Diagnoes Red Eye

Question 1

DDX Conjunctivitis: Diffuse conjunctival hyperemia, +/- chemosis and ocular discharge, No corneal disease and eye otherwise normal

Answer 1

1. KCS
2. Infectious disease (chlamydophilla or herpes)
3. Mechanical/Chemical Irritants (FB)
4. Stress

Question 2

Diagnostics Conjunctivitis

Answer 2

STT
Fluoroscein Stain Test
Swab and Culture

Question 3

DDX Superficial Keratitis/Keratoconjunctivitis: conjunctival hyperemia, long-branching corneal vessels (superficial - location and direction may indicate disease type)

Answer 3

1. Non-ulcerative superficial keratitis (KCS, exposure, abherrant hairs/entropion, immune-mediated keratitis, pannus, CSK - chronic superficial keratitis)
2. Superficial corneal ulceration (look for underlying disease)

Question 4

Diagnostics Superficial Keratitis/Keratoconjunctivitis

Answer 4

Good physical
STT
Fluoroscein

Question 5

DDX Stromal Keratitis: conjunctival hyperemia, vessels straighter, hedge-like (location may help determine cause)

Answer 5

1. non-ulcerative stromal keratitis (primary corneal disease; secondary to glaucoma or uveitis)
2. Deep ulcer/laceration

Question 6

Diagnostics Stromal Keratitis

Answer 6

Check Pressure (high gluacoma, low uveitis)
STT
Fluoroscein
Pupil size (large/mydriasis glaucoma, small/miosis uveitis)

Question 7

Superficial, branching corneal neovascularization

Answer 7

Superficial corneal disease

Question 8

Deep, hedge-like corneal neovascularization

Answer 8

Deep stromal or intraocular

Question 9

LOCATION Ulcerative keratitis: horizontal, equatorial ulcer

Answer 9

Trouble blinking

Question 10

LOCATION Ulcerative keratitis: Third eyelid associated ulcer

Answer 10

FB under the 3rd eyelid

Question 11

LOCATION Ulcerative Keratitis: lateral bottom lid ulcer

Answer 11

Entropion with trichiasis

Question 12

LOCATION Ulcerative Keratitis: upper lid ulcer

Answer 12

Ectopic cilia

Question 13

DDX Intraocular disease: episcleral injection, +/- conjunctival hyperemia, +/- 360˚ Deep corneal vessels

Answer 13

1. Uveitis (most common)

2. Glaucoma

Question 14

Diagnostics Intraocular disease

Answer 14

Check pressure (low uveitis, high glaucoma)
Pupil Size (small uveitis, big glaucoma)
History (past problems with pressure)
Signs of inflammation (uveitis)

Question 15

DDX Subconjunctival hemorrhage: free blood with no distinct pattern beneath conjunctiva, obscures view of episcleral vessels and sclera

Answer 15

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

Question 16

Diagnostics subconjunctival hemorrhage

Answer 16

History and PE
Bloodwork (cbc/chem/ua and Coag profile)
Fluoroscein

Question 17

DDX Intraocular hemorrhage (hyphema): diffuse redness mixed with aqueous humor (recent) or a dark settled clot (resolving)

Answer 17

1. Intraocular Mass/Neoplasia
2. Uveitis
3. retinal detachment
4. high BP/hypertension
5. Coaguation disorder/vasculitis (warfarin and vWF)
6. Trauma (blunt or sharp, rapid decompression)
7. hyperviscosity syndromes (multiple myeloma and BM neoplasia, FIP in cats)
8. platelet disorders
9. congenital/genetic defects (collie eye, color dilute Aussie and mini dachsunds, uveal cyst and pigmentary uveitis in goldens)
10. chronic glaucoma

Question 18

Diagnostics Intraocular hemorrhage

Answer 18

Bloodwork (cbc/chem/ua and Coag Profile)
Ultrasound (can see hiding structures)
Blood pressure

Question 19

What are the most important immediate rule outs of the red eye?

Answer 19

1. Corneal Ulcer (Fluoroscein stain)
2. Dry Eye (STT)
3. Glaucoma (increased pressure, big pupil)
4. Uveitis (dec. pressure, small pupil, hypopion, flare, synechia)

Question 20

Intraocular disease

Answer 20

episcleral injection, conjunctival hyperemia, deep 360 degree neovascularization, hyphema

Question 21

extraocular/corneal disease

Answer 21

conjunctival hyperemia, corneal neovascularization

Question 22

ocular manifestation of systemic disease

Answer 22

Subconjunctival or intraocular hemorrhage, conjunctival hyperemia, retinal hemorrhages on fundic exam, hyphema