This document provides information about various causes of red eyes, including symptoms, signs, and treatment for each condition. It discusses infective conjunctivitis, corneal ulcer/keratitis, uveitis, acute angle-closure glaucoma, allergic conjunctivitis, subconjunctival haemorrhage, episcleritis, scleritis, blepharitis/meibomianitis, orbital cellulitis, herpes simplex infection of the eyelids, and pterygium. For each condition, it outlines the characteristic red eye symptoms, signs visible to the doctor, and typical treatment approaches. The document is intended to educate students on the different reasons a person may experience red eyes and

1. Students 'Name: *Cheng Chanroth
*Thai Phanthep
*Kun Salim

2. Objective
 To Know about reason of the red eyes.
 Avoid or prevent of the red eyes.
 To know method to treat of the red eyes.

3. The Red Eye
 Anatomy of eye

4. Definition
 Red eyes (or red eye) is a condition where the
white of the eye (the sclera) has become
reddened or "bloodshot."
 The appearance of red eye can vary widely. It
can look like there are several squiggly pink or
red lines on the sclera.

5. Symptoms
 Red eye can occur in one or both eyes, and it can be associated with several symptoms,
including:
 Irritation
 Burning
 Itching
 Dryness
 Pain
 Discharge
 Watery eyes
 Sensitivity to light
 Blurry vision

6. Cause
 The appearance of red eyes is caused by dilation of tiny blood vessels that are located
between the sclera and the overlying clear conjunctiva of the eye.
 These tiny blood vessels (many of which normally are invisible) can become swollen
because of environmental or lifestyle-related reasons or because of specific eye
problems.
 The red it cause by many disease, including:
 Infective conjunctivitis
 Corneal ulcer/keratitis/abscess
 Uveitis
 Acute angle-closure glaucoma

7. Cause

8. Infective conjunctivitis
 Conjunctivitis, or pinkeye, occurs when the conjunctiva of the eye becomes inflamed.
 The eye can become red or pink, swollen, and irritated, and there may be mucus.
Infective conjunctivitis can be highly contagious.

9. Symptoms
 Red eye.
 Discomfort or itch.
 Discharge (watery or purulent).
 General flu-like symptoms in viral cases.
 History of contact with people with red eyes.

10. Signs
 Generalized redness of conjunctiva and especially
the tarsal conjunctiva (posterior surface of the lids).
 Cervical lymphadenopathy in viral cases.

11. Cause of conjunctivitis
 Infective conjunctivitis may be caused by germs. Bacterial conjunctivitis is more
common in children, whilst viral conjunctivitis is more common in adults.
 Infection is the most common cause of conjunctivitis. However, conjunctivitis may also
be due to:
 Allergy: many people with hay fever (pollen allergy) have a red and inflamed conjunctiva.
 Irritation: irritant conjunctivitis sometimes occurs. For example, your conjunctiva may become
inflamed after getting some shampoo in your eyes. Chlorine in swimming pools is a common
cause of mild irritant conjunctivitis.

12. Management
 Hygiene advice,e.g.avoid sharing towels.
 In purulent cases,swab for C&S (culture and sensitivity).
 Prescribe topical antibiotics, e.g. chloramphenicol hourly for 1 day then qds(4 times
a day) for 1 week or fusidic acid bd (2 times a day) for 1 week.

13. Corneal ulcer/keratitis/abscess
 Keratitis is an inflammatory condition that affects the cornea of your eye. The
cornea is the clear part that covers both the iris and the pupil
 Keratitis can be caused by an infection or injury to the eye.

14. Symptoms
 Painful red eye in a patient who may give a history of wearing contact
lens,foreign material injuring the eye.
 Photophobia.
 Purulent discharge is seen in bacterial cases.

15. Signs
 May have decreased visual acuity depending on the location of the ulcer
(keratitis).
 Pus in fornices in bacterial cases
 Fluorescein staining reveals area of epithelial defect under cobalt blue light.

16. Management
 Immediate ophthalmological opinion plus corneal scrape as risk of perforation
and permanent central corneal scar.
 Antiviral ointment (e.g.Aciclovir five times per day) is used for herpes simplex
virus (HSV) dendritic ulcer.
 Intensive antibiotic drops are required for bacterial ulcer (e.g. ofloxacin hourly).

