This document summarizes various ocular conditions that can present with red eye. It distinguishes between low risk and high risk red eyes. Low risk conditions include blepharitis, dacryocystitis, conjunctivitis, pterygium and pinguecula. High risk conditions are more severe and include corneal defects such as abrasion and ulceration, acute glaucoma, acute uveitis, and scleritis. Each condition is then described in more detail covering symptoms, signs, classification, etiology, risk factors, treatment and management goals. The document emphasizes the importance of distinguishing between low and high risk red eyes to determine appropriate treatment and follow up.

1. High Risked Red Eye
Nawat Watanachai
Ramathibodi
Hospital
Mahidol University

2. Low Risk Red Eye



Lid
• Blepharitis
Lacrimal system
• Dacryocystitis
Conjunctiva
• Conjunctivitis
• Pterygium & Pinguecula

3. High Risked Red Eye
1.
2.
3.
4.
Corneal defects
• Abrasion
• Ulceration
Acute glaucoma
Acute uveitis
Scleritis

4. 1. Corneal Defects

1.1 Abrasion
1.2 ulceration


5. 1. Corneal defects
1.1 corneal abrasion
- Only corneal epithelium lost
- cleaner
1.2 cornel ulcer
- Epithelium defect with
stromal defect
- Much more severe/ infected

6. 1.1 Corneal abrasion



History
• Trauma
Symptoms
• Sudden Pain
• Lacrimation
• Photophobia
• Blurred vision
Signs
•
•
•
Ciliary injection
Irregular light
reflex
Fluorescein
staining

7. 1.1 Corneal Abrasion
Rx








Remove FB+/Pressure patching
Debridement
Contact lens
Lubrication
Stromal puncture
Generally cure in 24-48
hrs
Watch closely for
superimposed infection

8. 1.2 corneal ulceration



History
• Trauma+/ Vegetative materials
 Occupational accident
• Immune defect
Symptoms : pain, lacrimation,
photophobia, blurred vision
Sign : ciliary injection, white corneal
stromal lesion, F stain

9. 1.2 Corneal ulceration


Infection
• Bacteria : Staph, Strept,
Pseudomonas, Bacillus
• Fungus : Aspergillus, Penicillium
• Virus : HSV, HZV
• Parasite
Non infection
• Neurotrophic
• Immune mediated

10. 1.2 Corneal Ulceration Rx




Antimicrobial
agents
• Broad spectrum
• Rapidly heavily
treat
Cycloplegics
Steroid +/Penetrating
keratoplasty

11. 2. Acute glaucoma





Sudden onset of
increasing intraocular
pressure
Pressure may as high as
50-60 mmHg
Rapid optic nerve
damage due to
insufficient vascular
supply
Other structural damage
Normal IOP is around
8-21 mmHg

12. 2. Acute glaucoma


angle-closure glaucoma
• Primary
• Secondary
 Lens dislocation
 Neovascular glaucoma
Open-angle glaucoma
• Acute uveitis
• Phacolytic glaucoma

13. 2.Acute Angle-Closure Glaucoma

Mechanism
• Relative pupillary
block
• Iris bombe
• Iridotrabecular
contact

14. 2. Acute Angle-Closure
Glaucoma
• Relatively common in Orientals
• > 40 years
• Women > men

POAG Risk factors
• Increased lens thickness
• Small corneal diameter
• Short axial length

15. 2.Acute Angle-Closure Glaucoma
Symptoms
- Very severe
Pain
- Nausea &
vomiting
- Halos
- Blurred vision
- Marked red eye

16. 2.Acute Angle-Closure Glaucoma

Signs
• Ciliary flush
• Elevated IOP
• Corneal edema
• Fixed,oval,
dilated pupil
• Glaukomflecken

17. 2. Acute Angle-Closure
Glaucoma

AIM
• Decrease IOP
• Restore vision
• Prevent re-increase IOP

18. 2.Acute Angle-Closure Glaucoma
Medical Rx





Hyperosmotic agents
Carbonic anhydrase inhibitors
Beta-blockers
Alpha 2 agonists
Miotics

