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{{SK}} Red eye in kids, Conjunctivitis, outbreak-epidemic-symptoms.
{{SK}} Red eye in kids, Conjunctivitis, outbreak-epidemic-symptoms.
==Overview==
==Overview==
[[Red eye]] in children is a common consultation purpose. Mostly benign, this sign may also cause visual impairment. We differentiate three kinds of red eye: localised, diffused and perikeratic injection. The last one must be recognized because of its association with severe [[ocular diseases]]. Diagnosis must be sure and treatment has to be efficient to not pertubate childrens visual development. Unfortunately, physical examination on children is not always easy. Consultation with an [[ophthalmologist]] is justified if a doubt remains, in case of chronic pathology or resistance to first intention treatment. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications rare.   
[[Red eye]] in children is a common consultation purpose. Mostly benign, this sign may also cause [[visual impairment]]. We differentiate three kinds of [[red eye]]: localised, diffused and [[perikeratic]] injection. The last one must be recognized because of its association with severe [[ocular diseases]]. Diagnosis must be sure and treatment has to be efficient to not [[pertubate]] childrens [[visual]] development. Unfortunately, physical examination on children is not always easy. Consultation with an [[ophthalmologist]] is justified if a doubt remains, in case of [[chronic pathology]] or resistance to first intention [[treatment]]. Generally, [[viral]] and [[bacterial conjunctivitis]] are self-limiting conditions, and serious complications rare.   


==Historical Perspective==
==Historical Perspective==


*[[Red eye]] in children was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*Can not find any historical perspective in [[Red eye]] in children.
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
   
   
==Classification==
==Classification==


*Red eye may be classified according to [classification method] into three subtypes/groups:<ref name="pmid18506971">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>
*[[Red eye]] may be classified according to classification method into three subtypes/groups:<ref name="pmid18506971">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>


:*localised
:*Localised
:*diffused
:*Diffused
:*perikeratic injection
:*[[perikeratic]] injection


==Pathophysiology==
==Pathophysiology==


*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*On microscopic histopathological analysis, [[viral]], [[bacterial]] like  ''[[Streptococcus pneumonia]], [[Haemophilus influenzae]], [[Moraxella catarrhalis]],'' or ''[[Staphylococcus aureus]]'' and   [[fungal]] <ref name="pmid6873498 DOI: 10.1186/s12879-019-4612-0">{{cite journal| author=Hunt A| title=Tuberous sclerosis: a survey of 97 cases. II: Physical findings. | journal=Dev Med Child Neurol | year= 1983 | volume= 25 | issue= 3 | pages= 350-2 | pmid=6873498  DOI: 10.1186/s12879-019-4612-0 | doi=10.1111/j.1469-8749.1983.tb13770.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6873498  }}</ref> are characteristic findings of [[red eye]].
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==Causes==
==Causes==
'''Common causes of Red Eye in Children'''<ref name="urlRed Eye - American Academy of Ophthalmology">{{cite web |url=https://www.aao.org/eye-health/symptoms/red-eye-3 |title=Red Eye - American Academy of Ophthalmology |format= |work= |accessdate=}}</ref>
*[[Blepharitis]]
*[[Cellulitis]]
*[[Conjunctivitis]] (Pink Eye)
*[[Corneal Abrasion]]
*Corneal Ulcer
*[[Eye Allergies]]
*Fungal Keratitis
*[[Glaucoma]]
*[[Herpes Keratitis]]
*[[Pinguecula]] and [[Pterygium]]
*[[Retinoblastoma]]
*[[Subconjunctival Hemorrhage]]
*[[Uveitis]]
'''Common causes of Red Eye in Children'''
'''Common causes of Red Eye in Children'''


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Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.


*globe ruptures or perforations
*[[globe ruptures]] or perforations
*intraocular infections
*[[intraocular infections]]
*'''Carotid–cavernous sinus fistula'''
*'''Carotid–cavernous sinus fistula'''


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Red eye is diffrentiated from many disease, the most common is conjunctivitis . Others include: Bacterial conjunctivitis, Viral conjunctivitis, Allergic conjunctivitis,Chemical conjunctivitis, Foreign body, Blepharitis, Hordeola , Keratitis, Endophthalmitis , Dacrocystitis, Anterior uveitis (iridocyclitis) :associated with juvenile RA, Behcet diease and IBS; sudden onset pain, photophobia, blurred vision, irregular pupil, poor vision, Posterior uveitis (choroiditis) and  Scleritis/Episcleritis <ref name="urlwww.textbooks.com">{{cite web |url=https://www.textbooks.com/Nelson-Essentials-of-Pediatrics-5th-Edition/9781416001591/Kliegman-Marcdante-Jenson-and-Behrman.php |title=www.textbooks.com |format= |work= |accessdate=}}</ref>.
[[Red eye (medicine)|Red eye]] is diffrentiated from many disease, the most common is [[conjunctivitis]] . Others include: [[Bacterial conjunctivitis]], [[Viral conjunctivitis]], [[Allergic conjunctivitis]],[[Chemical conjunctivitis]], [[Foreign body]], [[Blepharitis]], [[Hordeola]] , [[Keratitis]], [[Endophthalmitis]] , [[Dacrocystitis]], [[Anterior uveitis]] ([[iridocyclitis]]) :associated with [[juvenile RA]], [[Behcet diease]] and [[IBS]]; Sudden onset [[pain]], photophobia, blurred vision, irregular pupil, poor vision, Posterior uveitis (choroiditis) and  Scleritis/Episcleritis<ref name="pmid17491745">Baba I (2005) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17491745 The red eye - first aid at the primary level.] ''Community Eye Health'' 18 (53):70-2. PMID: [https://pubmed.gov/PMIDt: 17491745 PMID: 17491745]</ref> <ref name="urlwww.textbooks.com">{{cite web |url=https://www.textbooks.com/Nelson-Essentials-of-Pediatrics-5th-Edition/9781416001591/Kliegman-Marcdante-Jenson-and-Behrman.php |title=www.textbooks.com |format= |work= |accessdate=}}</ref>
 