17. Uveitis
 Inflammation of the uveal tract:iris,ciliary body and choroid.

18. Symptoms
 Painful and red.
 Photophobic eye with or without a history of autoimmune disease
 Blurred vision or floaters.

19. Signs
 Ciliary/circumcorneal injection (engorgement of episcleral vessels around the iris
root)
 Reduced visual acuity
 ±Sluggish or irregular pupil due to reflex sphinter spasm
 Iris details may be hazy due to inflammatory cells in the aqueous

20. Management
 For uveitis the treatment is a reducing regimen of topical steroid
(e.g.dexamethasone 0.1%) to reduce the inflammation.
 cyclopentolate 1% for pain relief.

21. Acute angle-closure glaucoma
 Acute angle-closure glaucoma is a serious eye condition that occurs when the
fluid pressure inside your eye rises quickly

22. Symptoms
 Redness of your eye
 Blurred or reduced vision
 Sudden, severe pain
 The pain may spread around your head and be felt as a severe headache
 Your eye usually feels hard and tender
 The clear surface of your eye (your cornea) can look hazy.

23. Causes
 Fluid drains out of your eye through a system of canals.
 These canals live in a mesh of tissue between your iris (the colored part of your
eye) and your cornea (the clear outer layer).
 When your iris and cornea move closer together, it “closes the angle” between
them.

24. Causes
 Acute angle closure glaucoma completely blocks your canals. It stops fluid from
flowing through them.
 The pressure that builds up can damage your optic nerve. If you don’t treat the
problem quickly enough, you could lose your sight completely.

25. Management
 The first thing your doctor will do to treat your acute angle closure attack is try to
get rid of some of the pressure in your eye. They might use:
 Drops that narrow your pupil
 Medication to lowers the amount of fluid your eye makes
 Make a small hole in your iris. This is called a laser iridotomy, and it helps the fluid start
flowing again inside your eye. It’s an outpatient treatment, and takes a few minutes.
 Pull the edges of your iris away from your drainage canals. This called laser iridoplasty
or gonioplasty

26. Management
 If you have cataracts, your doctor may consider surgery to replace the lens in your eye.
This type of surgery can be harder to do when you’re having an acute attack.

27. More on the red eyes

28. Allergic conjunctivitis
 An eyes inflammation caused by an allergic reaction to substances like pollen or
mold spores.
 Sudden, unilateral, itchy lid swelling and marked conjunctival chemosis.
 Signs are worse than symptoms. Triggered by plant allergens.
 Resolves spontaneously without treatment within 24–36h.

29. Symptoms
 Itchy red eye in patient who may have a history of atopy(e.g. asthma, eczema,
hay fever).
 Sudden, unilateral, itchy lid swelling and marked conjunctival chemosis.
Signs
 Diffuse or localized conjunctival injection.
 Chemosis, normal vision

30. Treatment
 Topical mast cell stabilizer and antihistamine bd (such as Opatanol or Zaditen).
 Topical steroids initially if severe.
 Vernal keratoconjunctivitis sicca (VKC): treat as for allergic and refer to an
ophthalmic unit.

31. Subconjunctival haemorrhage (SCH)
 when one or more blood spots appear on the white of your eye.
 The eye's conjunctiva contains a lot of tiny blood vessels that can break.
 If they break, blood leaks between the conjunctiva and sclera
 This bleeding is the bright red spot that you see on the white of your eye.

32. Symptoms
 Sudden onset of painless red eye.
 Occasionally patient says he ‘felt something give’ or ‘pop’.
Signs
 Localized dense red haemmorhage on an otherwise normal eye.

33. Treatment
 Reassure it will resolve spontaneously.
 Ask patient about excessive straining such as severe coughing or vomiting which
can cause SCH—usually bilateral.
 Check blood pressure, full blood count (FBC) and blood glucose.

34. Episcleritis
 inflammation of your episclera, which is a clear layer on top of the white part of
your eye, called the sclera.

