Red Eye



Red Eye





COMMON CAUSES OF AN ACUTELY RED EYE



  • Subconjunctival hemorrhage*


  • Conjunctivitis*


  • Corneal abrasion (see Chapter 5)


  • Corneal foreign body (see Chapter 5)


  • Hordeolum (stye) and chalazion*


LESS COMMON CAUSES OF AN ACUTELY RED EYE NOT TO BE MISSED



  • Acute narrow-angle glaucoma*


  • Uveitis*


  • Episcleritis and scleritis*


  • Keratitis*


  • Penetrating ocular injury (see Chapter 5)


  • Corneal ulcer*


OTHER CAUSES OF AN ACUTELY RED EYE



  • Traumatic iritis and hyphema (see Chapter 5)


  • Ultraviolet exposure (flash burns, sunlamps, snow glare) (see Chapter 5)


DIFFERENTIAL DIAGNOSIS

The differential diagnosis of the acutely red eye includes subconjunctival hemorrhage, conjunctivitis, corneal abrasion and ulcer, iritis, acute narrow-angle glaucoma, uveitis, and keratitis (Table 17-1). The differential diagnosis can be refined if the physician recognizes the specific findings of conjunctival versus ciliary injection as well as the historical features that suggest a particular disorder as follows:



  • Are the inflamed vessels bright red and peripheral to the limbus (conjunctival injection) or more violaceous and both emanating from and adjacent to the limbus (ciliary injection)?


  • Do the affected vessels move easily with the conjunctiva when it is lightly brushed with a moistened cotton swab (conjunctival injection), or do the vessels appear deep and fixed (ciliary injection)?


  • Does the patient report deep eye pain or a more superficial discomfort (conjunctivitis)?









    Table 17-1 Differential Diagnosis of the Red Eye


































































































































































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    Laterality

    Discharge

    Adenopathy

    Photophobia

    Itching

    Pain

    Pupil

    Fluorescein

    Cornea


    Conjunctivitis











    Bacterial

    Bilateral

    Purulent

    None

    +

    –

    –

    wnl

    None

    Clear

    Viral (adenoviral)

    Bilateral

    Watery/mucoid

    Preauricular

    ++

    –

    +

    wnl

    P

    Clear

    Chlamydial

    Bilateral

    Watery/mucoid

    Preauricular

    +

    –

    –

    wnl

    P

    Clear

    Allergic

    Bilateral

    Watery

    None

    –

    ++

    –

    wnl

    None

    Clear


    Iritis

    Unilateral

    None

    None

    +++

    –

    ++

    wnl

    None

    KP


    Glaucoma











    Acute angle closure

    Unilateral

    Watery

    None

    ++

    –

    +++

    Fixed

    None

    E


    Cornea abrasion

    Unilateral

    Watery

    None

    ++

    –

    +++

    wnl

    G

    E


    Corneal ulcer











    Bacterial

    Unilateral

    Purulent

    None

    +++

    –

    +++

    wnl

    G

    I

    Viral (herpes simplex)

    Unilateral

    Watery

    +/-

    ++

    –

    ++

    wnl

    D

    E


    Scleritis

    Unilateral

    Watery

    None

    +

    –

    ++

    wnl