The Red Eye
Differential Diagnosis
Differential Diagnosis of “red eye”
Conjunctiva
Pupil Cornea
Anterior
chamber
IOP
Subconjunctival
Haemorrhage
Bright red
Normal Normal Normal
Normal
Conjunctivitis
Injected
vessels,
fornices.
Discharge
Normal Normal Normal
Normal
Iritis
Injected
around cornea
Small,
fixed,
irregular
Normal,
KPs
Turgid,
deep
Normal
Acute glaucoma
Entire eye red
Fixed,
dilated,
oval
Hazy
Shallow
High
Conjunctivitis
Follicles
Purulent discharge
Papillae
Chemosis
Redness
Subconjunctival Haemorrhage
• Diffuse or localised
area of blood under
conjunctiva.
Asymptomatic
• Idiopathic, trauma,
cough, sneezing,
aspirin, HT
• Resolves within 10-14
days
Dry Eye Syndrome
• Poor quality
– Meibomian gland disease,Acne rosacea
– Lid related
– Vitamin A deficiency
• Poor quantity
– KCS
• Sjogren Syndrome
• Rheumatoid Arthritis
– Lacrimal disease ie, Sarcoidosis
– Paralytic ie, VII CN palsy
Corneal Abrasion
• Surface epithelium sloughed off.
• Stains with fluorescein
• Usually due to trauma
• Pain, FB sensation, tearing, red eye
Corneal Ulcer
• Infection
– Bacterial: Adnexal infection, lid malposition,
dry eye, CL
– Viral: HSV, HZO
– Fungal:
– Protozoan: Acanthamoeba in CL wearer
• Mechanical or trauma
• Chemical: Alkali injuries are worse than acid
Episcleritis
• Superficial
• Idiopathic, collagen
vascular disorder (RA)
• Asymptomatic, mild
pain
• Self-limiting or topical
treatment
Scleritis
• Deep
• Idiopathic
• Collagen vascular disease (RA,AS, SLE,
Wegener, PAN)
• Zoster
• Sarcoidosis
• Dull, deep pain wakes patient at night
• Systemic treatment with NSAI or Prednisolone if
severe
Uveitis
Anterior: acute recurrent and chronic
Posterior: vitritis, retinal vasculitis, retinitis,
choroiditis
Panuveitis:anterior and posterior
Anterior uveitis (iritis)
• Photophobia, red eye, decreased vision
• Idiopathic. Commonest
• Associated to systemic disease
– Seronegative arthropathies:AS, IBD, Psoriatic
arthritis, Reiter’s
– Autoimmune: Sarcoidosis, Behcets
– Infection: Shingles, Toxoplasmosis, TB,
Syphillis, HIV
Ciliary flush
Posterior synechiae
KPs
Fibrin
Hypopyon
Flare
Acute Angle-closure Glaucoma
• Symptoms
– Pain, headache,
nausea-vomiting
– Redness, photophobia,
– Reduced vision
– Haloes around lights
Corneal oedema
Ciliary hyperaemia
Dilated pupil