35. Symptoms
 Red eye.
 Usually painless,or can have mild dull pain.
Signs
 Localized or diffuse episcleral injection.
 Non-tender.
 Normal vision.
 No discharge

36. Treatment
 G Voltarol qds.
 Rarely systemic indomethacin

37. Scleritis
 A disorder in which the sclera becomes severely inflamed and red.
Symptoms
 Extremely painful red eye.
 May have blurred vision.
Signs
 Intense injection of the scleral and episcleral vessels.
 Globe extremely tender.

39. Treatment
 Rule out systemic disease,e.g.rheumatoid arthritis
 Non-necrotizing: Treat with systemic indomethacin 100mg od for 4 days, then
reduce to 75mg po od until inflammation is resolved.
 Necrotizing:high dose immunosupression.

40. Blepharitis/meibomianitis
 Low-grade chronic staphylococcal lid margin disease with ‘redrimmed’ eyelids in
young adults and middle-aged persons.
Symptoms
 Itchy,sore,watery eyes.
Signs
 Red-rimmed lid margins, eyelash crusts and collarettes, and distorted lid margin
microanatomy: irregularities, pits and telangiectasia.

42. Management
 Daily lid hygiene using sodium bicarbonate or dilute baby shampoo and cotton bud lash
scrubbing.
 Chloramphenicol ointment,or G fusithalmic
 ±Doxycycline or Minocycline.
Treatment
 Lid hygiene bd.
 G fucithalmic bd for up to 3 months.
 Topical lubricant six times per day.
 Review after 3 months, if no improvement add minocycline 100mg bd for 3 months.

43. Meibomianitis
 Thick oily meibomian secretion causing stingy sore eyes and red thickened
eyelids.
 Often associated with rosacea.
Treatment
 G chloromycetin hourly for 3 days,qds for 10 days.
 Hot compresses and remove lash if there is a stye.
 If early pre-septal cellulitis,add systemic antibiotics for 10 days

44. Orbital cellulitis
 serious infection that causes inflammation of the soft tissue behind the eye. It can
cause pain, swelling, and protrusion of the eyeball.
 Distinguish between pre-septal(perioseptal)and post-septal(Orbital cellulitis)
orbital cellulitis.

45. Pre-septal
 Involves only the eyelids but can spread posterior to the orbital septum to
become post-septal.
 One or both eyelids are swollen and tender.
 White eye, which moves fully with no impairment of vision or proptosis.
 Treat with i.v.antibiotics.

46. Post-septal
 Potentially severe life-threatening condition (cavernous sinus thrombosis),unless treated.
 Painful orbital/eyelid red swelling and proptosis;child is feverish and unwell.
 Associated with an upper respiratory tract infection and undiagnosed sinusitis.
 May not be able to open eye to see limited eye movements.
 Conjunctiva red and swollen.
 Vision may be affected: reduced visual acuity and red desaturation with a relative afferent papillary
defect due to optic nerve compression.
 Do a CT scan to exclude sinus disease and subperiosteal abscess,which need surgical draining and
bacteriology
 Infection from: Haemophilus infuenzae, Streptococcus, Staphylococcus negativerodsor Gram.
 Urgent admission, blood cultures and treatment with i.v. antibiotics.

47. Primary herpes simplex infection of eyelids
Symptoms
 Sore red eye and eyelid usually in a child.
Signs
 Vesicles on lids in early stages—eschar in later stages.

48. Treatment
 Occ aciclovir five times per day for 1 week,then tds for 1 week, bd for 1 week,od
for 1 week and then stop.
 Exclude corneal involvement with fluorescein.

49. Pterygium
 a pinkish, triangular tissue growth on the cornea of the eye. It typically starts on the cornea
near the nose.
Symptoms
 Localized redness medially,irritation +/-blurred vision.
Signs
 Wing-shaped abnormal growths of conjunctival-derived fibrovascular tissue.
 Inflammation and blurred vision due to visual axis obstruction or astigmatism.

51. Aetiology
 Subconjunctival elastotic degeneration from UV damage and
dryness,e.g.Australia and other dry desert equatorial countries.
Treatment
 Medical—topical lubricants +/-G Volterol.
 Surgical
 excision and conjunctival autografts.
 b-irradiation or antimetabolites applied perioperatively in recurrence.

52. Thank So For No Questions!!!!