This document provides an overview of causes and symptoms of red eye. It discusses various conditions that can cause redness of the eye including conjunctivitis, pterygium, subconjunctival hemorrhage, corneal abrasion, keratitis, iritis, episcleritis, trichiasis, entropion, orbital cellulitis, acute dacryocystitis, hyphaema, and corneal ulcer. Signs and symptoms of red eye such as pain, discharge, photophobia, and visual changes are described for different conditions. Evaluation of red eye involves characterizing symptoms and performing an examination of the conjunctiva, cornea, anterior chamber, eyelids, and orbit.

1. RED EYE

2. INTRODUCTIONRed eye-non-specific term to describe an eye that appears red due to illness, injury, or some other conditionCaused by enlarged, dilated blood vessels, leading to the appearance of redness on surface of eye2/85

3. CAUSES OF RED EYEConjunctiva

4. Conjunctivitis

5. Dry eye

6. Pterygium

7. Subconjunctivalhaemorrhage

8. Trauma

9. Cornea

10. Abrasion

11. Foreign body

12. Laceration

13. Corneal ulcer

14. Keratitis

15. Contact lens wearSclera

16. Episcleritis

17. Scleritis

18. Iris and ciliary body

19. Iritis

20. Iridocyclitis

21. Anterior chamber

22. Hyphaema

23. Acute angle closure glaucoma

24. Eyelid

25. Triachiasis

26. Entropion

27. Ectropion

28. Orbit

29. Orbital cellulitis

30. Acute dacryocystitis3/85

31. SYMPTOMS ASSOCIATED WITH RED EYESYMPTOMSPain –corneal ulcer, iritis, acute glaucoma

32. Visual loss

33. Eye discharge

34. Purulent – bacterial conjunctivitis

35. Clear – viral or allergic cause

36. Gritty sensation – common in conjunctivitis

37. Itching – common in allergic eye disease, blepharitis and topical drop hypersensitivity

38. Photophobia -panuveitis4/85

39. SIGNS OF THE RED EYESVesicles Follicles Ciliary flushIrregular pupil Papillae Foreign bodyDilated conjunctival vesselsDischargeCorneal ulcerHypopyonDendritic ulcer Dilated episcleral vessels3512648101271195/85

40. blepharitisConjuctivitis with follicularViral conjuctivitis6/85

41. OCULAR HISTORYCharacterize the symptoms: Duration – hours, days, weeks Acute , Subacute and ChronicTypes of discharge – clear, purulent, etc.Unilateral or bilateral Precipitating event – trauma, contact lens usage Previous episodes of a similar problem Past medical history – DM, hypertensionAllergic history 7/85

42. CONJUNCTIVA

43. CONJUNCTIVAThin, vascular mucous membrane/ epitheliumConjuntival causes of red eyes:Bact, viral, chlamydial, allergic conjunctivitis, opthalmianeonatorum(will be presented further by Nafis) dry eye, pterygium, subconjunctival haemorrhage, injury.9/85

44. PTERYGIUMTriangular fold of conjunctiva that usually grows from the medial portion of the palpebral fissure towards & invades the corneaNon-malignant fibrovascular growthPredisposing factors:Hot climatesChronic drynessExposure to sun*Prevalent in Southern countriesMx – surgical removal10/85

45. SUBCONJUNCTIVAL HAEMORRHAGE‘Extensive bleeding under the conjunctiva’Features: red eye, comfortable, no visual disturbance, Hx of trauma, spontaneously in elderly patient (compromised vascular struc in arteriosclerosis), may occur after coughing, sneezing, heavy lifting objects.Mx: check BP to exclude HPT (esp if occur repeatedly), usually resolve spontaneously within 2 weeks.11/85

46. CORNEA

47. Function:Transmission of light

48. Refraction of light

49. Barrier against infection, foreign bodies5 layersEpitheliumBowman’s membraneStromalDesscemet’s membraneEndothelium-extensive sensory fibre network(V1 distribution)13/85

