1. DR GODSWILL AMECHI NNAJI MBBS, FWACP, FMCGP, FCA, MBA, MPH
RED EYE
DR GODSWILL AMECHI NNAJI
MBBS, FWACP, FMCGP, FCA, MBA, MPH

2. Epidemiology of red eye in Nigeria
14.8% of ophthalmic patients
Male > Females
63% of patients are below 20 years of age
Common causes of red eyes (Nigerian Teaching hosp) include;
Allergic conjunctivitis – 40%
microbial conjunctivitis – 17%
Corneal ulcer - 11%
Inflammed Pterygium - 11%
Most causes of red eye are treatable

3. Causes of red eye Red eye is caused by dilated scleral blood vessels.
Infectious causes such as bacteria or viruses.
Non-infectious, e.g. Allergy, chemical irritation, underlying inflammatory diseases, or trauma.

4. Causes of red eye Dust or other particles in the eye
Allergy (pollen, pest dander, dust, chemicals, contact lens solution)
Infection
Injury
Blepharitis
Conjunctivitis
Eye dryness (dry eye syndrome)
Excessive exposure sun
Corneal scratches: Injuries caused by sand, dust, or overuse of contact lenses
Corneal ulcer
Uveitis: Inflammation of the uvea, (iris, ciliary body, and choroid). Cause may be unknown, an autoimmune disorder, infection, or exposure to toxins. In iritis - only the iris is inflamed.
Acute glaucoma

5. Common causes of red eye in children
Bacterial conjunctivitis
Neonatal conjunctivitis
Blepharitis
Burns
Child abuse
Corneal abrasion
Eczema
Episcleritis
Eye allergy
Iritis
Keratitis
Measles
Meibomitis
Stevens-Johnson syndrome
Sub-conjuntival haemorrhage

6. Common symptoms associated with red eyes
Eye pain,
Itching/ irritation/ no irritation
Photophobia/ sensitivity to light
Watering/ tearing
Eye discharge
Swollen eyes
Visual disturbances – blurring of vision/ impaired vision

7. Aetiology Sub-conjuntival haemorrhage commonly due to sudden increase in pressure e.g. violent sneezing, straining or coughing resulting in ruptured capillaries within the bulbar conjunctiva.
Symptoms:- red eye, no pain, no discharge, no change in vision
Causes
Elevated BP/ anticoagulant drugs
Rubbing the eyes
Viral infection
Some eye surgeries
Child birth/newborn infants
Physical Exam
Bright red, dense bloody patch, alarming but of little significance
Exam & Tests
BP, Visual acuity and visual field tests, funduscopy

8. Conjunctivitis Most common eye infection (contagious)
Different types of conjunctivitis include;
Allergic conjunctivitis – commonest cause of red eye
Viral (commonest especially in school children)
Bacterial

9. Allergy Substances provoking allergy include; Pollen, pet dander,
dust,
certain chemicals in make-up,
contact lens solutions
Substances provoke the immune system and ultimately leading to release of histamine resulting in dilation of blood vessels in the conjunctiva leading to redness and waterying of the eyes.
Rx – avoiding known allergens, use of antihistamine eye drops for prevention

10. Dry eye syndrome
Insufficient or poor quality tear glad resulting in inadequate lubrication and nourishment of the eyes.
Chronic dry eyes may lead to irritated and inflamed eyes.
Rx - artificial tears-eye drops

11. Contact lenses Improper caring of contact lenses
Keratitis or fungal eye infection may occur with contact lenses use
Tight fitting contact lenses can worsen dry eyes syndrome (by reducing normal tear production – reduction in oxygen reaching cornea and reduction of normal tear flow production)
Prevention – keep lenses clean and disinfected, regular check-up, use of gas permeable lenses and daily disposable lenses.

