Red eye is a non-specific term that is used to describe an eye that appears red due to intraocular or extra-ocular pathologies which can be as a result of infections, inflammations, allergies or trauma. It is usually as a result of vasodilation in the anterior portion of the eye. It is a sign of an underlying disease, not a diagnosis.

1. RED EYE
AKINTOLA O.O, AITO I.T

2. OUTLINE
• Introduction
• Epidemiology
• Brief anatomy of the eye
• Common causes of red eye
• Diagnosis
• Conclusion

3. Introduction
• Red eye is a non-specific term that is used to describe an eye that
appears red due to intraocular or extra-ocular pathologies which can be
as a result of infections, inflammations, allergies or trauma.
• It is usually as a result of vasodilation in the anterior portion of the
eye. It is a sign of an underlying disease, not a diagnosis.

4. Epidemiology
• Red eye is a very common presentation. Conjunctivitis and sub-
conjunctiva hemorrhage are the common causes.
• The exact figures are not available as many are asymptomatic and so
go under-reported
• Red eye can occur at all age groups depending on the aetiology
• There is no gender or racial predilection

5. Brief anatomy

6. Causes of red eye
1. Conjunctiva
• Viral conjunctivitis – adenovirus, poxvirus, coronavirus
• Bacterial conjunctivitis – S. pneumonia, H. influenza
• Allergic conjunctivitis – vernal keratoconjunctivitis, atopic
keratoconjunctivitis
• Chlamydia conjunctivitis
• Sub-conjunctiva hemorrhage – trauma, hypertension,
• Pterygium

7. Causes of red eye

8. Causes of red eye
• Chlamydia conjuctivitis
• Subconjunctiva hemorrhage
• Pterygium

9. Treatment
Viral conjunctivitis
• Topical steroids
• Artificial tears for symptomatic relief
• Hand hygiene
• Discontinuation of contact lens
• Topical antibiotics if secondary bacteria infection is suspected

10. Treatment
• Bacterial conjunctivitis – mostly self-limiting but topical antibiotics
such as chloramphenicol, gentamicin, quinolones, polymixin B, etc,
can be administered.
• Systemic antibiotics in cases of gonococcal, meningococcal and H.
influenza infections
• Topical steroids
• Eye irrigation
• Hand hygiene
• Discontinuation of contact lens

11. Treatment
• Allergic conjunctivitis
• Allergen avoidance, if possible
• Mast cell stabilizers and antihistamines
• Topical steroids

12. Causes of red eye
2. Cornea
• Keratitis – bacterial, viral, fungal, parasitic, exposure
• Corneal ulcer
• Corneal abrasions
• Corneal laceration
• Foreign body impaction

13. Causes of red eye
Fungal(A,C) and bacterial(B,D) Corneal ulcers
keratitis

14. Causes of red eye
• Corneal abrasion
• Corneal laceration
• Foreign body

15. Bacterial keratitis
• This is as a result of the entry of pathogens either through a
compromised or intact cornea
• Organisms that cause bacterial keratitis via compromised barrier
include S. aureus, P. aeruginosa
• Those that penetrate the intact cornea are N. gonorrhea, H. influenza,
Meningitides
Risk factors
• Contact lens wear
• Injury
• Ocular diseases like VKC, blepharitis

16. Bacterial keratitis
Clinical features
• Painful red eye
• Purulent discharge
• Chemosis
• Photophobia
• Stroma infiltrates
• Hypopyon
• Corneal ulceration

17. Viral keratitis
• Causative agents: Herpes zooster, Herpes simplex
Clinical features
• Painful red eye
• Photophobia
• Watery discharge
• Grayish corneal opacity
• Foreign body sensation

18. Fungal keratitis
• Causative agents include: Candida spp, Aspergillus
Risk factors
• Contact lens wear
• Trauma
• Chronic use of topical steroids
Clinical features
• Slow course
• Painful red eye
• Stroma infiltrates
• Hypopyon