50. Corneal Ulcer (will be presented later)Corneal abrasion epithelium defect due to trauma, contact lens use fluorescein and blue light, defect shine in green.Corneal foreign body foreign body in or on cornea. cause intense irritation and profuse watering.MxTopical antibiotic (drop/ointment)Tropical NSAIDS, cyclopegicTight patch14/85

51. KERATITISDef : Inflammation of the corneaType : InfectiveBacterialViralProtozoalNon InfectiveAutoimmune (eg: RA, SLE)Non Autoimmune (eg: Marginal keratitis)15/85

52. BACTERIAL KERATITISCAUSES - Staphylococcus epidermidis - Staphylococcus aureus - Streptococcus pneumoniae - Coliforms - Pseudomonas - HaemophilisPREDISPOSING FACTOR

53. Keratoconjunctivitissicca (dry eye)

54. A breach in corneal epithelium (eg following trauma)Prolonged contact lens wear

55. Prolonged use of topical steroids16/85

56. SYMPTOMS & SIGNS

57. severe pain

58. purulent discharge

59. ciliary injection

60. visual loss

61. hypopyon

62. white corneal opacity, can be seen with naked eye

63. MANAGEMENT

64. Scrapes taken from base of ulcer for Gram-staining & culture

65. Rx: Dual therapy of intensive topical antibiotics (eg: cefuroxime for Gram +ve bacteria and gentamicin for Gram –ve bacteria)

66. Monotherapy: fluoroquinolones (eg: ciprofloxacin, ofloxacin)

67. Initially by tissue adhessive (cyanoacrylate glue) and subsequent corneal graft– for severe or unresponsive disease where cornea may perforate.17/85

68. VIRAL KERATITISHerpes simplex keratitisCauses: Type 1 or Type 2 Herpes Simplex VirusMost are asymptomaticAccompanied by:FeverVesicular lid lesionFollicular conjunctivitisPre-auricular lymphadenopathyPathognomonic: dendritic ulcer on corneaDendritic ulcer may heal without scar, but may progress to stromal keratitis, a/w inflammatory infiltration, oedema and ultimately loss of corneal transparency and permanent scarring  if severe – corneal graftRx: topical antivirus (trifluridine)– heal within 2 weeks.18/85

69. 19/85

70. Herpes zoster ophthalmicus(ophthalmic shingles)

71. Cause : Varicella zoster virus

72. Area affected: ophthalmic division of CN V

73. Accompanied by: prodromal period with systemically unwell, vesicles, lid swelling, iritis, 2° glaucoma.

74. Rx: - oral antiviral (eg: aciclovir, famciclovir) to reduce post-infective neuralgia - topical antiviral and steroids and antibacterials to cover secondary infection for the ocular disease.20/85

75. PROTOZOAL KERATITISAcanthamoeba keratitisCommonly due to used of contact lenses and exposure to contaminated water or soil.Presentation: painful keratitis, redness of the eye and photophobia.Rx: topical chlorhexidine, polyhexamethylene biguanide (PHMB) and propamidine.21/85

76. SCLERAWhite fibrous outer protective coat of eyeContinous with cornea ant and the dura of optic nerve posteriorly

77. ScleritisEtiology50% systemiccollagen vascular dzGranulomatousMetabolicInfectiouschemical/physical agents50% idiopathicRxSystemic NSAID/steroidTreat underlying etiologyEpiscleritisEtiologyMostly idiopathic, rest collagen vascular dz, infections(herpes zoster,herpessimplex,syphillis),IBDRxSelf-limitedTropical steroid if painful23/85

78. ANTERIOR CHAMBER

79. Anterior chamber’s causes of red eyes:-Hyphaemais blood in the front (anterior) chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.Acute Congestive Glaucoma(will be presented by Joo Qing)25/85

80. EYELIDS

81. TRICHIASISIrritation of cornea due to aberrant eyelashes grow inward with a normal eyelid position.

82. May result from chronic inflammatory lid diseases(blepharitis), Steven-johnsonsyn, trauma,burn etc

83. Rx: - topical lubricant -epilation with forceps - electrolysis for isolated lashes - cryotherapy - laser ablation - surgery in cases resistant to other treatment.27/85

84. ECTROPIONEversion of the lid leads to disruption of tears flow.

85. Types:-