Red eye resident survival guide: Difference between revisions

Jump to navigation Jump to search
Line 92: Line 92:
{{familytree | | | | | |!| | | | | | |!| | | | | | |!| | | | | |!| | |}}
{{familytree | | | | | |!| | | | | | |!| | | | | | |!| | | | | |!| | |}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | D01 | | | | | D02 | | | | | D03 | | | | D04 | | | D01= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | D01 | | | | | D02 | | | | | D03 | | | | D04 | | | D01= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':
<br>❑ Pain <br> If has tired eyes, burning or itching: [[keratoconjunctivitis]]<br>❑ No pain <br>[[Lid retraction]] <br>[[Exophthalmos]] <br>[[Diplopia]] <br>[[Endocrine orbitopathy]]</div> | D02= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':<br>❑ Pain <br>Lid malposition: <br>[[Entropion]] <br>[[Ectropion]] <br>[[Trichiasis]]<br>❑ No pain <br>[[Lagophthalmos]]</div> | D03= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':<br>❑ Pain <br>[[Photokeratitis]]<br>❑ No pain <br>[[Chemosis]] <br>Seasonal <br>Allergen <br>Allergic [[conjunctivitis]]</div> | D04= <div style="float: left; text-align: center; width: 16em; padding:1em;"> '''Consider the following''':<br>❑ Pain <br> Suspicion of: <br>[[Foreign body]] <br>[[Perforation]] <br>Acute angel closure [[glaucoma]]<br>❑ No pain <br>[[Subconjunctival hemorrhage]]</div>}}
<br>❑ [[Pain]] <br> If has tired eyes, [[burning]] or [[itching]]: [[keratoconjunctivitis]]<br>❑ No [[pain]] <br>[[Lid retraction]] <br>[[Exophthalmos]] <br>[[Diplopia]] <br>[[Endocrine orbitopathy]]</div> | D02= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':<br>❑ [[Pain]] <br>Lid malposition: <br>[[Entropion]] <br>[[Ectropion]] <br>[[Trichiasis]]<br>❑ No pain <br>[[Lagophthalmos]]</div> | D03= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''Consider the following''':<br>❑ [[Pain]] <br>[[Photokeratitis]]<br>❑ No [[pain]] <br>[[Chemosis]] <br>Seasonal <br>Allergen <br>[[Allergic]] [[conjunctivitis]]</div> | D04= <div style="float: left; text-align: center; width: 16em; padding:1em;"> '''Consider the following''':<br>❑ [[Pain]] <br> Suspicion of: <br>[[Foreign body]] <br>[[Perforation]] <br>Acute angel closure [[glaucoma]]<br>❑ No [[pain]] <br>[[Subconjunctival hemorrhage]]</div>}}


{{familytree/end}}
{{familytree/end}}

Revision as of 17:15, 17 August 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Synonyms and keywords: An approach to red eye, Red eye diagnostic approach, Red eye workup algorithm

Overview

Red eye is an essential sign of eye inflammation. Although it is usually benign and can be managed by primary care physician, It is important to distinguish between benign and sight-threatening diagnoses. Its most common cause is conjunctivitis. However, the other common causes are subconjunctival hemorrhage, blepharitis, scleritis, corneal abrasion, glaucoma and foreign body. Red eye can be concomitant with photophobia, eye discharge, pain, itiching and visual changes.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[1]

Common Causes

Diagnosis

In the assessment of a patient with red eye, taking a precise history and examination and identifying red flags is essential.
Red flags include:


Taking history includes:


Examination includes:

Mild to Severe

[3][2]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild or no pain with mild blurring or normal vision
 
 
 
 
 
 
 
Moderate to severe pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Local
 
Diffuse
 
 
 
 
 
Vesicular rash, Corneal ulcer, Iritis, Acute angle gluacoma, Chemical burn, Traumatic eye injury
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discharge
 
 
 
 
 
Emergency Ophthalmology referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intermittent
 
 
 
Continuous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dry eye
 
Watery or Serous
 
 
Mucopurulent to Purulent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Itching
 
Clamydial Conjunctivitis
 
Acute bacterial conjunctivitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild to non
 
 
 
Moderate to severe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral Conjunctivitis
 
 
 
Allergic Conjunctivitis
 
 
 
 

Acute or Chronic

[4]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic
 
 
 
 
 
 
 
 
 
 
 
Acute
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unilateral
 
 
 
 
 
 
 
Unilateral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider the following:
Pain
If has tired eyes, burning or itching: keratoconjunctivitis
❑ No pain
Lid retraction
Exophthalmos
Diplopia
Endocrine orbitopathy
 
 
 
 
Consider the following:
Pain
Lid malposition:
Entropion
Ectropion
Trichiasis
❑ No pain
Lagophthalmos
 
 
 
 
Consider the following:
Pain
Photokeratitis
❑ No pain
Chemosis
Seasonal
Allergen
Allergic conjunctivitis
 
 
 
Consider the following:
Pain
Suspicion of:
Foreign body
Perforation
Acute angel closure glaucoma
❑ No pain
Subconjunctival hemorrhage
 
 

Treatment

The management of the red eye will depend on the underlying cause.

