The Red Eye

Reganit, Chelsea Marie A.

Conjunctivitis
Inflammation of the conjunctiva

Viral Conjunctivitis
Inflammation of palpebral
conjunctiva and bulbar
conjunctiva
Acute
Adenovirus type 3
direct contact
Incubation 5-12 days

Viral Conjunctivitis
Clinical
presentation
Edema and
hyperemia of one of
both eyes.
Conjunctival
injection
Ipsilateral palpable
preauricular
lymphadenopathy.

Viral Conjunctivitis
Management:
Topical vasoconstrictors (naphazoline)
and steroids (Vexol, Flarex,)
Sulfonamide drops

Bacterial Conjunctivitis
Etiology
Hyperacute: Neisseia gonorrhea
Acute catarrhal: S. pneumonia,
Staphylococcus
Subacute: Hemophylus influenza
Chronic: Moraxella, pseudomonas, gram
negative species

Bacterial Conjunctivitis

Irritation
Hyperemia
tearing
Copious purulent discharge
from both eyes
Mild decrease in visual
acuity

Bacterial Conjunctivitis
Diagnosis:
Gram stain: presence of polymorphonuclear
cells and predominant organism

Complications:
secondary keratitis, corneal ulcer

Bacterial Conjunctivitis
Management
Broad spectrum topical antibiotics
Polytrim (polymixin B sulfate and trimethoprim
sulfate)
Gentamicin 0.3%
Tobramycin 0.3%

Chlamydial/Gonococcal
Conjunctivitis
Eye infection greater than
3 weeks
Mucopurulent discharge
Conjunctival injection
palpable preauricular node
Conjunctival papillae
Chemosis

Conjunctival papillae

Chlamydial/Gonococcal
Conjunctivitis
Diagnosis
Fluorescent antibody stain, enzyme
immunoassay tests
Giemsa stain: Intracytoplasmic inclusion
bodies in epithelial cells,
polymorphonuclear leukocytes and
lymphocytes

Chlamydial/Gonococcal
Conjunctivitis
Management:
Oral
Tetracycline
Azithromycin
Amoxicillin and erythromycin or Doxycycline

Topical: erythromycin, tetracycline or

sulfacetamide
Gonococcal: ceftriaxone 1g IM, and then 1gm
IV 12-24 hours later
Topical Fluoroquinolone

Allergic Conjunctivitis
Usually allergy to air born allergen
Mediated by IgE
May occur with hay fever, asthma or
rhinitis

Allergic Conjunctivitis
Conjunctival injection
Thin, watery discharge
photophobia and
visual loss
Large cobblestone
papillae
Lids swollen and red

Allergic Conjunctivitis
Management
Avoid contact with allergen, cold compresses,
artificial tears
Topical antihistamines, topical vasoconstrictors
or decongestants such as phenylephrine
(vasoconstrict and retard release of
inflammatory mediators)
Mast cell stabilizers (Alomide and Crolom)
Severe cases : topical steroids such as Vexol,
Flarex or Alrex

Blepharitis
Can be associated with a bacterial
infection such as S. aureus or a chronic
skin condition

Blepharitis
Two forms
Anterior
affects outside lids where eyelashes attach
Caused by bacteria or seborrheic

Posterior
meibomian glands
Leads to gland plugging and Chalazion formation

Blepharitis
S Aureus:
Itching,
lacrimation,
tearing, burning,
photophobia

Seborrheic:
lid margin
erythema, dry
flakes, oily
secretions on lid
margins,
associated dandruff

Blepharitis
Complications
thickened lid margins
dilated and visible capillaries
eyelash loss
Ectropion and Entropion
corneal erosions

Blepharitis
Management
Lid hygiene
Antibiotic ointment to lid margins after
cleaning ie. Bacitracin, erythromycin
Lubrication to relieve foreign body
sensation

Subconjunctival
Haemorrhage
Bleeding of the
conjunctival or episcleral
blood vessels into the
subconjunctival space
Idiopathic, trauma,
cough, sneezing, aspirin,
hypertension
If traumatic must do
thorough exam

Subconjunctival Hemorrhage
No therapy
Reassurance that the condition is not
serious and will resolve in 1-3 weeks
Hematologic coagulation studies are
not indicated unless there are
associated retinal hemorrhages or
many recurrences

Corneal & Conjunctival Foreign

Body
pain, tearing, photophobia and foreign body
sensation
Foreign body may be flushed out or can be
removed with a g25 needle
Treatment with antibiotics is necesssary
Flip lid if no FB seen and linear abrasion

Chemical Injury
True ocular emergency
Requires immediate irrigation with
nearest source of water
Management dependent on acid or
alkaline offending substance

Chemical Burns
Management
Immediate irrigation
Topical antibiotics
Cycloplegia
Removal of particulate matter

Goal is to reepithelialize the cornea

Contact Lens Wear Associated

Red Eye
Prolonged contact lens wear or
poorly fitting lenses may cause a red
eye.
Severe pain.
Tearing.
If opacity is noted or corneal
infection is suspected,treat as if
infected.
Bacterial, parasite, fungus are
possible pathogens.

Bacterial Keratitis

Red, painful eye

Watery - purulent discharge
May have corneal opacity
May have decreased vision

Bacterial Keratitis
Diagnosis
Confirmation with scrapings and cultures
Gram stain

Management
Initial broad spectrum treatment with
antibiotics eg. Flouroquinolone and
Bacitracin, Cefazolin and Amikacin
Modify treatment based on culture
results