4. INTRODUTION
• A frequent cause of presentation to eye clinics and
GOPD clinics.
• Sign of ocular inflammation
• Caused by dilatation/engorgement of ocular blood
vessels.
• Broad spectrum of disease entities
• Self -limiting conditions, e.g., ocular allergy,and
inflamed pterygium,
• Potentially sight / life-threatening conditions such
as orbital cellulitis, uveal tumor, and
endophthalmitis.
5. EPIDEMIOLOGY
Up to 5% of primary care consultations are eye-
related
About 96% of General Practitioners (GPs) do not
undergo postgraduate ophthalmology training
Out of 2623 patients with red eye at FMC Birnin
Kebbi
49.15 % - ocular allergy
11.2% - microbial conjuctivitis
10.9% - ocular trauma
6. EPIDEMIOLOGY
At AKTH(2004 – 2005) Out of 4723 new patients
seen in the eye clinic
14.8% had red eye
40% - allergic conjuctivitis
17% - microbial conjuctivitis
11% - corneal ulcer
11% - -inflammed pterygium
Ghana(2004) of 21,391 patients seen as
outpatients, 40% had red eye issues
11. Clinical evaluation – History
• Bio data (name, DOB, sex, race,
occupation)
• Chief complaint
• History of present illness
• Onset
• Location (unilateral /bilateral /sectoral)
• Pain/ discomfort (gritty, FB sensation,
itch, deep ache)
• Photosensitivity
• Watering +/or discharge
12. Evaluation cont’d
• Present status of vision (patient’s perception
of his/her visual status) and ocular symptoms
• Past ocular history (eye diseases, injuries,
treatments, surgeries, medications)
• PMH
• Drug history
• Family and social especially history of ocular
disease
• Exposure to person with red eye
• Trauma , contact lens use
13. Clinical evaluation cont’d Examination
• Inspect whole patient
• Visual acuity- each eye + pin hole
• Lymphadenopathy- preauricular nodes
• Eyelids
Lid edema
Vessicles
Allergic shiners
• Invert eye lid to check for forieng body
• Conjunctiva (bulbar and palpebral)
• Cornea (clarity, staining with fluorescein, sensation)
• Globe tenderness by gentle digital presure
• Pupils shape/ reaction to light / accommodation
• Eye movements
• Fundoscopy
19. BLEPHARITIS cont’d
• Signs
• Erythema of lid margins
• Eyelash debris
• Eyelid crusting
• Eyelash loss
• Chronic conjunctivitis
TREATMENT
• Warm compresses, lid hygeine
• Artificial tears
• Occasional steroid/antibiotic ointment
20. Acute Hordeolum
• Acute focal staph
infection of lid
• External (stye) :-glands of
Zeiss
• Internal:- Meibomian
glands (internal hordeola)
• Typically occurs at the
middle
• Warm compresses
• Topical antibiotic eyedrop
• Oral antibiotics if infection
spreads beyond the eyelid
21. CHALAZION
• A benign painless bump or nodule inside the
upper or lower eyelid
• Due to blocked oil glands(meibomian)
• Gradual in onset
• May develop after stye
• Can cause astigmatism secondary to pressure
on the cornea
22. CHALAZION TREATMENT
• Most , slowly shrink and disappear
• Warm compresses
• Massage with compression
• Oral tetracycline may hasten
resolution secondary to its lipid
transforming capability
• EXCISION usually from conj side
35. Chlamydia conjunctivitis
• Ocular inoculation from genital infection with
Chlamydia trachomatis – subtypes D and K
• Usually associated with risk of corneal perforation
• Women> men
• Most common cause of ophthalmia neonatorum
SYMPTOMS
• Acute or sub acute
• Irritation
• Tearing
• Photosensitivity
37. Subconjunctival Hemorrhage
AETIOLOGY ;-
• blunt trauma,
• straining ,coughing, vomitting
• bleeding disorders
• HTN
• Use of NSAIDS
PRESENTATION ;-
• Localised haemorrhage
• Often unilateral
• Painless
• Good vision
38. Subconjunctival H. cont’d
• Usually no obvious cause
• often told by others that “eye is red.”
TREATMENT
• check BP
• Reassurance , Gradually reabsorbs
• NSAID is contraindicated
• If recurrent, exclude bleeding tendency
• Refer if both eyes are involved, persistence,
recurrent or pain developes
39. CORNEAL ULCERS/ ABRASIONS
CAUSES: injury,
UV light (welder’s arc)
contact lens related
recurrent erosion
dry eye
lid malposition.