<ref name="urlwww.cehjournal.org">{{cite web |url=https://www.cehjournal.org/wp-content/uploads/red-eye-the-role-of-primary-care.pdf |title=www.cehjournal.org |format= |work= |accessdate=}}</ref><ref name="pmid3099921">{{cite journal| author=Dart JK| title=Eye disease at a community health centre. | journal=Br Med J (Clin Res Ed) | year= 1986 | volume= 293 | issue= 6560 | pages= 1477-80 | pmid=3099921 | doi=10.1136/bmj.293.6560.1477 | pmc=1342247 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3099921  }}</ref><ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }}</ref>


<ref name="urlwww.cehjournal.org">{{cite web |url=https://www.cehjournal.org/wp-content/uploads/red-eye-the-role-of-primary-care.pdf |title=www.cehjournal.org |format= |work= |accessdate=}}</ref>




Differential diagnosis of red eye with no injury
 
[[Differential diagnosis]] of [[red eye]] with no [[injury]]
{| class="wikitable"
{| class="wikitable"
! colspan="1" rowspan="1" |
! colspan="1" rowspan="1" |
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==Epidemiology and Demographics==
==Epidemiology and Demographics==


*The prevalence of red eye in children  is approximately [number or range] per 100,000 individuals worldwide.
*
*In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
*Of 840 [[patients]], 525 were [[men]] (62.5%) and 315 were [[women]] (37.5%). Most of the [[patients]] were over 39 years of age. 55.7 percentage of them lived in cities and 44% were from villages. The most common eye [[symptoms]] with [[eye redness]] were: [[Eye abrasion]] (57%), [[tears]] in eyes (49%) and [[swollen eye lid]] (30%). [[Red eyes]] without any symptoms in eyes were diagnosed as [[runny nose]] (4.2%) and [[headaches]] (3.4%). 11.9% and 19.6% of the patients had a previous history of [[red eye]] and had visited doctors for [[red eyes]] respectively.<ref name="pmid17265788">Van de Velde FJ (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17265788 The relaxed confocal scanning laser ophthalmoscope.] ''Bull Soc Belge Ophtalmol''  (302):25-35. PMID: [https://pubmed.gov/PMID: 17265788 PMID: 17265788]</ref>
   
   
===Age===
===Age===


*Patients of all age groups may develop [disease name].
*Patients of all age groups may develop [[red eye]].
*Red eye is more commonly observed among patients aged [age range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
   
   
===Gender===
===Gender===


*males are more commonly affected with red eye in children than females<ref name="pmid29450327">Farokhfar A, Ahmadzadeh Amiri A, Heidari Gorji Mohammad A, Sheikhrezaee M (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29450327 Common causes of red eye presenting in northern Iran.] ''Rom J Ophthalmol'' 60 (2):71-78. PMID: [https://pubmed.gov/PMID: 29450327 PMID: 29450327]</ref>.
*[[males]] are more commonly affected with red eye in children than [[females]]<ref name="pmid29450327">Farokhfar A, Ahmadzadeh Amiri A, Heidari Gorji Mohammad A, Sheikhrezaee M (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29450327 Common causes of red eye presenting in northern Iran.] ''Rom J Ophthalmol'' 60 (2):71-78. PMID: [https://pubmed.gov/PMID: 29450327 PMID: 29450327]</ref>.
   
   
===Race===
===Race===


*There is no racial predilection for red eye in children.
*There is no racial predilection for [[red eye]] in children.


==Risk Factors==
==Risk Factors==
Common risk factors in the development of red eye in children are <ref name="urlCKS is only available in the UK | NICE">{{cite web |url=https://www.nice.org.uk/cks-uk-only |title=CKS is only available in the UK &#124; NICE |format= |work= |accessdate=}}</ref><ref name="urlRed Eye in Children">{{cite web |url=https://fpnotebook.com/Eye/Sx/RdEyInChldrn.htm |title=Red Eye in Children |format= |work= |accessdate=}}</ref>
Common [[risk factors]] in the development of [[red eye]] in children are <ref name="urlCKS is only available in the UK | NICE">{{cite web |url=https://www.nice.org.uk/cks-uk-only |title=CKS is only available in the UK &#124; NICE |format= |work= |accessdate=}}</ref><ref name="urlRed Eye in Children">{{cite web |url=https://fpnotebook.com/Eye/Sx/RdEyInChldrn.htm |title=Red Eye in Children |format= |work= |accessdate=}}</ref><br />
<br />


