The document provides guidance on evaluating patients presenting with red eye, noting that it can be caused by various ocular diseases ranging from minor irritations to serious conditions. Red eye symptoms and signs are described that can help determine if the cause is vision-threatening, such as blurred vision and pain, or non-vision threatening, like itching. Examination of the eye is also outlined to assess factors like conjunctival discharge, corneal opacity, pupil size and shape, and intraocular pressure to identify potential conditions causing the red eye.

1. Evaluation of a red eye
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2.  Commonest presentation of various ocular diseases.
 Need to know whether it is a minor eye irritation or a
serious eye disease.

3. I. Conjunctivitis (Bacterial, Viral, & Allergic)
II. Corneal Ulcer
III. Acute Glaucoma
IV. Acute Iridocyclitis
V. Sub-conjunctival hemorrhage
VI. Episcleritis, Scleritis
VII. Dacryoadenitis & Dacryocystitis
VIII.Eye lid pathology such as style, blepharitis

4.  Vision-threatening:
 Orbital Cellulitis
 Scleritis
 Uveitis
 Trauma
 Hyphema
 Acute Glaucoma
 Corneal Infections
 Non-vision-threatening:
 Blepharitis
 Hordeolum
 Chalazion
 Conjunctivitis
 Dry eyes
 Corneal Abrasions
 Subconjunctival
hemorrhage

5.  “Red eye” refers to hyperemia of superficial visible
vessels of the conjunctiva, episclera & sclera.
 Can be caused by disorders of any of the adjoining
structures:
 Conjunctiva-common, often not serious.
 Cornea-common, potentially serious
 Episclera-not common, not serious, usually allergic
 Sclera-not common, may indicate serious systemic
diseases such as Collagen Vascular Disease
 Iris & Ciliary body-serious
 Acute Glaucoma-serious
 Adnexal disease-not serious

6.  Inspect whether redness due to hemorrhage,
conjunctival hyperemia, ciliary flush or combination.
 Conjunctival discharge & categorize it as to amount
(profuse or scanty) & character (purulent,
mucopurulent or serous)
 Inspect IOP (high, normal or low)
 Using flashlight: detect opacities of cornea,
irregularities of the corneal mirror reflection.
 Stain cornea with fluorescein-search for corneal
disruption

7.  Estimate depth of anterior chamber (normal or
shallow)
 And detect blood or pus in anterior chamber, if any.
 Detect irregularities of pupil (compare bilaterally)
 Detect limitation of eye movement.

8.  Blurred vision-that doesn’t subside s upon blinking
 Suggests a serious ocular disease such as an inflamed
cornea, iridicyclitis or glaucoma.
 Doesn’t occur in simple conjunctivitis
 Pain-may indicate keratitis, iridicyclitis, or acute
glaucoma.
 Pts with conjunctivitis complain of scratchiness but not
of severe pain.
 Photophobia-accompanies iritis
 Pts. with conjunctivitis have normal light sensitivity
A. Symptoms associated with a Red eye:

9.  Halos-usually a sign of corneal edema, often resulting
from an rise in IOP.
 Exudation-a symptom of conjunctival or eyelid
inflammations
 Not in iridocyclitis or glaucoma.
 Corneal ulcer-serious, may be manifested by discharge.
 Itching-suggests allergic conjunctivitis
 Upper respiratory infection & fever may be associated
with viral conjunctivitis. (Adenovirus)

10.  Ciliary flush-an injection of the deep conjunctival &
episcleral vessels surrounding cornea, danger sign.
 Not present in conjunctivitis
 Conjunctival hyperemia-engorgement of larger &
more superficial bulbar conjunctival vessels.
 Is a non-specific sign
 Corneal opacities in a pt with red eye ALWAYS denote
disease.
 Corneal epithelium disruption
 Apply fluorescein stain under cobalt blue light.

11.  Pupil size & shape abnormalities.
 In iridicyclitis-smaller than fellow eye ‘cause of reflex
spasm of iris sphincter muscle; distorted also by
posterior synachiae
 In acute glaucoma-partially dilated & may not be quite
round.
 Conjunctivitis does NOT affect pupil.
 Shallow Ant Chamber:
 Suggests possibility of acute glaucoma(closure).
 IOP-to rule out glaucoma in any red eye without
obvious infection
 Tonometer be cleaned afterward to prevent office
transmission.

12.  Sudden proptosis(forward displacement):
 Looking down at pts from above.
 Common cause is thyroid disease
 Discharge:
 Purulent(creamy white) or mucopurulent (yellowish)
suggests bacterial etiology.
 Serous (watery, clear or yellow-tinged) suggests a viral
etiology
 Scanty, white, stringy exudate sometimes occurs in
allergic conjunctivitis.

13.  Smears of exudate or conjunctival scrapings:
 PMNs & bacteria in bacterial conjunctivitis
 Eosinophils in allergic conjunctivitis.
 Cultures for bacteria & sensitivity determination (to
Antibiotics)
 Most cases of conjunctivitis are managed without
laboratory assistance.
 Cases of presumed bacterial conjunctivitis, which do
not improve in two days with antibiotic treatment,
should be referred to an ophthalmologist for
confirmation of diagnosis & appropriate studies.

14.  A. Prolonged use of topical anesthetic:
 Inhibit growth & healing of corneal epithelium
 May cause severe allergic reactions.
 It eliminates the protective blink reflex, thus exposing
cornea to dehydration & injury
 B. Topical corticosteroids serious side effects:
 Herpes Simplex keratitis & fungal keratitis, both
potentiated by corticosteroids.
 Causes formation of cataracts.
 Use for 2-6weeks may cause an elevation of IOP.

15.  PC:
 Ask abt main complains & list in chronological order.
 HPC:
 If symptom were sudden/gradual
 Severity of symptom
 Check for common symptom:
 Visual loss/impairment
 Visual field defects
 Dazzling
 Pain/Foreign body sensation
 Discomfort/itchy/Dry eyes
 Discharge/Epiphora
 Diplopia
 Photophobia/Haloes/Floaters

16.  POH:
 Past & present eye problems as well as any past eye
operations
 List drugs of treatment used then.
 PMH:
 Relevant systemic medical diseases e.g. DM, HTN,
leprosy, hyperthyroidism, arthritis, cancers, etc.
 DH:
 List current drugs used for treatment of:
 Existing medical conditions
 Eye conditions

17.  Allergies:
 Food(s)? Drug(s)?
 Have asthma?
 Caution with treating asthmatics with anti-glaucoma beta-
blockers such as Timoptol
 FH:
 Some eye diseases run in families:
 Myopia
 Glaucoma
 Retinitis pigmentosa ,etc.
 Occupation:
 Help decide what level of vision the pt needs for work.

18.  Visual Acuity
 Examination of external eye & ocular adnexia
 Ocular alignment & motility exam
 Pupillary examination
 Examination of anterior segment-penlight
 Visual field examination-via
 Examination of posterior segment via fundoscopy
 Macular function test
 Tonometry to determine IOP
 Visual pathway examinations

19.  Snellen chart at 6meters
 If top can’t be discerned:
 Test done closer to the chart.
 If chart can’t be read at 1m:
 Pts may be asked to count fingers
 If can’t:
 Asked to detect hand movements
 If can’t:
 Asked to perceive only light (LP)
 To achieve optimal visual acuity, the pt should be
asked to look through pinhole.

20.  www.uptodate.com
 Monograph, by Dr. Ernest Than Tun Oo
 ABC of Eyes, 4th Ed., PT Khaw