Red eye Flashcards
What are some commonly presenting conditions causing red eye?
Bacterial and viral conjunctivitis
Dry eyes
Adnexal problems (ectropion / entropion / blepharitis)
What are some vision-threatening causes of red eye?
AACG Anterior uveitis Corneal ulcers Trauma (perforations of globe) Scleritis (can perforate globe)
What are the risk factors associated with anterior uveitis?
HLA-B27 TB Syphilis Lyme disease Sarcoidosis
What are the risk factors associated with scleritis and episcleritis?
Connective tissue diseases such as
RA
Granulomatosis with polyangiitis (Wegner’s)
SLE
What are the risk factors associated with AACG?
Hypermetropia
Mydriatics
Systemic anticholinergic medications
What are the risk factors associated with subconjunctiuval haemorrhage?
HTN
Systemic anticoagulation
What are the risk factors associated with dry eyes?
Connective tissue disorders such as
Sjogren’s syndrome
RA
SLE
What are some typical symptoms reported in AACG? How would you manage a patient with AACG?
Halos around lights Blurred vision Pain One eye Headache N&V
Immediate referral to an ophthalmologist
Immediate treatment consists of CAI such as acetazolamide or methazolamide, to decrease aq humour formation
What key questions should be asked initially in the HPC?
When the condition started
Unilateral or bilateral (e.g., a foreign body or trauma is usually unilateral, whereas conjunctivitis may start as unilateral then become bilateral)
Onset of the symptoms and signs (e.g., acute onset may indicate a corneal foreign body or abrasion or foreign body trauma).
What associated symptoms should be elucidated?
The most important to note are
The presence of reduced visual acuity or
A deep aching pain within the eye
Indicating the presence of a more serious underlying diagnosis, such as angle-closure glaucoma, anterior uveitis, or scleritis.
What questions should you ask if you suspect a foreign body?
Were they wearing eye protection?
Nature of activity? (use of mechanical saws and hammering)
Contact lens wearer?
Discharge present? (points towards conjunctivitis)
What may the nature of the discharge reveal about the aetiology?
If the discharge is watery, purulent, or mucopurulent (e.g., a watery discharge is seen in viral conjunctivitis, whereas a profuse mucous discharge is seen in chlamydial conjunctivitis and a purulent discharge in gonococcal conjunctivitis)
What further questions may you ask if you suspect red eye due to allergy?
If its worse in the mornings?
If there is any itch present?
Do they have a history of atopy?
What eye pathologies may photophobia indicate?
Anterior uveitis
Corneal epithelial disturbance
Don’t forget to consider systemic associations of photophobia such as meningitis
What medications are known to precipitate red eye?
Mydriatics
Systemic anticholinergics
Anticoagulants predipose to subconjunctival haemorrhage