*the Upper Respiratory Infection
*The [[Upper Respiratory Infection]]
*Viral Conjunctivitis (Pink Eye)
*[[Viral Conjunctivitis]] ([[Pink Eye]])
*Irritant Conjunctivitis
*[[Irritant Conjunctivitis]]
*#Smog
*#[[Smog]]
*#Chlorinated pool
*#[[Chlorinated pool]]
*Bacterial Conjunctivitis
*[[Bacterial Conjunctivitis]]


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==


*Early clinical features include,  tearing, discharge, itching, pain, foreign body sensation, photophobia, and vision changes.
*Early [[clinical features]] include,  [[tearing]], [[discharge]], [[itching]], [[pain]], [[foreign body]] [[sensation]], [[photophobia]], and [[vision changes]].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [[red eye]] include  severe [[pain]], visual loss, marked pain or decreased vision with the use of [[contact lenses]], [[trauma]], [[chemical injury]] and recent eye surgery. On examination, signs for concern include decreased visual acuity, [[pupil irregularity]], [[sluggish pupillary]] reaction to light, [[corneal opacification]], [[hyphema]] or [[hypopyon]], and elevated [[Intraocular pressure (IOP)|intraocular pressure]].Be especially alert when a patient has unilateral [[redness]]. Patients with red-flag [[symptoms]] or [[signs]] require immediate referral to an [[ophthalmologist]]<ref name="pmid18249256">Mahmood AR, Narang AT (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18249256 Diagnosis and management of the acute red eye.] ''Emerg Med Clin North Am'' 26 (1):35-55, vi. [http://dx.doi.org/10.1016/j.emc.2007.10.002 DOI:10.1016/j.emc.2007.10.002] PMID: [https://pubmed.gov/PMID: 18249256  DOI: 10.1016/j.emc.2007.10.002 PMID: 18249256  DOI: 10.1016/j.emc.2007.10.002]</ref><ref name="pmid165647692">Wirbelauer C (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16564769 Management of the red eye for the primary care physician.] ''Am J Med'' 119 (4):302-6. [http://dx.doi.org/10.1016/j.amjmed.2005.07.065 DOI:10.1016/j.amjmed.2005.07.065] PMID: [https://pubmed.gov/PMID: 16564769  DOI: 10.1016/j.amjmed.2005.07.065 PMID: 16564769  DOI: 10.1016/j.amjmed.2005.07.065]</ref>.
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*[[Prognosis]] is generally excellent and the cure within days unless causes assisted with [[systemic]] illnesses.
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===


*The diagnosis of red eye in children is made when detailed patient history and careful eye examination are token<ref name="pmid185069713">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>. at least [one] of the following [six] diagnostic criteria are met
*The [[diagnosis]] of [[red eye]] in children is made when detailed [[patient history]] and careful [[Eye examinations|eye examination]] are token<ref name="pmid185069713">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>. at least [one] of the following [six] [[diagnostic criteria]] are met


*reduced visual acuity
*Reduced [[visual acuity]]
*ciliary flush (circumcorneal injection)
*[[ciliary flush]] ([[circumcorneal injection]])
*corneal abnormalities including edema or opacities ("corneal haze")
*[[corneal]] abnormalities including [[edema]] or [[opacities]] ("corneal haze")
*corneal staining
*Corneal staining
*abnormal pupil size
*Abnormal [[pupil]] size
*abnormal intraocular pressure
*Abnormal [[Intraocular pressure (IOP)|intraocular pressure]]


===Symptoms===
===Symptoms===


*Red eye is usually asymptomatic.
*[[Red eye]] is usually asymptomatic.
*Symptoms of red eye may include the following:<ref name="pmid200825092">Cronau H, Kankanala RR, Mauger T (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20082509 Diagnosis and management of red eye in primary care.] ''Am Fam Physician'' 81 (2):137-44. PMID: [https://pubmed.gov/PMID: 20082509 PMID: 20082509]</ref>
*Symptoms of [[red eye]] may include the following:<ref name="pmid200825092">Cronau H, Kankanala RR, Mauger T (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20082509 Diagnosis and management of red eye in primary care.] ''Am Fam Physician'' 81 (2):137-44. PMID: [https://pubmed.gov/PMID: 20082509 PMID: 20082509]</ref>


:*eye discharge
:*Eye [[discharge]]
:*pain
:*[[pain]]
:*photophobia
:*[[photophobia]]
:*itching
:*[[itching]]
:*visual changes and redness
:*Visual changes and [[redness]]
   
   
===Physical Examination===
===Physical Examination===


*Patients with red eye in children usually appear with only red eye .
*Patients with [[red eye]] in children usually appear with only [[red eye]] .
*Physical examination may be remarkable for:<ref name="urlRed Eye in Children2">{{cite web |url=https://fpnotebook.com/eye/sx/RdEyInChldrn.htm |title=Red Eye in Children |format= |work= |accessdate=}}</ref>
*[[Physical examination]] may be remarkable for:<ref name="urlRed Eye in Children2">{{cite web |url=https://fpnotebook.com/eye/sx/RdEyInChldrn.htm |title=Red Eye in Children |format= |work= |accessdate=}}</ref>