Life-threatening causes

Acute angle closure glaucoma Endophthalmitis Necrotizing Scleritis Herpetic keratitis Chemical injury

[6]


Anterior uveitis Subconjunctival hemorrhage Neonatal conjunctivitis Corneal ulcer
  • Topical corticosteroids[10]
    • The most common is prednisolone acetate 1%
    • dexamethasone 0.1%
    • prednisolone sodium phosphate 1%

Gonococcal conjunctivitis[12]

Chlamydial conjunctivitis

Herpetic conjunctivitis

  • topical vidarabine or trifluridine for 10 days
  • Evaluate and treat for systemic herpes

Other causes

Foreign body Conjunctivits Blepharitis Scleritis
  • Bacterial
    • Topical antibiotic, corticosteroid
  • HSV
    • Topical ganciclovir or Oral acyclovir or valacyclovir if non-resolving
  • First line
  • Second line
    • Oral corticosteroids
      • Prescribed when oral NSAID treatment fails

Do's

  • Using artificial tears in patients with dry eye.
  • Protection against UV rays.
  • Observe hygiene protocols.

Don'ts

  • Avoid wearing contact lenses.
  • Avoid using sharp equipment especially in children.

References

  1. Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M (2017). "Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician". West J Emerg Med. 18 (3): 509–517. doi:10.5811/westjem.2016.12.31798. PMC 5391903. PMID 28435504.
  2. 2.0 2.1 Cronau H, Kankanala RR, Mauger T (2010). "Diagnosis and management of red eye in primary care". Am Fam Physician. 81 (2): 137–44. PMID 20082509.
  3. Noble J, Lloyd JC (2011). "The red eye". CMAJ. 183 (1): 81. doi:10.1503/cmaj.090379. PMC 3017259. PMID 20921253.
  4. Frings A, Geerling G, Schargus M (2017). "Red Eye: A Guide for Non-specialists". Dtsch Arztebl Int. 114 (17): 302–312. doi:10.3238/arztebl.2017.0302. PMC 5443986. PMID 28530180.
  5. Murray D (2018). "Emergency management: angle-closure glaucoma". Community Eye Health. 31 (103): 64. PMC 6253313. PMID 30487684.
  6. Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
  7. Novosad BD, Callegan MC (2010). "Severe bacterial endophthalmitis: towards improving clinical outcomes". Expert Rev Ophthalmol. 5 (5): 689–698. doi:10.1586/eop.10.52. PMC 3092298. PMID 21572565.
  8. Lawuyi LE, Gurbaxani A (2016). "Refractory necrotizing scleritis successfully treated with adalimumab". J Ophthalmic Inflamm Infect. 6 (1): 37. doi:10.1186/s12348-016-0107-y. PMC 5059540. PMID 27734292.
  9. Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD (2013). "Ocular chemical injuries and their management". Oman J Ophthalmol. 6 (2): 83–6. doi:10.4103/0974-620X.116624. PMC 3779420. PMID 24082664.
  10. Harthan JS, Opitz DL, Fromstein SR, Morettin CE (2016). "Diagnosis and treatment of anterior uveitis: optometric management". Clin Optom (Auckl). 8: 23–35. doi:10.2147/OPTO.S72079. PMC 6095364. PMID 30214346.
  11. Tarlan B, Kiratli H (2013). "Subconjunctival hemorrhage: risk factors and potential indicators". Clin Ophthalmol. 7: 1163–70. doi:10.2147/OPTH.S35062. PMC 3702240. PMID 23843690.
  12. Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N (2018). "Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis". J Pediatric Infect Dis Soc. 7 (3): e107–e115. doi:10.1093/jpids/piy060. PMC 6097578. PMID 30007329.
  13. Macedo Filho ET, Lago A, Duarte K, Liang SJ, Lima AL, Freitas Dd (2005). "Superficial corneal foreign body: laboratory and epidemiologic aspects". Arq Bras Oftalmol. 68 (6): 821–3. doi:10.1590/s0004-27492005000600019. PMID 17344985.
  14. Putnam CM (2016). "Diagnosis and management of blepharitis: an optometrist's perspective". Clin Optom (Auckl). 8: 71–78. doi:10.2147/OPTO.S84795. PMC 6095371. PMID 30214351.
  15. Wood M (1999). "Conjunctivitis: diagnosis and management". Community Eye Health. 12 (30): 19–20. PMC 1706007. PMID 17491982.