocorticoids Atropine Methotrexate (more severe)

Glaucoma
This is a disease in which there is progressive damage to the optic nerve, resulting in progressive, irreversible loss of vision. It is not necessarily caused by raised intraocular pressure, although it is frequently associated with it and is a significant risk factor. There are 2 main categories open angle reduced flow through the trabecular meshwork closed angle iris pushed forward to prevent a.h. from draining

Of the two, closed angle is more acute and pain and discomfort often cause the patient to seek medical attention. Open angle tends to progress more slowly so that the patient may not notice a deterioration in their vision until the disease has progressed quite far aka “sneak thief of sight” In the case of acute glaucoma, a sudden severe rise in intraocular pressure caused by reduced anterior chamber aqueous fluid drainage may result in the following symptoms: Symptoms: Sudden onset of severe eye pain Visual Blurring Rainbow-like haloes around lights Nausea and Vomiting Reduced Visual Acuity Diffuse Ocular Redness Pupil = semi-dilated and not reactive to light The raised pressure can be caused either by increased production or decreased absorption through the trabecular meshwork. This can be detected using tonometry (e.g. “air puff”)

posterior chamber aqueous humour

All 4 of these are characterised by: redness (hyperaemia) watering (epiphora) irritation (chemosis) Note that there are no pupillary or corneal abnormalities. Whilst it may appear quite dramatic. Allergic This tends to be very itchy. and resembles anterior uveitis (or ‘iritis). Subconjunctival Haemorrhage This is bleeding underneath the conjunctiva where blood collects between the outer conjunctiva and the sclera beneath it. fragile blood vessels within it and has a typically bright red initially. It should disappear within 2 weeks. pain or any photophobia Bacterial This is characterised by a purulent discharge produced by pyogenic bacteria. It is characterised by the rapid and spontaneous appearance of blood underneath the conjunctiva with no changes in visual acuity. Whilst pus is a hallmark feature of this form of conjunctivitis. it may be associated with one of the more severe of the following causes: minor eye trauma eye rubbing blood thinners severe coughing straining strenuous exercise vomiting severe hypertension This condition usually requires no treatment if there is no obvious cause (e. Redness appears as fine and diffuse within the conjunctiva.Conjunctivitis This is a disease characterised by acute inflammation of the conjunctiva (the outermost layer or the eye and the inside of the eyelids). . It is caused by the rupture of small. This may cause the lids to stick together after sleeping or crusting of the eye and surrounding skin. it is usually not painful or harmful.g. There is often a ropy. allergic or chemical. before turning green or yellow. There is also no change in visual acuity. it only affects one eye but often spreads to the other. However. Like viral conjunctivitis. and acute infection can be painful. viral. non-purulent mucoid discharge. Viral aka “pink eye” This is often associated with an upper respiratory tract infection. pupils or the cornea. common cold or a sore throat. increased venous pressure Patients should be discouraged from taking NSAIDs or aspirin until the condition is resolved. The eye may feel gritty. It may be bacterial. Symptoms include a watery discharge and itching. trauma). with characteristic swelling of the conjunctiva and eyelid. it is not essential.

People with this condition often have bouts. Simple This comes on quickly but is characterised by mild inflammation. Corneal Ulcer aka “ulcerative keratitis” This is an inflammatory or infective condition of the cornea. It is frequently idiopathic. which is the thin membrane which covers the sclera and lies between the sclera and conjunctiva. . Nodular This is more painful and lasts longer. In both forms. Scleritis This is inflammation of the sclera and is often associated with underlying vasculitis. This is frequently associated with underlying health conditions including SLE and rheumatoid arthritis. Symptoms include mild to sever eye pain. the pupils and the cornea are normal. Causes: Trauma Contact Lenses Infection bacterial. It usually clears up by itself but artificial tears may make the patient more comfortable. Infective causes can be elucidating using corneal scraping and culture testing. The redness is often diffuse and this condition is commonly painless. 2. visual acuity. fungal Chemical Injury Dry Eye = keratoconjunctivitis sicca Pain Foreign Body Sensation Blurred Vision Photophobia Reduced Visual Acuity Redness often maximal around the edge of the cornea “ciliary injection” Symptoms: Diagnosis is made using a slit-lamp examination in conjunction with a fluorescein stain. This stain is taken up by the exposed corneal stroma and makes it appear green.Episcleritis This is inflammation of the episclera. viral. There are two types 1. diffuse or localised redness and normal pupillary and corneal appearances. typically occurring every 1-3 months. The redness & inflammation is commonly localised to one part of the eye and there are often raised lumps in this area. It lasts for 7-10 days. characterised by disruption of its epithelial layer and with frequent involvement of the corneal stroma. normal or decreased visual acuity. Treatment is directed at the cause.

There is decreased visual acuity. diffuse or localised redness. It is a dreaded consequence of eye surgery and often results in visual loss or loss of the affected eye altogether. injury or spread via the bloodstream. a small. photophobia and floaters. Causes: Infection Trauma Retained Intraocular Foreign Bodies Haematogenous (spread via the bloodstream) Symptoms include blurred vision.Endopthalmitis This is infection of the internal coats of the eye after eye surgery. eye pain. fixed pupil and a cloudy cornea .

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