:*#Redness of entire Eyelid or swollen Eyelid
:*#[[Redness]] of entire [[Eyelids|Eyelid]] or [[Swelling|swollen]] Eyelid
:*##Assess for Periorbital Cellulitis
:*##Assess for [[Periorbital cellulitis|Periorbital]] [[Cellulitis]]
:*##Assess for acute Ethmoiditis
:*##Assess for acute [[Ethmoiditis]]
:*#Associated Eye Pain or constant eye tearing, blinking
:*#Associated Eye [[Pain]] or constant eye [[tearing]], [[blinking]]
:*##Assess for Corneal Ulcer
:*##Assess for [[Corneal]] [[Ulcer]]
:*##Assess for Herpes Simplex VirusKeratitis
:*##Assess for [[Herpes simplex|Herpes Simplex]] [[VirusKeratitis]]
:*##Assess for Eye Foreign Body
:*##Assess for Eye Foreign Body
:*#Blurred Vision
:*#[[Blurred vision|Blurred]] Vision
:*##Assess for Uveitis
:*##Assess for [[Uveitis]]


===Laboratory Findings===
===Laboratory Findings===


*There are no specific laboratory findings associated with red eye in children.
*There are no specific [[Laboratory findings template|laboratory findings]] associated [[red eye]] in children like in [[viral conjunctivitis]], unless the causes associated with [[Bacterial conjunctivitis]]
*An [elevated] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of red eye in children.
*An elevated concentration of serum [[CRP]] or [[WBC]] is diagnostic of [[Bacterial Conjunctivitis]] in  [[red eye]] in children.
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
*Other [[Laboratory findings template|laboratory findings]] consistent with the diagnosis of [[red eye]] in children include a systemic symptom if related to systemic illness like Rheumatic arthritis.


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no [[ECG]] findings associated with red eye in children.


OR
<br />
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
There are no x-ray findings associated with red eye in children. However, an [[x-ray]] may be helpful in the [[diagnosis]] of [[complications]] of traumatic [[red eye]], which include a plain [[skull X-ray]] is performed to exclude [[cranial]] and [[facial]] [[fractures]] and will visualize [[radio-opaque]] [[foreign bodies]] FBs<ref name="urlThe injured eye">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013431/ |title=The injured eye |format= |work= |accessdate=}}</ref>.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
There are no [[echocardiography]] findings associated with [[red eye]] in children accept in some diseases like [[conjunctivitis]] in [[Kawasaki syndrome]]. However, an [[ultrasound]] may be helpful in the [[diagnosis]] of [[complications]] of [[emergency]] [[red eye]].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
There are no [[CT-scans|CT]] scan findings associated with [[red eye]] in children. However, a [[CT scans]] are the test of choice for [[Orbit (anatomy)|orbital]] and IOFB localization in traumatic [[red eye]]. A [[CT scan]] will often diagnose other unsuspected cranial and facial injuries <ref name="urlThe injured eye">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013431/ |title=The injured eye |format= |work= |accessdate=}}</ref><ref name="pmid10599667">{{cite journal |vauthors=Lakits A, Prokesch R, Scholda C, Bankier A, Schmoldt A, Benthe HF, Haberland G, Tarentino AL, Maley F, Pesce MA, Bodourian SH, Nicholson JF, Hasan FM, Kazemi H, Gehler J, Cantz M, O'Brien JF, Tolksdorf M, Spranger J, Weatherall DJ, Hendrickson WA, Ward KB |title=Orbital helical computed tomography in the diagnosis and management of eye trauma |journal=Ophthalmology |volume=106 |issue=12 |pages=2330–5 |date=December 1999 |pmid=10599667 |pmc=1596154 |doi=10.1016/S0161-6420(99)90536-5 |url=}}</ref>.
 
OR


[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
. [[Computed tomography imaging]] of the [[orbits]] should be performed if a high-velocity [[Penetrating wound|penetrating]] injury is suspected. If acute [[glaucoma]] is suspected, [[Intraocular pressure (IOP)|intraocular      pressure]] should be measured in the [[Emergency department|emergency departmen]]<nowiki/>t.<ref name="urlEvaluation of red eye - Diagnosis Approach | BMJ Best Practice US">{{cite web |url=https://bestpractice.bmj.com/topics/en-us/496/diagnosis-approach#referencePop19 |title=Evaluation of red eye - Diagnosis Approach &#124; BMJ Best Practice US |format= |work= |accessdate=}}</ref>
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
There are no [[MRI]] findings associated with [[red eye]] in children. However, a [[MRI]] may be helpful in the [[diagnosis]] of [[complications]] of traumatic [[red eye]]. The on-call [[ophthalmologist]] must be proficient at [[ocular]] [[ultrasound]], as it is an indispensible tool for the [[diagnosis]] and triage of [[ophthalmic]] [[emergencies]]<ref name="urlOcular Ultrasound: A Quick Reference Guide for the On-Call Physician">{{cite web |url=https://eyerounds.org/tutorials/ultrasound/index.htm |title=Ocular Ultrasound: A Quick Reference Guide for the On-Call Physician |format= |work= |accessdate=}}</ref>.
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
New diagnostic instruments for imaging the [[anterior segment of the eye]] have been developed using the [[corneal topographer]] as optical coherence tomography ([[OCT]]) may be helpful in the [[diagnosis]] of red eye. Findings on an [[OCT]] suggestive of/[[diagnostic]] of [[keratoconus]] or [[pellucid marginal corneal]] degeneration  include [[epithelial edema]]  in the [[epithelial]] layer and [[stromal]] layer associated with [[Intraocular pressure (IOP)|intraocular pressure]] elevation<ref name="pmid21476312">Maeda N (2011) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21476312 [New diagnostic methods for imaging the anterior segment of the eye to enable treatment modalities selection].] ''Nippon Ganka Gakkai Zasshi'' 115 (3):297-322; discussion 323. PMID: [https://pubmed.gov/PMID: 21476312 PMID: 21476312]</ref>.
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
<br />


