conditions must be ruled out in any patient presenting with a red eye
as they can rapidly progress to blindness. If in doubt, treat the
condition as the most severe one.
conditions usually present with eye PAIN.
present with CILIARY INJECTION which is engorgement of the deep
vessels around the limbus, giving the eye a bluish discoloration,
while less urgent conditions present with diffuse injection of
with trauma, but also can occur spontaneously in hypertensive
patients, after Valsalva or heavy maneuvers, in patients on aspirin or
recurrent: R/O bleeding tendency, R/O occult malignancy.
Reassurance. Treat the underlying condition if present.
Conjunctivitis secondary to blepharitis or accompanying it.
blepharitis: Lid hygiene and antibiotic ointment.
edema, erythema, hotness and tenderness. Red eye, decreased vision,
decreased ocular motility.
secondary to trauma, insect bite, dacryocystitis, stye, furuncle.
CT scan to
R/O extent of spread.
Admission, IV antibiotics.
differentiated from preseptal cellulitis, a milder condition in which
the infection does not cross the orbital septum. No red eye, no
limitation of EOM, no decreased vision. Treatment includes warm
compresses, P0 antibiotics.
4. Foreign Body:
cause of red eye.
must be everted as the foreign body might not be apparent.
linear or dot-like scratches on the cornea.
Treatment: Removal + topical antibiotics.
important symptom is itching.
symptoms: diffuse injection, foreign body sensation, tearing....
findings: giant papillae mainly on the upper eyelids, Trantas dots
perilimbally, shield ulcer on the cornea.
with other allergic conditions: allergic rhinitis, asthma.
Treatment: Cold compresses, lubrication, topical antihistamines (Naphcon
A), topical mast cell stabilizers (Alomide) , topical steroids (FML)
is epidemic keratoconjunctivitis caused by adenovirus.
include: diffuse injection, watery discharge, foreign body sensation.
URTI or contact with persons infected or previous infection in the
preauricular lymph node, follicles in the lower eyelid.
Eye precautions most important, lubrication, cold compresses.
the eyelids may be present.
exam: typical dendrites on the cornea that uptake fluorescein.
Acyclovir eye ointment.
evolution of symptoms: red eye, thick ropy discharge, eyelid sticking,
Conjunctival swab cultures
Start topical antibiotics (broad spectrum) pending cultures.
the disease is severe pain and ciliary injection.
differentiated from episcleritis (a milder more superficial condition)
associated with connective tissue diseases.
recognition and treatment is essential since it can lead to melting
Treatment: Systemic steroids + immunosuppressants
of the episclera, a milder condition than scleritis, usually NOT
associated with systemic conditions.
injection in one quadrant of the eye.
Topical NSAIDs or mild topical steroid.
secondary to microtrauma, contact lens wear or can be sterile.
photophobia, ciliary injection.
must be taken and the ulcer is assumed to be infectious, since it can
progress rapidly to perforation.
Fortified antibiotics pending results of cultures, cycloplegics.
patients with narrow angles often after conditions that cause
dilatation of the pupil.
pain, ciliary injection, photophobia, nausea, vomiting, headache.
exam: Elevated lOP (by tonometry), corneal edema, closed angle on
gonioscopy, fixed mid-dilated pupil.
Start immediately P0 Diamox, IV mannitol, topical beta blockers, laser
PT, anterior chamber paracentesis.
of the uvea: iris, ciliary body and choroid.
Choroiditis, retinitis, chorioretinitis.
with CT diseases, inflammatory bowel disease.
eye pain, photophobia, decreased vision.
exam: ciliary injection, anterior chamber reaction (flare and cells),
vitreous cells in posterior uveitis, keratic precipitates, Koeppe
nodules and Busacca nodules, sheathing of BV in retinitis.
Can lead to
blindness if not properly treated.
episodes of uveitis need systemic investigation for an underlying
disease: CBC, ESR, U/A, CXR, Calcium, ACE level, ANA, RA latex, VDRL,
is mandatory in all cases to RIO posterior uveitis.
topical steroids, cycloplegics. Intermediate/posterior uveitis:
topical + systemic steroids. Steroid ocular injections in some cases,
Inflammation of all the layers of the eye.
Is the most severe ophthalmological emergency.
Severe eye pain, ciliary injection, anterior chamber reaction,
Can occur post-op and is the most feared condition.
Treatment: Might need enucleation if topical, systemic (IV), and
intraocular injections of antibiotics fail.