Red eye
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The document outlines the role of family physicians in assessing and treating red eye. It discusses differentiating urgent from non-urgent causes of red eye and provides details on examination techniques. Key parts of the examination include assessing vision, using a penlight to examine soft tissues, and evaluating the pupil, iris, cornea, sclera, conjunctiva and eyelids. Common conditions like conjunctivitis, keratitis and iritis are described. The document emphasizes that a thorough history and physical are important to identify potential emergencies like acute glaucoma that require prompt referral.
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Red eye
- 1. ROLE OF FAMILY PHYSICIAN CLINICAL SCHEME P R E PAR E D B Y : D R . AH M E D I B R AH I M E L D E S O U K Y AB O U E L E L A FAM I LY M E D I C I N E R E G I S T R AR M B B C H , M S C , M R C G P. I N T Red eye
- 2. Role of family physician Assessing whether Emergency action (including referral) is needed, or whether Treatment can be accomplished without additional resources
- 3. Usually urgent Acute glucoma Eye injury (destruction – hyphema) Keratitis (inflamed cornea) Iritis (inflamed iris) Scleritis (inflamed sclera) Episleritis
- 4. Usually cold Conjunctivitis Blepharitis Subconjunctival hemorrhage Inflamed pterygium Inflamed pinguecula Dry eye syndrome Tiredness Drugs abusing
- 5. Case scenario First physician 27 years old female patient with no medical history complain of left eye redness for 1 day.
- 6. Case scenario Second physician 27 years old female patient with no medical history complain of left eye redness for 3 days. The patient sought medical advice 2 days ago and received medical treatment without any improvement.
- 7. Case scenario Third physician 27 years old female patient with no medical history complain of left eye redness for 5 days. The patient sought medical advise twice and last time received treatment of Ofloxacin eye drops QID Chloramphincol eye ointment OD But there was no improvement with the treatment
- 8. Case scenario Fourth physician 27 years old female patient with no medical history complain of left eye redness for 7 days. The patient sought medical advice 3 times and received different medical treatment without any improvement. Left eye is red but not rigid, visual acuity is intact, no blurred vision, no halos around light. Left eye is red, painful with photophobia and excessive lacrimation. Redness of sclera and conjunctiva without any rash around the eye. No ulcer, subconjunctival Hge, hyphema or hypopyon.
- 9. Case scenario The patient was referred to hospital in urgent basis and seen in the same day and was diagnosed as left anterior uveitis for first episode. Treatment was given and further investigation for any association was done. Medical number: 3501238872
- 10. Clinical scheme Careful history Testing vision (visual acuity) Carrying out a penlight examination Ocular movement Good anterior segment examination
- 11. History Onset Prior episodes Presence of underlying illnesses Trauma Unilateral or bilateral Foreign body sensation Photophobia Blurred vision Pain Discharge Contact lenses
- 12. Photophobia Very important symptom and sign Photophobia ……..> look to the pupil - Normal…most probably keratitis - Constricted &/or irregular…most probably iritis - Dilated…”fixed dilated with no pupillary light reflex”… most probably Acute glucoma
- 13. Visual acuity The first part of the eye exam is an assessment of acuity. Change in acuity with a new, specific, visual complaint is a dangerous sign.
- 14. Penlight examination Inspect the soft tissues around the eyes with a penlight. (1) You are looking for excessive redness of the conjunctiva. Hemorrhage You are also looking for excessive mucus, dryness, lumps. You are looking for any change in the color (yellowness, brown/black pigment). Perform the Pupillary light reflex.
- 15. Ocular movement Ocular movement used to screen for defects in eye movements and alignment. Test eye movements by having the patient follow your pen movement. There are several ways to test eye alignment. The simplest but least sensitive is to observe the position of the Corneal light reflex. (3) A better way to test eye alignment is the Cover test. (4)
- 16. Examination
- 17. Pupil Regularity Size Reaction to light
- 18. Iris Clearance Size relation with the pupil Ciliary flush
- 19. Cornea Comment on cornea o Clear o FB o Abrasion and / or Ulcer o Inflammation Corneal related symptoms Blurred or cloudy vision Tearing Sensitivity to light + / - Pain
- 21. Sclera Check alteration in color Clearness FB To have a good examination of Sclera you have to ask the patient to move his eye.
- 22. Conjunctiva Color Inflammation Examination done by gently applying pressure and pulling down and away on the skin below and above the eye lid
- 23. Eye lid Inflammation Edema or swelling Position and relation with the pupil and margin Rash Mass
- 24. Red flags and dangerous sign Visual abnormalities (Reduced visual acuity up to visual loss – Diplopia – blurred vision – halos) Ciliary flush (circumcorneal injection) Corneal abnormalities including edema or opacities ("corneal haze") Corneal staining Abnormal pupil size (esp. dilated) Abnormal intraocular pressure
- 25. Pay attention for Unilateral symptoms Acute symptoms Rigid eye Tender eye Painful eye Photophobia Excessive lacrimation
- 26. Acute glucoma Key words Sudden severe unilateral pain Halos around light Fixed dilated pupils Relation to dark situation Others: Photophobia, lacrimation, blurring vision
- 27. Eye injury History of trauma Other: swelling, erythema, ecchymosis
- 28. Hyphema Key words Trauma Pain Blurred vision Most important sign: Fluid level in the bottom of iris or cornea
- 29. Keratitis Key words: discomfort sensation, vision affection Discomfort: pain and a 'gritty' sensation. Vision affection: impaired eyesight, photophobia Important sign: hazy cornea
- 30. Iritis
- 31. Iritis Key words: Blurred vision Photophobia Eye pain Important sign: Ciliary flush Pupil: Irregular, constricted
- 32. Scleritis Key words: Severe ocular pain: often described as deep or boring. Photophobia Tearing
- 33. Episcleritis Key words: Mild eye pain Mild redness
- 34. Conjunctivitis Bacterial: mucopurulant discharge Viral: watery discharge with very good general condition Allergic: recurrent
- 35. Blepharitis Key words: Gritty/burning sensation or foreign-body sensation Important sign: Red/swollen eyelids Crusting at the eyelid generally worse on waking Eyelid sticking, itching Eyelids appear greasy Eyelash loss
- 36. Subconjunctival Hge Key words Trauma Sudden or severe sneeze or cough, vomiting, heavy lifting, or even rubbing one's eyes too roughly post-operative complication in eye surgeries HTN
- 37. Pterygium
- 38. Pinguecula
- 39. Pterygium Pay attention in patient with inflamed Pterygium will complain from: Burning Gritty feeling Itching Sensation of a foreign body in the eye Blurred vision
- 40. Loss of vision in the red eye Consider: Iritis (uveitis) Scleritis Acute glaucoma (pain; nausea and vomiting) Chemical burns
- 41. The painful red eye Causes to consider: Keratitis Uveitis (iritis) Episcleritis Scleritis Acute glaucoma Hypopyon (pus in the anterior chamber) Endophthalmitis (inflammation of internal structures—may follow surgery) Corneal abrasion/ulceration
- 42. Conclusion Red eye is very important presentation. Main target is to differentiate emergency cases from cold cases. Good history taking is essential. Red flags symptoms and signs. Routine examination is a must. Examine iris, cornea, sclera, conjunctiva and eye lid in every case.
- 43. Thank you References: Pub med Med escape John Murtagh’s 6 edition