*[Disease name] may also be diagnosed using [diagnostic study name].
*[[Red eye]] may also be [[diagnosed]] using [[color-Doppler imaging echography]] of dural [[carotid-cavernous fistula]] of [[ophthalmological]] manifestation<ref name="pmid1602104">Soulier-Sotto V, Beaufrere L, Laroche JP, Dauzat M, Bourbotte G, Bourgeois JM | display-authors=etal (1992) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1602104 [Diagnosis by Doppler color echography of dural carotid-cavernous fistula of ophthalmological manifestation].] ''J Fr Ophtalmol'' 15 (1):38-42. PMID: [https://pubmed.gov/PMID: 1602104 PMID: 1602104]</ref>.
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
*Findings on include [[color-Doppler imaging]] echography  flow reversal with a [[systolic]] component in the superior and inferior enlarged [[ophthalmic veins]] and [[Embolization]].


==Treatment==
==Treatment==
treatment is based on the underlying etiology, and Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections<ref name="pmid185069714">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>. clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.<ref name="pmid16564769">Wirbelauer C (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16564769 Management of the red eye for the primary care physician.] ''Am J Med'' 119 (4):302-6. [http://dx.doi.org/10.1016/j.amjmed.2005.07.065 DOI:10.1016/j.amjmed.2005.07.065] PMID: [https://pubmed.gov/PMID: 16564769 DOI: 10.1016/j.amjmed.2005.07.065 PMID: 16564769 DOI: 10.1016/j.amjmed.2005.07.065]</ref>
[[treatment]] is based on the underlying etiology, and Recognizing the need for emergent referral to an [[ophthalmologist]] is key in the [[primary care]] management of [[red eye]]. Referral is necessary when [[severe pain]] is not relieved with [[topical anesthetics]]; [[topical steroids]] are needed; or the patient has vision loss, copious purulent discharge, [[corneal]] involvement, traumatic [[Eye injury causes|eye injury]], recent [[ocular surgery]], [[distorted pupil]], [[herpes infection]], or [[recurrent infections]]<ref name="pmid185069714">Sauer A, Speeg-Schatz C, Bourcier T (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18506971 [Red eye in children].] ''Rev Prat'' 58 (4):353-7. PMID: [https://pubmed.gov/PMID: 18506971 PMID: 18506971]</ref>. Clinical signs that require an urgent [[ophthalmic]] consultation are [[chemical burns]], [[intraocular infections]], [[globe ruptures]] or [[perforations]], and [[acute glaucoma]].<ref name="pmid16564769">Wirbelauer C (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16564769 Management of the red eye for the primary care physician.] ''Am J Med'' 119 (4):302-6. [http://dx.doi.org/10.1016/j.amjmed.2005.07.065 DOI:10.1016/j.amjmed.2005.07.065] PMID: [https://pubmed.gov/PMID: 16564769 DOI: 10.1016/j.amjmed.2005.07.065 PMID: 16564769 DOI: 10.1016/j.amjmed.2005.07.065]</ref>


