10/21/2015

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OphthalmologyArticles
Revision Notes
/ Biology Notes
/ Ophthalmology

RedEye
Written by: Sana Rasool from Manchester University,

History

Examination

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Causesofredeye
There are many different causes of a red eye. After taking a full history and thoroughly
examining the eyes, a management plan can be made.

Anterioruveitis

Inflammation of the iris and ciliary body

Risk factors:
Previous uveitis
Seronegative arthropathy, especially
HLA B27 positive patients
Herpes zoster ophthalmicus
Syphilis
Tb

Clinical features:
Young or middle aged patients
Pain worse when reading
Photophobia
Reduced visual acuity

On examination:
Pupil may be small and irregular (due
to posterior synechiae adhesions of iris
to the lens)
On using slit lamp, anterior chamber
may show:
cells (moving, white specks)
hypopyon pus in anterior
chamber
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flare(looking through frosted

glass)
keratic precipitates may be seen at the
back of the cornea

Management:
Treat underlying cause if found.
Topical steroids
Mydriatics to prevent synechaie being
formed which can cause acute glaucoma.

Acuteangleclosureglaucoma

Due to occlusion of the angle where aqueous

fluid is normally drained, therefore leading to a
sudden increase in intraocular pressure.

Clinical features:
Usually in patients over 50 yrs
Severe pain
Red eye
Haloes around lights
Reduced visual acuity
Fixed semidilated pupil not reactive to
light
Eye feels hard on palpation
Hazy cornea
Systemic symptoms headache,
nausea, vomiting

Management:
Urgent ophthalmological referral to
prevent visual loss
IV acetazolamide 500mg
Pilocarpine 4% topical to constrict pupil
To restore normal aqueous flow, a hole
needs to be made in the iris. This can be
done with a laser (iridotomy) or surgically
(iridectomy)

Scleritis
Inflammation of white sclera itself
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Usually very painful significantly more

redness present compared to episcleritis
Associated with other autoimmune
conditions
Visual acuity may be affected
Management may need
immunosuppressants
Complications corneal ulceration,
intraocular inflammation

Episcleritis
Inflammation of episclera
Mild eye irritation and redness
Normal visual acuity
Management usually self limiting, but
steroids may help

Cornealulceration
Causes
Infection
Corneal abrasion
Contact lenses
Exposure keratopathy (ie a patient with
facial nerve palsy who is unable to close
eyelids).

Clinical Features
Pain
Foreign body sensation
Mild to moderate red eye
Blurred vision
Photophobia

Examination
Staining the cornea with fluorescein
shows an area of corneal epithelial defect,
and shows up yellow.

Management
Viral infection Topical acyclovir
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Bacterial or fungal infection Broad

spectrum antibiotics
Noninfectious ulcer treat the cause.

Subconjunctivalhaemorrhage
Bright red blood between white sclera and
conjunctiva. Usually benign
Can be caused by:
Severe coughing or straining
Hypertension
Blood disorders
Idiopathic

Clinical features:
Diffuse area of bright red blood
May be a foreign body
No pain, blurred vision or photophobia
Eye examination otherwise normal

Management:
Exclude hypertension
Check coagulation profile, especially if
patient is on warfarin
Reassure patients that it is benign and
may take a few weeks to fade

Conjunctivitis

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References
ABC of Eyes. 4th edition.
Kennerley Banke's Clinical Ophthalmology. 4th ediition.
Image 1 Hypopyon in anterior uveitis taken from
http://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_
lny8tU/s1600/ant+uveitis.jpg (http://2.bp.blogspot.com/_LMdPu119VcY/TUvZrm6K2MI/AAAAAAAAAac/nJx_
lny8tU/s1600/ant+uveitis.jpg)

Image 2 Acute angle closure glaucoma taken from http://www.medrounds.org/glaucoma

guide/2006/12/section9cdiagnosisofacuteangle.html (http://www.medrounds.org/glaucoma
guide/2006/12/section9cdiagnosisofacuteangle.html)

Image 3 Scleritis taken from http://eyepathologist.com/images/KL21711.jpg

(http://eyepathologist.com/images/KL21711.jpg)

Image 4 Episcleritis taken from http://www.gp

training.net/protocol/ophthalmology/redeye/episcl.jpg (http://www.gp
training.net/protocol/ophthalmology/redeye/episcl.jpg)

Image 5 Corneal ulcer taken from

http://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg
(http://www.revophth.com/CMSImagesContent/2004/9/1_588_0.jpg)

Image 6 Subconjunctival haemorrhage taken from

http://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg
(http://www.tedmontgomery.com/the_eye/eyephotos/pics/SubconjunctivalHemorrhage.jpg)

Skills
Eye Examination & Vision Assessment
Identifying and Treating Eye Emerge
Ocular History Taking
Using an Ophthalmoscope
Conditions
Agerelated Macular Degeneration
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