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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

  • 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

    • 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

    • 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 symptoms

    Read excerpts from these other book chapters related to Eye symptoms:

    Medical Books Excerpts
    • DIPLOPIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • EYE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • NYSTAGMUS
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • PAPILLEDEMA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • SCOTOMA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • Red Eye
    • "In a Page: Signs and Symptoms" (2004)
    • [ read ]
    • Diplopia
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Nystagmus
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • NYSTAGMUS
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • RED EYE
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Diplopia
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Eye pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Nystagmus
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Scotoma
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Nystagmus
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Eye discharge
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Diplopia
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Nystagmus
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Scotoma
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Raccoon eyes
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Diplopia
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Nystagmus
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Papilledema
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Red Eye
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Scotoma
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Eye Pain
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Red Eye
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Eye pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Ocular deviation
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Diplopia
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Eye pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Nystagmus
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Scotoma
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Nystagmus
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Red Eye
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Diplopia
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Nystagmus
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Scotoma
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • NYSTAGMUS
    • "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 symptoms



    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

     » Next page: Eye Discharge (In A Page: Pediatric Signs and Symptoms)

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