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The Red Eye Differential Diagnosis
Differential Diagnosis of “red eye”
Conjunctivitis Follicles Purulent discharge Papillae Chemosis Redness
Subconjunctival HaemorrhageDiffuse or localised area of blood under conjunctiva. Asymptomatic Idiopathic, trauma, cough, sneezing, aspirin, HT Resolves within days
Dry Eye Syndrome Poor quality Poor quantityMeibomian gland disease,Acne rosacea Lid related Vitamin A deficiency Poor quantity KCS Sjogren Syndrome Rheumatoid Arthritis Lacrimal disease ie, Sarcoidosis Paralytic ie, VII CN palsy
Corneal Abrasion Surface epithelium sloughed off.Stains with fluorescein Usually due to trauma Pain, FB sensation, tearing, red eye
Corneal Ulcer InfectionBacterial: Adnexal infection, lid malposition, dry eye, CL Viral: HSV, HZO Fungal: Protozoan: Acanthamoeba in CL wearer Mechanical or trauma Chemical: Alkali injuries are worse than acid
Episcleritis Superficial Idiopathic, collagen vascular disorder (RA)Asymptomatic, mild pain Self-limiting or topical treatment
Scleritis Deep IdiopathicCollagen vascular disease (RA,AS, SLE, Wegener, PAN) Zoster Sarcoidosis Dull, deep pain wakes patient at night Systemic treatment with NSAI or Prednisolone if severe
Uveitis Anterior: acute recurrent and chronicPosterior: vitritis, retinal vasculitis, retinitis, choroiditis Panuveitis: anterior and posterior
Anterior uveitis (iritis)Photophobia, red eye, decreased vision Idiopathic. Commonest Associated to systemic disease Seronegative arthropathies:AS, IBD, Psoriatic arthritis, Reiter’s Autoimmune: Sarcoidosis, Behcets Infection: Shingles, Toxoplasmosis, TB, Syphillis, HIV
Ciliary flush Posterior synechiae Fibrin Flare Hypopyon KPs
Acute Angle-closure GlaucomaSymptoms Pain, headache, nausea-vomiting Redness, photophobia, Reduced vision Haloes around lights Ciliary hyperaemia Dilated pupil Corneal oedema
Acute Conjuctivitis Lawrence Pike.
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