Chemical such as Alkali , acid
• Alkali injuries, worse than acid
• Infectious causes includes;- ,Bacterial , Viral,
Fungal , Protozoa
41. TREATMENT cont’d
• +/- Patch, +/- bandage lens
• if less than 10mm no patching is required
• Trauma related abrasions heal quickly,
24-48 hours
• Never patch a contact lens patient – risk
of infection
• Never give topical anesthetics for pain
control due to toxic effects on the corneal
epithelium
42. DRY EYE SYNDROME
• Not enough tears or evaporates too quickly
• Disruption in tear production affecting quality
or quantity
• Causes can be divided into
1. Lacrimal pathology ;-
CNVII palsy
Meibomian gland dysfunction
medications such as
1. anticholenergics
2. anti histamines
3. diuretics 4. ß Blockers ,5.antidepressants
43. DRY EYE SYNDROME cont’d
2. Excessive evaporation of aqueous layer ;- vit
A defficienc
ocular medications
contact lenses
allergic conjuctivitis
other causes includes;-
• autoimmune disorders eg sjogrens syndrome,
RA, lupus
• HIV
• Excessive use of the computer
44. DRY EYE SYNDROME cont’d
Symptoms
Burning or foreign body sensation
Tearing
Itching
Usually worse as the day progresses
Wind or low humidity > heat
INVESTIGATION ;- Schirmer’s test
Treatment
Artificial tears(preservative free)
Tear replacement plugs
Rarely, lateral tarsoraphy
45. PINGUECULUM
• yellow spot or bump on the conjunctiva
• Often on the side near the nose
• Deposit of protein ,fat ,or calcium
• Pingueculitis occurs due to excessive exposure to
sunlight , wind ,dust or extremely dry conditions
• Symptoms usually come from disruption of tear film
• This leads to
Burning sensation
Stinging
Itching
Foreing body sensation
Blurred vission
46. PINGUECULUM CONT’D
Treatment
• sunglasses
• Photochromic lenses
• Goggles
• Artificial tears
• Steroid eye drops (not for
long use)
• NSAIDS ,
• referral for surgical removal
47. PTERYGIUM
• Benign change in the bulbar conjunctiva(
Wing shaped)
• Usually extends onto the cornea
• Not restricted to the medial side of the
cornea
• Associated with wind and sun exposure
• Redness secondary to the increased
vascularity of the lesion;
• Preceded by pinguecula.
48. PTERYGIUM CONT’D
TREATMENT
Lubrication – tears
Topical vasoconstrictors
Topical NSAIDs
Topical steroids (not
recommended for long
term use)
Referral for Surgical
excision
57. UVEITIS
• Inflammation of the uveal tract
• Classified into
1. Anterior uveitis ;- iritis
2. Intermediate uveitis ;-
Anterior cyclitis – anterior portion of the
cilliary body
Pars plenitis – posterior part of the cilliary
body
3. posterior uveitis;- choroid body
58. UVEITIS cont’d
IRITIS
CAUSES CAN BE
1. Infections
2. Neoplasia
3. Trauma
4. Ischemic
5. Inflammation
6. Idiopathic
More than 50 % are HLA B27
related – associated with
conditions as RA, and
IBD,
SIGNS AND SYMPTOMS
• Progressive , often unilateral
• Limbal (circumcorneal) flush
(redness)
• Pain
• Photophobia
• Decreased vision
• Irregular pupils
• possibly hypopyon
59. UVEITIS cont’d
TREATMENT
• Usually good prognosis
• May reoccur
• Cycloplegic eye drops eg cyclopentolate
• Topical steroids
• possible systemic immunosuppressive medications
• Aim is to reduce inflammation and to prevent
1. Glaucoma
2. cataracts, and
3. macula edema
Patient should be referred to an ophthalmologist
60. Acute Angle Closure Glaucoma
SINGS AND SYMPTOMS
• Sudden rise in intraocular pressure
( IOP)
• Non – reactive mid-dilated pupil
• photophobia
• Halos around light
• decrease in vision
• Pain
• Cloudy cornea (corneal edema)
• Nausea and vomiting
61. ACUTE ANGLE CLOSURE GLAUCOMA CONT’D
• Visually threatening
• High pressure can lead
optic nerve
retinal damage
TREATMENT
• Aimed at lowering IOP:-
• Lie patient down
• topical beta-blockers – timolol
• Sympathomimetics - pilocarpine, apraclonidine,
• iv acetazolamide, oral glycerine or isosorbide
• Prompt referral
• Definitive treatment: Iridectomy
• Good prognosis if early intervention
62. Red flags
• These are signs and stmptoms that need urgent
referral ;-
Marked redness of one eye
Sudden, severe ,pain with vomitting
Sudden in visual acuity
Irregular pupils
Ocular tenderness
Ocular presure > 40mmhg
The trio of pain ,photophobia and in visual
acuity
63. SUMMARY
• Ther are numerous causes of red eye .The
family physician should
1. Rule out vision threatening complications
2. Look for ocular sings before making diagnosis
as symptoms are always not enough
• The important issue is
Timely and Accurate diagnosis
Appropriate referral when indicated
64.
65. REFERENCE
• Monsudi KF, Azonobi IR, Ayanniyi AA. Pattern of red eye in a
Tertiary Eye Clinic in Nigeria. Afr J Med Health Sci [serial
online] 2015 [cited 2017 Nov 19];14:101-4. Available from:
http://www.ajmhs.org/text.asp?2015/14/2/101/170170
• Causes of red eye in Aminu Kano Teaching Hospital,, Kano--
Nigeria..Lawan A. Niger J Med. 2009 Apr-Jun
• Presntation by Anthony Cavallerano, OD .VA Boston Health
Care System New England College of Optometry Boston,
Massachusetts Anthony.cavallerano@va.gov
• Community Eye Health. 2005 Mar; 18(53): 70–72 Isaac Baba,
Cataract Surgeon, Bawku Hospital, PO Box 45, Bawku, Ghana
• Red eyes and red-flags: improving ophthalmic assessment
and referral in primary care ; Caroline Kilduff , Charis Lois.
66. REFERENCE
• Medscape Red Eye Updated: Apr 18, 2017 Author:
Robert H Graham, MD; Chief Editor: Andrew A Dahl,
MD, FACS
• Primary Care for the Red Eye Alice L. Bashinsky,
M.D. Phillip C. Hoopes, Jr, M.D. September 2, 2003
• Approach to Red eye in PHC Dr.Hamad Alyami
Family Medicine Specialist Dr.Zainab
Alibrahim,Anthony Cavallerano, OD
• Red eye presentation by Abdulrahman Al-Muamm
• Acute red eye presentation by En Min Cho
GPVTS Canterbury
