Red eyes (red eye) is a condition in which white part of eye i.e sclera has become reddened. It is due to multiple causes.
Causes of acute Red eyes
A. Subconjunctival haemorrhage
G. Acute angle closure glaucoma
Subconjunctival hemorrhage:- Seems as bright red eye, with minimal discomfort and with normal vision . It can affect one or both eyes as well.
Causes of Subconjunctival hemorrhage – Sneezing , coughing, minor injury , HTN, and rearly bleeding disorders eg clotting factors disorders etc . More common in person who receiving anticoagulant and antiplatelets medications.
Thus reassurance and treatment of underlying conditions is needed to get over this condition.
Conjunctivitis:- Inflammation of conjunctiva is know as conjunctivitis. Also called as “pink eye “.
Clinical features of Conjunctivitis:- grittiness , redness and discharge. Pain, burning, scratchiness, or itchiness ( allergic cause ) might happen.
Causes of Conjunctivitis :- chemical , infective , allergic or traumatic . In case of newborn babies this can be serious condition thus gonococcal and chlamydial infections should be well evaluated and should exclude them in right time.
Bacterial conjunctivitis is prulent , mostly self – limiting and is if needed then treatment is done with topical broad-spectrum antibiotics . Chlamydial and adenovirus infection can also leads conjunctivitis.
Viral conjunctivitis associated with an infection of the URTI , a common cold, or a sore throat. Presentation as an excessive watering and itching and usually begins in one eye initially , then goes easily to the other eye as well.
Adenovirus infection ( viral infection) most common , usually affect one eye with more severity and onset and leads much watery than sticky eye.
Allergic leads veneral conjunctivitis clinical presentation such as itchy eyes, usually worse in spring and early summer session and also associated with other allergic condition such as hay fever. Have a cobblestone appearance mostly on under the upper lid. Giant puppilay conjunctivitis seen in those who wear contact lens.
Inflammation of cornea is know as keratitis.This condition is usually can be moderate to intense pain and involves among the following clinical presentation such as pain, impaired eyesight, photophobia red eye and a ‘gritty’ sensation.
Classification of keratitis
1. On the basis of chronicity
• Nummul keratitis
• Acute epithelial keratitis
• Diciform keratitis
• Neurotrophic keratitis
• Mucus plaque keratitis
2. On the basis of infectious cause
Herpes simplex keratitis caused by herpes simplex virus that leaves dendritic ulcer . Herpes zoster keratitis that is associated with Herpes Zoster Opthalmicus from shingles.
Bacteria such as staphylococcus aureus and pseudomonas aeruginosa those who wear contact lens.
Aspergillus fumigatus and Candida albicans .
Those who wear contact lenses and is usually caused by Acanthemoeba .
O. volvulus cause parasitic keratitis.
3. On the basis of stage of disease
a. Superficial punctate keratitis
b. Ulcerative keratitis
4. On the basis of environmental ateology
Mostly due to UV radiation that can cause snow blindness or welders arc eye.
b. Exposure keratitis
It’s mainly due to dryness of the cornea that is mainly caused by incomplete or inadequate eyelid closure i.e lagophthalmos .
c. Contact lens acute red eye
Non-ulcerative sterile keratitis that is associated with colonization of Gram ( -ve) bacteria on contact lenses.
Inflammation of the uvea is called uveitis. t. The uvea consists of Iris , ciliary body and chroid. Uveitis can be anterior ( iritis) or rarely posterior.
In anterior uveitis , the pupil is small and or irregular that is due to formation of posterior synechiae. Pain , some visual loss , photophobia , headache, blurring of eye , redness of eye usually present.
In posterior uveitis , there is usually present as white eye and blurred vision . Usually chronic course that’s why granulomatous diseases, Reiter’s syndrome, Behcets disease , toxoplasmosis and CMV infection these should be excluded.
Treatment uveitis:- Topical systemic steroids and some how immunosuppressive drugs. It’s management should be done under supervision of opthalmologist.
Episcleritis and scleritis
Inflammation of episcleral tissue is known as episcleritis. Usually occurs as an idiopathic situation. Episcleritis is more common than scleritis.
Inflammation of sclera is know as scleritis. Scleritis is less common , more dangerous situation in which the deeper sclera is involved. Around 1/2 patient with scleritis have underlying systemic disorders such as rhematoid etc.
Systemic non steroidal anti inflammatory or steroids or immunomodulatory agents required .
Acute angle closure glaucoma
Mostly happens in older , often hypermetropia people .Mostly in Asian .Here cornea becomes hazy, pupil oval , dilated and non reacting , poor vision and feeling of hard in eyes .In severe case often present with vomitting and is confused with acute abdominal problems.
Red eyes Diagnosis
Tonometry ( intraocular measurement) and iridiocorneal angle examined by gonioscopy .
Red eye Treatment
Need urgent treatment in order to reduce intraocular pressure with pilocarpine eyedrops, oral acitazolamide and if refractory then manitol is used and followed by YAG laser iridotomy, laser iridoplasty , anterior chamber paracentesis. This condition is usually bilateral and for prophylactic second eye need to do iridotomy.
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