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 Post subject: RED EYE- BACK TO BASICS
PostPosted: 07 Jan 2014 14:37 
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Red eye .

There are six serious, and sight-threatening causes of red eye:

acute glaucoma, keratitis, iritis, scleritis, penetrating eye injury or embedded foreign body (may not always cause red eye), and acid or alkali burns to the eye.

Acute glaucoma occurs when the usual drainage of aqueous humour into the anterior chamber suddenly becomes blocked. It is clinically characterized by pain in the eye (usually unilateral), headache, and blurring of vision. Signs include ciliary injection, hard and tender eye, fixed and dilated pupil unresponsive to bright light, hazy cornea, headache, nausea or vomiting, and markedly diminished vision.

Keratitis is a breach of the corneal epithelium caused by infection, trauma, or impairment of the protective mechanism of the eye (e.g. lid malposition or tear deficiency). It is clinically characterized by a unilateral, painful, photophobic, injected eye; corneal ulceration (a dendritic ulcer indicates herpes simplex infection); ciliary injection; and altered vision, depending on the site of the ulcer.

Iritis is inflammation of the iris. It may be associated with other inflammatory disorders, such as ankylosing spondylitis or collagen disorders, but the cause of the inflammation is usually not known. It may occur secondary to keratitis or acute glaucoma and is clinically characterized by pain, which is usually unilateral; photophobia; headache; and watering of the eye. Ciliary injection may be the only sign. The pupil may be constricted, or distorted from previous attacks. Less commonly, vision may be diminished.

Scleritis is inflammation of the sclera (the white outer wall of the eye), characterized by severe pain. It is usually associated with infections, chemical injuries, or autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Scleritis occurs most often in people between the ages of 30 and 60 and is rare in children.

Other causes of red eye include conjunctivitis (the moist common cause) and subconjunctival haemorrhage.
Subconjunctival haemorrhage occurs due to the rupture of a blood vessel into the space between the sclera and the conjunctiva due to trauma. It may occur with even very minor trauma, such as coughing or sneezing, and may be associated with hypertension.
History and findings of eye examinations (including negative findings) should always be documented. The important findings to document are pain, photophobia, visual acuity (measured using a Snellen chart), whether the condition is unilateral or bilateral, and where appropriate, the results of fluorescein staining. In all cases clinical judgment should be used with regards to the level of detail to document.

Serious causes of red eye need urgent referral for same-day assessment by an ophthalmologist or optometrist; these may be indicated by any of the following features:

Moderate-to-severe eye pain or photophobia.
Marked redness of one eye.
Reduced visual acuity.

Same-day assessment by an ophthalmologist or optometrist is also essential if any of the following features are present:


Suspected penetrating eye injury.
Irritant conjunctivitis caused by an acid or alkali burn (immediate referral) or other highly irritating substance; or if surgical correction of eyelid abnormalities, including entropion and trichiasis, is required.
Neonatal conjunctivitis.
Scleritis.

G Mohan.


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