12. Computer vision syndrome
Starring at computer screen for a long time (blinking less while working on computers result in poor production and circulation of tear.
Prevention
Frequent breaks from work stations
Specially designed computer glasses
Lubricating eye drops to keep the eyes moist

13. Eye injury
Trauma
Cosmetic eyelid surgery (dilation of the blood vessels to the injured area lead to redness)
Injury ranges from minor eye scratches (corneal abrasions) to deep puncture wound.
Use of fluorescein dye for diagnosis
Rx - primary eye care provider
Puncture injury should be referred promptly for treatment by eye specialists

14. Corneal ulcer Corneal ulcer or ulcerative keratitis
Corneal Infection by virus, bacteria, fungus, chlamydia trachomatis
infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma
Children who have vitamin A deficiency are at high risk of corneal ulcers
Causes corneal ulcer include trauma, chemical injury, contact lens and infection
Corneal healing by re-epithelialization for superficial ulcers and for deep ulcers mitosis , fibrosis, neovascularization and this may result in scarring
Immune-mediated eye disease resulting in ulcers at the border of the cornea and sclera, e.g. Rheumatoid arthritis, rosacea, systemic sclerosis resulting in a special type of corneal ulcer called Mooren's ulcer. A circumferential crater like depression of the cornea, just inside the limbus, usually with an overhanging edge.

15. Symptoms and treatment of corneal ulcer
Very painful – tearing, squinting, loss of vision, anterior uveitis, redness of the eyes, (miosis -small pupil, aqueuos flare,
Diagnosis
Slit lamp
Fluorescein dye
Treatment depends on findings
Antiviral - topical acyclovir ointment instilled at least five times a day.
Antibacteria- topical ointment or drops
topical cycloplegics e.g. atropine or homatropine
Conjunctival graft - conjunctival grafts or conjunctival flaps, soft contact lens
Vitamin A supplementation
Avoid topical cirticosteroid

16. Ocular herpes
Recurrent viral infection by type 1 herpes simplex virus (common cold sores)
Sign and symptoms
Eye redness
Swollen eyes, pain, watery discharge
Photophobia
Complications
Scarring of the cornea (if treatment is delayed)
Rx - Corneal transplant to restore vision

17. Uveitis inflammation of the uvea tract
Sign and symptoms
Inflammation of the iris,
Red eye
Photophobia
Visual disturbances – floaters and blurry vision
Causes include
Eye infection
Eye injury or trauma
Systemic autoimmune disorder
Unknown in many cases
Complications – loss of vision
Detached retina
Cataract
High ocular pressure

18. Glaucoma Signs and symptoms Gradual and asymptomatic loss of vision
Sudden onset of painful, bright-red eyes associated with halos around lights, loss of vision and nausea may signal acute angle-closure glaucoma
Acute angle-closure glaucoma – would require emergency attention to prevent permanent loss of vision within hours if not relieved.

19. Whitening eye drops
Used for treating red eyes can lead to vasoconstriction of conjuntival vessels
Rebound effect – rebound hyperemia
Chronic use can lead to dry eyes
Cold and Flu
Red eyes in sinus infection or blocked sinuses associated with sneezing and coughing

20. Pregnancy
Hormonal changes in pregnancy – dry itchy and sensitivity to light
Alter shape of the cornea
Intolerance to contact lenses
Blurry vision
Changes are not permanent – resolves weeks to months after delivery.

21. Smoking Smoking harms the eye Increase the risk of
age –related macular degeneration (AMD),
Cataract and uveitis
Irritant to the eye
Dry red itchy eyes
Marijuana can lead to red blood shot eyes (dilation of blood vessels on the eyes)
Excessive Alcohol use (lead to reduction of oxygen to RBC causing blood vessels to clump together resulting to blood shot eyes

22. Work/environmental hazards
Eye irritants/injurious items
Dry air, dust, smoke, and excessive sun exposure
Eye injuries by wind, e.g sand, wood fillings, metal and glass bits
Prevention
use of safety glass (personal protective devices)
Lack of Sleep
Puffy eyes and dark circles

23. Swimming Chlorine in swimming pools
Bacteria in rivers, lakes and other water sources
Prevention-
Use of swimming goggles
Removing contact lenses before swimming