Red Eye
A red eye is a diagnostic sign of ocular inflammation, which may be caused by a multitude of conditions. Most cases are benign and can be effectively managed by the primary care physician. Misdiagnosis of the more emergent conditions can have major vision-threatening complications; therefore, the key to management is prompt recognition of serious diseases that require ophthalmologic referral.
Differential Diagnosis
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Conjunctivitis
–Allergic (allergens, irritants)
–Viral (adenovirus, HSV, varicella)
–Bacterial: Adults (Staphylococcus aureus,
S. epidermidis, E. coli, Pseudomonas spp, Streptococcus spp), children (Haemophilus influenzae can cause otitis/conjunctivitis syndrome), Streptococcus pneumoniae, Moraxella catarrhalis, Staphylococcus spp), newborns (gonorrhea, Chlamydia)
Corneal abrasion/ulceration
Subconjunctival hemorrhage
Episcleritis
Scleritis (inflammation of conjunctiva and deep layers of globe)
Keratoconjunctivitis sicca
–Rheumatoid arthritis
–Sjögren's syndrome
Acute angle closure glaucoma
Acute iritis
Anterior uveitis
Pinguecula
Pterygium
Viral keratitis (disruption of the corneal epithelium): Herpes simplex/Zoster
Contact lens complications (e.g., infections with Acanthamoeba, Pseudomonas)
Trauma
Chemical burns (e.g., cyanoacrylate injury)
Orbital cellulitis (especially in children)
Acute ethmoiditis
Eyelid abnormalities
Trichiasis
Entropion
Molluscum contagiosum
Kawasaki's disease
Measles
UV radiation-induced photokeratitis
Pseudotumor cerebri
Workup and Diagnosis
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A thorough history is key to making accurate diagnosis
–History should focus on onset, visual changes, pain, trauma, photophobia, and fever
–Characteristics of a discharge clarity, color, and consistency should be ascertained
–Prior episodes and history of eye surgeries can provide valuable clues
–Co-morbid conditions (e.g., autoimmune disorders, hypertension, diabetes) can cause ocular symptoms
–Questions about contact lens use and medications
(e.g., anticholinergics) are important
-
Physical examination should include testing for visual acuity, extraocular muscles, pupil reactivity, photophobia, and disc assessment
–Eyelid inspection with eversion
Complete eye examination and focused head/neck and neurologic examination are indicated in all cases
Red flags include corneal opacification, deep pain, acute vision changes, photophobia, and blurred disc margins; pain suggests increased intraocular pressure above 40 mmHg, which necessitates immediate ophthalmologic referral
Slit-lamp examination with or without fluorescein dye
Laboratory studies may include culture and sensitivities for suspected infective causes, CBC and ESR for suspected inflammatory causes, rheumatoid factor and ANA for autoimmune causes
Treatment
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Ophthalmologic referral for HSV/herpes zoster keratitis or conjunctivitis, acute angle-closure glaucoma, scleritis, corneal ulcer, iritis, penetrating foreign bodies
-
Avoid treating patients with steroid eyedrops without ophthalmologic consultation
- Conjunctivitis
–Allergic: Avoid offending agents, cold compresses to eyes, NSAIDs, ocular decongestants, antihistamines
–Viral: Self-limited, good hygiene to avoid spread
–Bacterial: Antibiotic eye drops; avoid neomycin,
because allergic reactions are common
-
Subconjunctival hemorrhage: Reassurance, cool compresses, clears spontaneously in 1–2 weeks
-
Chemical eye injury: Immediate copious irrigation with normal saline for at least 30 minutes
-
Preventative measures include proper hygiene and daily cleaning of contact lenses, proper hand-washing techniques before all contact with eyes, eye protection in occupations entailing possible ocular injury
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to Eye discharge
Read excerpts from these other book chapters related to Eye discharge:
Medical Books Excerpts
- EYE PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Red Eye
- "In a Page: Signs and Symptoms" (2004)
- [ read ]
- EYE PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- RED EYE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Eye pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Eye discharge
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Red Eye
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Red Eye
- "Field Guide to Bedside Diagnosis" (2007)
- [ read ]
- Eye pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Eye pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Red Eye
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- EYE PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- RED EYE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Eye discharge
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Eye Discharge (In A Page: Pediatric Signs and Symptoms)
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