Red Eyes

Question 1

Answer 1

Conjunctivitis

Cause

Infective (bacterial > viral), dry eye or allergic

Common Pathogens

• H. influenzae
• Strep. pneumoniae
• Strep pyogenes
• Staph aureus

Symptoms

Sticky, Gritty, Itchy, Stringy discharge

Signs

Conjunctival erythema (sclera and the two lid linings) Associated with discharge

Management

• Topical propamide (mild) or chloramphenical (severe)
• Topical lubricants
• Topical mast stabiliser

Question 2

Answer 2

Episcleritis

Cause

Idiopathic

Symptoms

Irritation

Signs

Segmental erythema

Management

Self-limitingCan use:- Artificial tears- If severe - topical steroids or oral NSAIDs

Question 3

Answer 3

Iritis (Anterior uveitis)

Cause

Idiopathic

Can occasionally be due to:
- Connective Tissue Disease
- (49.9% HLA-B27)
- Infectious
— Syphilis
— Lyme disease
— Toxoplasmosis
— TB

Symptoms

Pain
Moderate photophobia

Signs

Ciliary flush (limbal erythema)
\+/- miosis

Management

• Tropical prednisolone
• Mydriatic medications (dilators) (atropine)

Question 4

Answer 4

Corneal Pathology

Cause

• Keratitis (HSV type 1)
• Corneal Ulcer

— Contact lens (50%)
— Abrasion
— Foreign body
Can have secondary bacterial infection
Symptoms

Pain (sharp)
Photophobia

Watering

Acuity loss

Foreign body sensation

Signs

Local erythema and corneal stainingEpithelial defects can be stained with fluorescein (ulcer)
Management

Ophthalmologist is indicated.

Keratitis - Topical antiviral (trifluridine)
Ulcer - Urgent referral and topical antibiotics hourly

Question 5

Answer 5

Scleritis

Cause

Systemic
Scleritis may be a manifestation of a systemic disease:
- SLE
- RA
- Ankylosing spondylitis
- TB
- Gout and many others
Symptoms

Pain (severe)
Pain (exaggerated on movement)

Photophobia

Acuity loss

Signs

Intense erythema limited to the eye.
Can be bilateral with autoimmune cause

Management

Systemic with NSAIDs and corticosteroids
- Topical corticosteroids are ineffective

Question 6

Fixed partially dilated pupil

Answer 6

Acute Glaucoma

Cause

Failure of aqueous drainage
Progressive optic neuropathy with associated visual field changes

Symptoms

Pain

Vomiting

Acuity loss

Signs

Intense unilateral erythema

Fixed mid dilated pupil

Management

Medical emergency and permanent loss of vision may result

Immediate laser iridotomy

Decrease IOP

• topical Beta-blockers
• Adrenergics
• Carbonic anhydrase inhibitors
• Hyperosmotic agents
• Miotic drugs (pilocarpine)