19. 2.AACG Surgical Rx

Iridectomy : the definitive treatment

20. 2.AACG Surgical Rx


Goniosynechialysis
For case of anterior
synechia

21. 2.AACG Surgical Rx

Filtering
surgery :
trabeculectomy

22. ตั้งใจเรียนหน่อยครับ

23. 3. Uveitis
Inflammation of the uveal tract
Opaque media  blurred vision
Inflammation  red, pain, swell
Tissue damage  glaucoma, cataract, retinitis etc.

24. 3. Uveitis : Classification



Anatomical
Clinical
Etiological

25. 3. Uveitis :
Anatomical Classification




Anterior uveitis
Intermediate uveitis
Posterior uveitis
Panuveitis
A
I
P

26. 3. Uveitis
anatomical classification
post
ant

27. 3. Uveitis :
Clinical classification


Acute
• Sudden onset
• < 6 week persistence
• Recurrent
chronic
• Prolonged persistence
• Less symptomatic

28. 3. Uveitis :
Etiological Classification


Exogenous
• Infectious eg.
Toxoplasmosis,
Toxocariasis, TB
Endogenous
• systemic
diseases eg.
SLE, RA
• Idiopathic

29. 3.1 Anterior Uveitis

Symptoms
• Photophobia
• Pain
• Decreased vision
• Lacrimation

30. 3.1 Anterior Uveitis
• Signs
 Ciliary injection
 Keratic precipitates
 hypopyon
 Aqueous cells/flare
 Iris atrophy
 Synechiae

31. 3.2 Intermediate Uveitis


Symptoms
 Floaters
 Decreased vision
 Mild eye pain
Signs
 Anterior vitreous
cells
 Mild ciliary
injection

32. 3.3 Posterior uveitis

Symptoms
• Floaters
• Impaired vision

Signs
Vitreous
cells/flare
 Choroiditis
 Retinits
 Vasculitis


33. 3. Uveitis & Arthritis




Ankylosing spondylitis
Reiter’s syndrome
Psoriatis arhritis
Juvenile RA

34. 3. Uveitis & Systemic
diseases
Non-infectious
Sarcoidosis
Behcet’s disease
Vogt-Koyanaki-Harada syndrome
Infectious
AIDS
Acquired syphilis
Tuberculosis
Leprosy

35. 3. Uveitis & Infections



Parasite
• Toxoplasmosis
• Toxocariasis
Fungus
• Histoplasosis
• Candidiasis
Virus
• Herpes zoster
• Herpes simplex
• Congenital
rubella

36. 3.Uveitis
Goal of Treatment
Prevent visual complications
 Relieve discomfort
 Treat the underlying disease,
if possible


37. 3.Uveitis
Treatment

Cycloplegics / mydriatics
• Relieve ciliary spasm
• Prevent posterior synechia
formation
• Synechialysis

38. 3.Uveitis
Treatment Options


Steroids
• Topical
• Periocular
• Systemic
Side effects
•
Ocular
Glaucoma
 Cataract
 Corneal
complications

•
Systemic

39. 3.Uveitis
Treatment options

Immunosuppressive
agents
• Cytotoxic drugs
• Cyclosporins
0001

40. 4. Scleritis


Diffuse
Nodular
-Inappropriate pain
-Scleral thickening
-Systemic disease
-Not response to drugs

41. High and Low Risked Red Eye
Red eye
High risk
Symptoms Pain
Discomfort/
irritation
Conjunctival
constrict/ NR Normal/ reactive
Injection
Pupil
Ciliary
Dilate/
VA
Red reflex
IOP
Decrease
Decrease/ absent
Increase/ decrease/
normal
Cloudy/ irregular
Cornea
Low risk
normal
Normal
normal
Clear/ normal

42. May the ‘light’ be with you!