19. Causes of red eye
3. Anterior uveitis – inflammation of the uvea; iris, choroid, cilliary
body. It can be acute or chronic.
• Iritis
• Iridocyclitis

20. -Sudden onset of unilateral ocular
pain
-Photophobia
-Blurry vision
-Peri-limbal / circum-corneal
redness/ciliary flush
-Tearing
-Miosis
-Keratic precipitates
-Posterior synechiae
-Aqueous flare and cells
-Hypopyon
-Anterior vitreous cells
(iridocyclitis)

21. • Usually asymptomatic until
complications occur
• Reduced vision - uni-
/bilaterally
• ±Redness
• Aqueous cells/Flare
• Keratic precipitates -pale,
irregular
• Iris atrophy
• Band Keratopathy
• Cataract
• Hypotony
• Glaucoma

22. Treatment
• Mydriatics – short acting (tropicamide, cyclopentolate) and long
acting (atropine, hematropine)
• Topical steroids
• Management of complications of chronic anterior uveitis

23. Acute angle-closure glaucoma
• When some fluids builds up in the front of the eye, this puts much pressure
on the eye, engorging the blood vessels of the sclera and can also lead to
the damage of the optic nerve
• Some symptoms include:
- Severe pain in the eye
- Headache
- Decreased or blurry vision
- Rainbows or halos in your vision
- Nausea and vomiting
- Fixed mid-dilated pupil
- Elevated Intra ocular pressure (stony hard globe)

24. Acute angle-closure glaucoma
• Diagnosis
History taking
Eye examination
Tonometry
Treatment
Drugs: miotics, sympatholytic drugs, sympathomimetic, prostaglandin
analogues, carbonic anhydrase inhibitor
Surgical: trabeculectomy, peripheral iridectomy, trabeculoplasty

25. Episcleritis
• This is an inflammatory condition affecting the episcleral tissue
between the conjunctiva and the sclera that occurs in the absence of
an infection. The causes of episcleritis is mostly unknown. It
sometimes flares up when you are tired , have been reading or
working for long periods on computers or are in a dry, dusty
environment
• Can be classified as Simple; with redness in a section and sometimes
throughout the comfort the eye with minimal discomfort

26. Episcleritis
-Or Nodular; with slightly raised bumps surrounded by dilated blood
vessels, usually in one area of the eye that may cause discomfort

27. Episcleritis
• Clinical features include
• Tearing,
• Sensitivity to light,
• A hot prickly, or gritty sensation in the eye
Diagnosis
Is typically based upon the history and physical examination and also
the use of phenylephrine 2.5%
Treatment
Corticosteroid eye drop, artificial tear eye drops, NSAIDs eg ibuprofen

28. Scleritis
• This is the inflammation in the episcleral and sclera tissues with injection in
both superficial and deep episcleral vessels. It may involve the cornea,
adjacent episcleral and the uvea and thus can be vision threatening.
Scleritis is often associated with an underlying systemic disease in up to
50% of patients
• Clinical features:
• Severe pain
• Tenderness of the eye
• Inflammation of the white part of the eye
• Blurred vision
• Tearing
• Extreme sensitivity to light

29. Scleritis
• Classification:
• Anterior: this is when the front of the sclera is inflamed, it’s the most
common type of scleritis
• Posterior Scleritis: this is when the back of the sclera is inflamed, its
less common but can lead to serious eye problems like detached
retina or glaucoma
• Diagnosis
History taking and fundoscopy/ophthalmoscopy
• Treatment:
• Medical: NSAID, Steroid, Immunosuppressive, Immunomodulators
• Surgical: in cases of perforation or excessive thinning

30. References
• Clinical Ophthalmology: A Systemic Approach. 7th edition. J.J Kanski,
Brad Bowling.
• www.medscape
• Lecture notes on ophthalmology. 9th edition. Bruce James, Chris
Chew, Anthony Bron.