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Acute unilateral red eye

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Presentation on theme: "Acute unilateral red eye"— Presentation transcript:

1 Acute unilateral red eye
Dr. Anthony Hall MD, FRANZCO

2 differential diagnosis of the unilateral red eye
Eyelid Conjunctiva Conjunctivitis Cornea Corneal foreign body/ulcer Infectious keratitis Sclera Anterior chamber Iritis Angle closure glaucoma Orbit

3 Eyelid

4 Acute lid problems Chalazion Preseptal cellulitis

5 Chalazion Obstructed and infected and inflamed meibomian gland
Unilateral, unifocal lid swelling

6 Chalazion – initial treatment
Topical antibiotics + oral if associated cellulitis Hot compresses If fails then surgery

7 Chalazion – surgical treatment
Lid everted Chalazion incised form tarsal surface

8 Preseptal cellulitis Acutely unwell Swollen, tender red eyelid
No orbital signs No proptosis, visual loss, movement problems

9 Orbital vs preseptal cellulitis
The orbital septum divides the eyelid from the orbit

10 Conjunctiva

11 Conjunctivitis Viral Watery discharge URTI Allergic Itch
Stringy discharge Atopic patient Usually bilateral!!

12 Viral conjunctivitis URTI Acute pain, redness, and watery discharge
Normal pupil Normal VA Normal cornea Management

13 Allergic conjunctivitis
Atopy Sub-acute irritation, itch, redness, and stringy discharge Normal pupil Normal VA Normal cornea

14 Subconjunctival haemorrhage

15 Cornea

16 Keratitis Suspect if Corneal fluorescein stain (dendritic)
Focal corneal swelling Past history HSV/VZV Contact lens wear Post trauma                                 

17 Keratitis management HSV Topical aciclovir till epithelium healed

18 Keratitis management Bacterial Intensive topical antibiotics

19 Corneal foreign body/ulcer
Suspect if History of grinding etc Fluorescein staining Corneal/subtarsal foreign body Always evert eyelid

20 Management of corneal FB
Topical LA Remove fb with 23 G needle Oc Chloro and pad 24 hrs

21 Underlying cornea is clear - iris details are seen
Corneal ulcer Without Fluorescein:  Underlying cornea is clear - iris details are seen

22 Fluorescein with or without cobalt blue filter

23 Anterior chamber

24 Trauma Hyphaema or corneal abrasion may follow trauma
In this setting beware of Keratitis Perforation

25 Iritis (acute anterior uveitis)
Inflammation confined primarily to the iris and anterior chamber Resolving totally within three months (not associated with other significant anterior or posterior segment pathology)

26 Iritis - symptoms pain redness photophobia epiphora

27 Iritis - signs ciliary flush small irregular pupil AC cells and flare
keratic precipitates hypopyon iris nodules spill over vitritis


29 Iritis - aetiology

30 B 27 related diseases Ankylosing spondylitis Psoriatic arthritis
Reiters syndrome (reactive arthritis) Inflammatory bowel disease associated arthropathy

31 Sarcoidosis Multisystem granulomatous disease 90% lung 90% lymph node
25-50% joint involvement 25% skin 25% eye

32 Syphilis Primary 4-6 weeks of ulcer Secondary 2-4 months
Skin rash and lymphadenopathy Eye and CNS involvement Latent/tertiary CVS and CNS

33 Viral Suspect if History of simplex or zoster Chronic course
Iris changes High pressure Keratitis (old or new)

34 Investigation of AAU Most important Clinical History Family history
Examination Less important HLA B 27 Sarcoidosis CXR ACE Syphilis serology

35 Principles of management of Iritis
Determine the underlying cause Control the inflammation Detect and control ocular complications of the inflammation the treatment

36 How to control the inflammation
Adequate high potency topical steroids Sub conjunctival steroids Oral steroids Aggressive dilation Regular and close review

37 Acute angle closure glaucoma
Unusual Severe pain Profound visual loss Cloudy cornea Fixed mid position pupil Treatment iridotomy





42 Orbital disease

43 Orbital cellulitis Pre septal Orbital Acute lid swelling
No chemosis, visual loss or eye movement disorder Secondary to trauma, chalazia, lacrimal sac disease Orbital Lid swelling Chemosis, visual loss, eye movement abnormalities Secondary to sinus disease

44 Pre septal Orbital

45 Treatment Pre septal Orbital Antibiotics Image Drain sinus disease
Drain orbital disease

46 Key steps in the diagnosis of the unilateral red eye
History Ocular Previous episodes CL wear Trauma Systemic Auto-immune disease Recent URTI Examination VA Cornea Pupil Conjunctiva


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