Clinical Approach to the Red Eye

Question 1

T/F: ocular redness is often a nonspecific finding

Answer 1

true

Question 2

Ocular redness is always blood. What 2 questions do you ask yourself about it?

Answer 2

1. is the blood INSIDE of vessels; if so, which ones?
2. is the blood OUTSIDE of vessels; if so, where is it?

Question 3

___________ is diffuse redness or small networks of vessels within the bulbar or palpebral conjunctiva OR the palpebral and bulbar surfaces of NM.

Answer 3

conjunctival hyperemia

Question 4

______________ is distinct, relatively straight vessels that are adherent to the sclera (not mobile over the globe), run posteriorly towards the equator from the limbus, is are indicative of intraocular disease.

Answer 4

episcleral injection

Question 5

___________ is loss of physiologic corneal transparency due to deep/stromal vessels, superficial vessels, or 360-degree deep neovascularization.

Answer 5

corneal neovascularization

Question 6

Deep/stromal corneal neovascularization indicates…

Answer 6

intraocular issues

Question 7

Superficial corneal neovascularization indicates…

Answer 7

superficial disease

Question 8

__________ is blood OUTSIDE of the vessels and can be either subconjunctival or hyphema (intraocular).

Answer 8

hemorrhage.

Question 9

_______________ hemorrhage obscures visualization of conjunctival vessels, episcleral vessels, and the sclera.

Answer 9

subconjunctival

Question 10

_________ is redness replacing normal aqueous humor and can variably obscure the iris, pupil, lens, or fundus. It has the ability to change over time.

Answer 10

hyphema

Question 11

What are 4 differentials for subconjunctival hemorrhage?

Answer 11

1. coagulation disorder/vasculitis
2. proptosis
3. trauma
4. strangulation

Question 12

What are 5 differentials for intraocular hemorrhage?

Answer 12

1. retinal detachment
2. coagulation disorder/vasculitis
3. systemic hypertension
4. uveitis
5. neoplasia

Question 13

A patient presents to your clinic with diffuse conjunctival hyperemia, chemosis, exudative discharge, and ocular discomfort. You perform cytology and see gram negative bacterial pathogens. What is the diagnosis?

Answer 13

infectious conjunctivitis

Question 14

What is the clinical appearance of SUPERFICIAL keratitis/keratoconjunctivitis?

Answer 14

long, branching corneal vessels
conjunctival hyperemia

Question 15

If keratitis is present (corneal vessels and conjunctival hyperemia), what are the 2 differentials?

Answer 15

1. non-ulcerative keratitis (KCS, aberrant hairs, entropion, immune-mediated keratitis, pannus/CSK)
2. ulcerative keratitis (corneal ulcer)

Question 16

You can use the location of the vessel pattern, flourescein stain, and STT to determine the cause of ulcerative keratitis.
Describe the most likely cause of the specific locations listed below:
A. linearally in the middle of the cornea
B. near NM
C. near lower lid
D. near upper lid

Answer 16

A. linearlly in the middle of the cornea = TROUBLE BLINKING
B. near NM = FB UNDER 3RD EYELID
C. near lower lid = ENTROPION with TRICHIASIS
D. near upper lid = ECTOPIC CILIA

Question 17

what are 2 differentials for episcleral injection?

Answer 17

episcleral injection indicates intraocular disease

1. uveitis
2. glaucoma

Question 18

If you are suspicious of surface ocular disease, what diagnostics can you do?

Answer 18

1. STT
2. Fluroscein stain
3. cytology, culture

Question 19

If you are suspicious of intraocular disease, what diagnostics can you do?

Answer 19

1. evaluate pupil size
2. tonometry (if uveitis = low pressure, if glaucoma = high pressure)

Question 20

what are the 4 most important immediate rule outs for red eye prior to treating empirically?

Answer 20

1. corneal ulcer
2. dry eye
3. glaucoma
4. uveitis