===Medical Therapy===
===Medical Therapy===


*The mainstay of therapy for red eye in children is good hygiene, such as meticulous hand washing, is important in decreasing the spread of acute viral conjunctivitis<ref name="pmid102">Schmoldt A, Benthe HF, Haberland G (1975) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10 Digitoxin metabolism by rat liver microsomes.] ''Biochem Pharmacol'' 24 (17):1639-41. PMID: [https://pubmed.gov/doi:10.1111/j.1600-0420.2007.01006.x. PMID 1797082 doi:10.1111/j.1600-0420.2007.01006.x. PMID 1797082]</ref><ref name="pmid103">Schmoldt A, Benthe HF, Haberland G (1975) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10 Digitoxin metabolism by rat liver microsomes.] ''Biochem Pharmacol'' 24 (17):1639-41. PMID: [https://pubmed.gov/doi:10.1056/NEJM200008033430507. PMID 10922425 PM doi:10.1056/NEJM200008033430507. PMID 10922425 PM]</ref>.  and Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates<ref name="pmidPMID: 2540136">{{cite journal| author=| title=Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis--a review of four clinical studies. The Trimethoprim-Polymyxin B Sulphate Ophthalmic Ointment Study Group. | journal=J Antimicrob Chemother | year= 1989 | volume= 23 | issue= 2 | pages= 261-6 | pmid=PMID: 2540136 | doi=10.1093/jac/23.2.261 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2540136  }}</ref> <ref name="pmidPMID: 17652708">{{cite journal| author=Protzko E, Bowman L, Abelson M, Shapiro A, AzaSite Clinical Study Group| title=Phase 3 safety comparisons for 1.0% azithromycin in polymeric mucoadhesive eye drops versus 0.3% tobramycin eye drops for bacterial conjunctivitis. | journal=Invest Ophthalmol Vis Sci | year= 2007 | volume= 48 | issue= 8 | pages= 3425-9 | pmid=PMID: 17652708 | doi=10.1167/iovs.06-1413 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652708  }}</ref>.
*The mainstay of therapy for [[red eye]] in children is good [[hygiene]], such as meticulous hand washing, is important in decreasing the spread of acute [[viral conjunctivitis]]<ref name="pmid102">Schmoldt A, Benthe HF, Haberland G (1975) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10 Digitoxin metabolism by rat liver microsomes.] ''Biochem Pharmacol'' 24 (17):1639-41. PMID: [https://pubmed.gov/doi:10.1111/j.1600-0420.2007.01006.x. PMID 1797082 doi:10.1111/j.1600-0420.2007.01006.x. PMID 1797082]</ref><ref name="pmid103">Schmoldt A, Benthe HF, Haberland G (1975) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10 Digitoxin metabolism by rat liver microsomes.] ''Biochem Pharmacol'' 24 (17):1639-41. PMID: [https://pubmed.gov/doi:10.1056/NEJM200008033430507. PMID 10922425 PM doi:10.1056/NEJM200008033430507. PMID 10922425 PM]</ref>.  and Any ophthalmic antibiotic may be considered for the [[treatment]] of acute [[bacterial conjunctivitis]] because they have similar cure rates<ref name="pmidPMID: 2540136">{{cite journal| author=| title=Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis--a review of four clinical studies. The Trimethoprim-Polymyxin B Sulphate Ophthalmic Ointment Study Group. | journal=J Antimicrob Chemother | year= 1989 | volume= 23 | issue= 2 | pages= 261-6 | pmid=PMID: 2540136 | doi=10.1093/jac/23.2.261 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2540136  }}</ref> <ref name="pmidPMID: 17652708">{{cite journal| author=Protzko E, Bowman L, Abelson M, Shapiro A, AzaSite Clinical Study Group| title=Phase 3 safety comparisons for 1.0% azithromycin in polymeric mucoadhesive eye drops versus 0.3% tobramycin eye drops for bacterial conjunctivitis. | journal=Invest Ophthalmol Vis Sci | year= 2007 | volume= 48 | issue= 8 | pages= 3425-9 | pmid=PMID: 17652708 | doi=10.1167/iovs.06-1413 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652708  }}</ref>.
*Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective second-generation topical histamine H1 receptor antagonist<ref name="pmidPMID: 30366797">{{cite journal| author=Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ | display-authors=etal| title=Conjunctivitis Preferred Practice Pattern®. | journal=Ophthalmology | year= 2019 | volume= 126 | issue= 1 | pages= P94-P169 | pmid=PMID: 30366797 | doi=10.1016/j.ophtha.2018.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30366797  }}</ref>
*Mild [[allergic conjunctivitis]] may be treated with an over-the-counter [[antihistamine]]/[[vasoconstrictor]] agent, or with a more effective [[second-generation topical histamine]] H1 receptor antagonist<ref name="pmidPMID: 30366797">{{cite journal| author=Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ | display-authors=etal| title=Conjunctivitis Preferred Practice Pattern®. | journal=Ophthalmology | year= 2019 | volume= 126 | issue= 1 | pages= P94-P169 | pmid=PMID: 30366797 | doi=10.1016/j.ophtha.2018.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30366797  }}</ref>
*Anti-inflammatory agents (e.g., topical cyclosporine [Restasis]), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye<ref name="pmidPMID: 303667982">{{cite journal| author=Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK | display-authors=etal| title=Dry Eye Syndrome Preferred Practice Pattern®. | journal=Ophthalmology | year= 2019 | volume= 126 | issue= 1 | pages= P286-P334 | pmid=PMID: 30366798 | doi=10.1016/j.ophtha.2018.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30366798  }}</ref>.
*[[Anti-inflammatory medication|Anti-inflammatory]] agents (e.g., topical [[Cyclosporine (ophthalmic)|cyclosporine]] [<nowiki/>[[Restasis]]]), topical [[corticosteroids]], and systemic [[omega-3 fatty acids]] are appropriate therapies for moderate [[dry eye]]<ref name="pmidPMID: 303667982">{{cite journal| author=Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK | display-authors=etal| title=Dry Eye Syndrome Preferred Practice Pattern®. | journal=Ophthalmology | year= 2019 | volume= 126 | issue= 1 | pages= P286-P334 | pmid=PMID: 30366798 | doi=10.1016/j.ophtha.2018.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30366798  }}</ref>.
*Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline. If the cornea is involved, refer to an eye centre where the baby will be treated with intensive antibiotic eye drops and, sometimes, systemic antibiotics.
*Patients with [[chronic blepharitis]] who do not respond adequately to [[Eyelids|eyelid]] [[hygiene]] and topical [[antibiotics]] may benefit from an oral [[Tetracycline (oral)|tetracycline]] or [[Doxycycline (oral)|doxycycline]]. If the [[cornea]] is involved, refer to an eye centre where the baby will be treated with intensive [[antibiotic]] [[eye drops]] and, sometimes, [[systemic antibiotics]].
   
   
===Surgery===
===Surgery===


*Surgical procedure can only be performed for patients with emergency case of  red eye like  intraocular infections, globe ruptures or perforations, and acute glaucoma or traumatic eye injury.
*Surgical procedure can only be performed for patients with [[emergency]] case of  red eye like  [[intraocular infections]], [[globe ruptures]] or [[perforations]], and [[acute glaucoma]] or traumatic [[eye injury]].
   
