How do we diagnose the cause of Acute Red Eye?
We base it on pain, redness, discharge & vision
What are the causes of acute red eye?
- Uveitis
- Conjunctivitis (Bacterial, viral, allergic)
- Scleritis
- Acute (closed angle) Glaucoma
- Keratitis/Corneal Ulcer
- Orbital Cellulitis
What is conjunctivitis?
Inflammation of the thin vascular membrane covering the inner surface of the eyelid and the sclera
What are the types of conjunctivitis?
Bulbar - affects conjunctiva over the sclera
Palpebral - affects conjunctiva on inside of lids
(Can be both)
What is the presentation of Conjunctivitis?
- No pain
- Peripheral & diffuse redness
- Vision unaffected
- Discharge
Bacterial = Pus
Viral = Watery
Allergic = Mucous
What is uveitis?
Inflammation of the middle vascular layer of the eye (ciliary body, iris & choroid)
How does uveitis present?
- None/mild irritation
- Pericorneal Redness
- No Discharge
- Blurred Vision
What are the types of Uveitis?
Ant - Iris
Intermediate - Ciliary Body
Post - Choroid
Panuveitis
What are the specific signs of anterior & intermediate uveitis?
Anterior
- Inflammatory cells leak from iris into Aqueous humor
- > Hazy cell filled Ant chamber and Hypopyon (cells settled inferiorly in ant chamber)
Intermediate
- Inflammatory cells leak from ciliary body in Vitreous Humour
- > Patient has hazy vision or “floaters”
Causes of Uveitis?
- Idiopathic
- Systemic Disease, often autoimmune (SLE/Sarcoid)
- Infection (TB, CMV, Herpes Simplex, Syphilis)
- Masquerade
Not actually uveitis e.g. intraocular lymphoma or leukaemia
Treatment of uveitis?
Depends on cause
- Systemic Steroids
- Systemic Immunosuppresants
- Infection treatment
- Topical Anti-inflammatories
How does scleritis present?
- Severe Boring type pain
- Diffuse redness
- Normal vision
- No discharge
How does Acute angle closure glaucoma present?
- Severe pain & headache
- Vomiting
- Fixed mid-dilated pupil
- Pericorneal Redness
- Vision loss
- Possible discharge
What causes acute angle-closure glaucoma?
Some event triggers closure of the angle in a predisposed eye leading to a back up of aqueous humor –> Raised IOP
How does a corneal abrasion or ulcer present?
- Severe pain on eye closing
- Pericorneal redness
- Possible discharge
- Visual loss
What are the types of eye cellulitis?
Preseptal
Orbital
What causes both types of cellulitis?
Preseptal cellulitis:
- Lid cyst or insect bite
Orbital Cellulitis
- Sinusitis & Dental Infection
How do the types of cellulitis present?
Severe Pain
Redness
Lid Swelling
Orbital Cellulitis also causes diplopia, blurred vision, limited extra ocular eye movements and Exophthalmos (outward bulging of the eye)
