The red eye

–Aim to distinguish acute emergency from less urgent Vision affected? Pain?Unilateral/bilateral? Distinguish conjunctival injection from ciliary flush

The red eye –Acute conjunctivitis –<3 weeks Red eye Discharge –Watery, mucoid, purulent Irritation –Cornea clear –Vision good  Swab for culture+sensitivity  clean + topical antibiotic chloramphenicol

The red eye Acute conjunctivitis Acute conjunctivitis –Papillae Non specific –Except Giant papillae atopic disease Fb –Follicles Physiologic in children Chlamydia,adenovirus, herpes simplex, molluscum, drug toxicity, trachoma drug toxicity, trachoma

The red eye Bacterial conjunctivitis –Less common than viral Conjunctival inflammation Purulent discharge –Usually self limiting –Occasionally sight threatening GonococcalSwab:Neonate,immunodeficient Severe cases Unresponsive cases

The red eye –Keratitis Inflammation of cornea –Infection BacteriaVirusFungusProtozoa –Dry Eye –Toxicity –Trauma ChemicalMechanical UV light (arc eye)  loss of transparency –Reduced acuity –+/-pain

The red eye Corneal ulcer –Emergency scrape for Gram stain and culture scrape for Gram stain and culture Intensive topical antibiotics –Fluoroquinolone –Fortified gentamicin and cefuroxime

The red eye Corneal foreign body Remove Topical antibiotic UV keratitis History of welding Cycloplegic + patch

The red eye –Uveitis Inflammation of iris, ciliary body, choroid Anterior uveitis –Pain –Sensitivity to light –Blurring –Ciliary flush Deep AC Clear cornea –But keratic precipitates AC flare and cells Irregular shape of pupil

The red eye –Uveitis Topical steroid –Prednisolone 1% Cycloplegia –Often recurrent –Chronic cases need investigation

The red eye Herpes simplex keratitis DiscomfortWateringPhotophobia Ciliary flush Dendritic pattern of fluorescein staining Reduced corneal sensation –Recurrent disease

The red eye –Herpes simplex keratitis Topical aciclovir +/- debridement with sterile swab Do NOT use steroid in epithelial disease –HSV can also affect stroma and endothelium which require steroid but these require close supervision

The red eye Herpes zoster ophthalmicus Reactivation of latent infection of trigeminal ganglion with varicella- zoster virus Older age group Can be triggered by malignancy, HIV, immunosuppression

The red eye –Herpes zoster ophthalmicus Prodromal fever, malaise Rash in dermatome –Vesicular, becoming crusty Painful (may  chronic) Inflammation can affect ALL parts of eye –Lids, cornea, sclera, AC, uvea, optic nerve, cranial nerves –Can result in corneal opacity, new vessels

The red eye –Herpes Zoster ophthalmicus –Oral aciclovir 800mg x5 daily for 10 days starting WITHIN 72 hrs of onset –Topical ACV not indicated –Topical steroids and cycloplegia for stromal keratitis and uveitis Need very slow taper –Respect this condition!

The red eye Acute glaucoma Pain Blurring of vision High IOP Ciliary flush Hazy cornea Mid-dilated pupil Shallow anterior chamber

The red eye Acute glaucoma Timolol 0.5% Pilocarpine 1%-2% –Q15 minutes x3 Prednisolone Oral/iv Diamox –Beware CCF, renal disease –When acute attack broken perform laser or surgical iridotomy