   
===Prevention===
===Prevention===
Practice good hygiene to control the spread of red eye. For instance:
Practice good [[hygiene]] to control the spread of red eye. For instance:<ref name="urlRed eyes: Causes, Symptoms, Diagnosis, and Treatment – Medlife">{{cite web |url=https://www.medlife.com/web/red-eyes-causes-symptoms-diagnosis-treatment/ |title=Red eyes: Causes, Symptoms, Diagnosis, and Treatment – Medlife |format= |work= |accessdate=}}</ref>


*Don't touch your eyes with your hands.
*Don't touch your [[eyes]] with your [[hands]].
*Wash your hands often.
*Wash your [[hands]] often.
*Use a clean towel and washcloth daily.
*Use a clean towel and washcloth daily.
*Don't share towels or washcloths.
*Don't share towels or washcloths.
*Change your pillowcases often.
*Change your pillowcases often.
*Throw away your eye cosmetics, such as mascara.
*Throw away your [[eye cosmetics]], such as mascara.
*Don't share eye cosmetics or personal eye care items.
*Don't share eye [[cosmetics]] or personal eye care items.


Keep in mind that red eye is no more contagious than the common cold. It's okay to return to work, school or child care if you're not able to take time off — just stay consistent in practicing good hygiene.
Keep in mind that [[red eye]] is no more [[contagious]] than the common cold. It's okay to return to work, school or child care if you're not able to take time off — just stay consistent in practicing good [[hygiene]].


===Preventing red eye in newborns===
===Preventing red eye in newborns===
Newborns' eyes are susceptible to bacteria normally present in the mother's birth canal. These bacteria cause no symptoms in the mother. In rare cases, these bacteria can cause infants to develop a serious form of conjunctivitis known as ophthalmia neonatorum, which needs treatment without delay to preserve sight. That's why shortly after birth all babies should have their eyes cleaned immediately, then an antibiotic ointment like tetracycline is applied to every newborn's eyes. The ointment helps prevent eye infection. During antenatal care, all mothers with vaginal infections should be treated. Educate traditional birth attendants, community health workers, and both parents as this is often a sexually transmitted disease.<ref name="urlwww.cehjournal.org">{{cite web |url=https://www.cehjournal.org/wp-content/uploads/red-eye-the-role-of-primary-care.pdf |title=www.cehjournal.org |format= |work= |accessdate=}}</ref>
Newborns' eyes are susceptible to [[bacteria]] normally present in the mother's [[birth canal]]. These [[bacteria]] cause no [[symptoms]] in the mother. In rare cases, these [[bacteria]] can cause [[infants]] to develop a serious form of [[conjunctivitis]] known as [[Ophthalmia neonatorum|ophthalmia]] [[neonatorum]], which needs treatment without delay to preserve sight. That's why shortly after birth all babies should have their eyes cleaned immediately, then an [[antibiotic]] [[ointment]] like [[tetracycline]] is applied to every [[newborn's]] eyes. The [[ointment]] helps prevent eye [[infection]]. During [[antenatal]] care, all mothers with [[vaginal]] [[infections]] should be treated. Educate traditional birth attendants, community health workers, and both parents as this is often a [[Sexually transmitted disease|sexually transmitted]] disease.<ref name="urlwww.cehjournal.org">{{cite web |url=https://www.cehjournal.org/wp-content/uploads/red-eye-the-role-of-primary-care.pdf |title=www.cehjournal.org |format= |work= |accessdate=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
   
   
[[Category:Pick One of 28 Approved]]
[[Category:Pediatrics]]
 
[[Category:Primary care]]
{{WS}}
{{WH}}

Latest revision as of 21:14, 24 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Synonyms and keywords: Red eye in kids, Conjunctivitis, outbreak-epidemic-symptoms.

Overview

Red eye in children is a common consultation purpose. Mostly benign, this sign may also cause visual impairment. We differentiate three kinds of red eye: localised, diffused and perikeratic injection. The last one must be recognized because of its association with severe ocular diseases. Diagnosis must be sure and treatment has to be efficient to not pertubate childrens visual development. Unfortunately, physical examination on children is not always easy. Consultation with an ophthalmologist is justified if a doubt remains, in case of chronic pathology or resistance to first intention treatment. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications rare.

Historical Perspective

  • Can not find any historical perspective in Red eye in children.

Classification

  • Red eye may be classified according to classification method into three subtypes/groups:[1]

Pathophysiology

Causes

Common causes of Red Eye in Children[3]

Common causes of Red Eye in Children

Life Threatening Causes

Life-threatening causes include conditions that could lead to death or permanent disability within 24 hours if left untreated.

Differentiating Red eye from other Diseases

Red eye is diffrentiated from many disease, the most common is conjunctivitis . Others include: Bacterial conjunctivitis, Viral conjunctivitis, Allergic conjunctivitis,Chemical conjunctivitis, Foreign body, Blepharitis, Hordeola , Keratitis, Endophthalmitis , Dacrocystitis, Anterior uveitis (iridocyclitis) :associated with juvenile RA, Behcet diease and IBS; Sudden onset pain, photophobia, blurred vision, irregular pupil, poor vision, Posterior uveitis (choroiditis) and Scleritis/Episcleritis[4] [5]

[6][7][8]



Differential diagnosis of red eye with no injury

CONJUNCTIVITIS CORNEAL ULCER ACUTE IRITIS ACUTE GLAUCOMA
Eye Usually both eyes Usually one eye Usually one eye Usually one eye
Vision Normal Usually decreased Often decreased Marked decrease
Eye pain Normal or gritty Usually painful Moderate pain, light sensitive Severe pain (headache and nausea)
Discharge Sticky or watery May be sticky Watering Watering
Conjunctiva Generalised (variable) redness Redness most marked around the cornea Redness most marked around the cornea Generalised marked redness
Cornea Normal Grey, white spot (fluorescein staining) Usually clear, (keratitic precipitates may be visible with magnification) Hazy (due to fluid in the cornea)
Anterior chamber (AC) Normal Usually normal (occasionally hypopyon) Cells will be visible with magnification Shallow or flat
Pupil size Normal and round Normal and round Small and irregular Dilated
Pupil response to light Active Active Minimal reaction as already small Minimal or no reaction
Intraocular pressure (IOP) Normal (but do not attempt to measure IOP) Normal (but do not attempt to measure IOP) Normal Raised
Useful diagnostic sign/test Pussy discharge in both eyes Fluorescein staining of the cornea Irregular pupil as it dilates with drops Raised IOP

Epidemiology and Demographics

Age

  • Patients of all age groups may develop red eye.

Gender

Race

  • There is no racial predilection for red eye in children.

Risk Factors

Common risk factors in the development of red eye in children are [11][12]

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with red eye in children.


X-ray

There are no x-ray findings associated with red eye in children. However, an x-ray may be helpful in the diagnosis of complications of traumatic red eye, which include a plain skull X-ray is performed to exclude cranial and facial fractures and will visualize radio-opaque foreign bodies FBs[18].

Echocardiography or Ultrasound

There are no echocardiography findings associated with red eye in children accept in some diseases like conjunctivitis in Kawasaki syndrome. However, an ultrasound may be helpful in the diagnosis of complications of emergency red eye.

CT scan

There are no CT scan findings associated with red eye in children. However, a CT scans are the test of choice for orbital and IOFB localization in traumatic red eye. A CT scan will often diagnose other unsuspected cranial and facial injuries [18][19].

. Computed tomography imaging of the orbits should be performed if a high-velocity penetrating injury is suspected. If acute glaucoma is suspected, intraocular pressure should be measured in the emergency department.[20]

MRI

There are no MRI findings associated with red eye in children. However, a MRI may be helpful in the diagnosis of complications of traumatic red eye. The on-call ophthalmologist must be proficient at ocular ultrasound, as it is an indispensible tool for the diagnosis and triage of ophthalmic emergencies[21].

Other Imaging Findings

New diagnostic instruments for imaging the anterior segment of the eye have been developed using the corneal topographer as optical coherence tomography (OCT) may be helpful in the diagnosis of red eye. Findings on an OCT suggestive of/diagnostic of keratoconus or pellucid marginal corneal degeneration include epithelial edema in the epithelial layer and stromal layer associated with intraocular pressure elevation[22].

Other Diagnostic Studies


Treatment

treatment is based on the underlying etiology, and Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections[24]. Clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.[25]

Medical Therapy

Surgery

Prevention

Practice good hygiene to control the spread of red eye. For instance:[32]

  • Don't touch your eyes with your hands.
  • Wash your hands often.
  • Use a clean towel and washcloth daily.
  • Don't share towels or washcloths.
  • Change your pillowcases often.
  • Throw away your eye cosmetics, such as mascara.
  • Don't share eye cosmetics or personal eye care items.

Keep in mind that red eye is no more contagious than the common cold. It's okay to return to work, school or child care if you're not able to take time off — just stay consistent in practicing good hygiene.

Preventing red eye in newborns

Newborns' eyes are susceptible to bacteria normally present in the mother's birth canal. These bacteria cause no symptoms in the mother. In rare cases, these bacteria can cause infants to develop a serious form of conjunctivitis known as ophthalmia neonatorum, which needs treatment without delay to preserve sight. That's why shortly after birth all babies should have their eyes cleaned immediately, then an antibiotic ointment like tetracycline is applied to every newborn's eyes. The ointment helps prevent eye infection. During antenatal care, all mothers with vaginal infections should be treated. Educate traditional birth attendants, community health workers, and both parents as this is often a sexually transmitted disease.[6]

References

  1. Sauer A, Speeg-Schatz C, Bourcier T (2008) [Red eye in children.] Rev Prat 58 (4):353-7. PMID: 18506971 PMID: 18506971
  2. Hunt A (1983). "Tuberous sclerosis: a survey of 97 cases. II: Physical findings". Dev Med Child Neurol. 25 (3): 350–2. doi:10.1111/j.1469-8749.1983.tb13770.x. PMID DOI: 10.1186/s12879-019-4612-0 6873498 DOI: 10.1186/s12879-019-4612-0 Check |pmid= value (help).
  3. "Red Eye - American Academy of Ophthalmology".
  4. Baba I (2005) The red eye - first aid at the primary level. Community Eye Health 18 (53):70-2. PMID: 17491745 PMID: 17491745
  5. "www.textbooks.com".
  6. 6.0 6.1 "www.cehjournal.org" (PDF).
  7. Dart JK (1986). "Eye disease at a community health centre". Br Med J (Clin Res Ed). 293 (6560): 1477–80. doi:10.1136/bmj.293.6560.1477. PMC 1342247. PMID 3099921.
  8. Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  9. Van de Velde FJ (2006) The relaxed confocal scanning laser ophthalmoscope. Bull Soc Belge Ophtalmol (302):25-35. PMID: 17265788 PMID: 17265788
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