Red eye resident survival guide: Difference between revisions

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{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0";
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Red eye Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Diagnosis|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Mild to Severe|Mild to Severe]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Acute or Chronic|Acute or Chronic]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Do's|Do's]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Red eye resident survival guide#Don'ts|Don'ts]]
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{{WikiDoc CMG}}; {{AE}} {{Arash.M}}
{{WikiDoc CMG}}; {{AE}} {{Arash.M}}


{{SK}} An approach to red eye, Red eye diagnostic approach, Red eye workup algorithm
==Overview==
==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 [[photophobia]], [[eye discharge]], [[pain]], [[itiching]] and [[visual changes]].
[[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==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<ref name="pmid28435504">{{cite journal| author=Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M| title=Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician. | journal=West J Emerg Med | year= 2017 | volume= 18 | issue= 3 | pages= 509-517 | pmid=28435504 | doi=10.5811/westjem.2016.12.31798 | pmc=5391903 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28435504  }} </ref>
Life-threatening [[causes]] include [[conditions]] which may result in death or permanent disability within 24 hours if left untreated.<ref name="pmid28435504">{{cite journal| author=Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M| title=Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician. | journal=West J Emerg Med | year= 2017 | volume= 18 | issue= 3 | pages= 509-517 | pmid=28435504 | doi=10.5811/westjem.2016.12.31798 | pmc=5391903 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28435504  }} </ref>
* Acute angle closure [[glaucoma]] [[(AACG)]]
* Acute angle closure [[glaucoma]] [[(AACG)]]
* [[Endophthalmitis]]
* [[Endophthalmitis]]
* [[Anterior uveitis]]
* [[Neonatal conjunctivitis]]
* Bacterial [[keratitis]]
* Bacterial [[keratitis]]
* [[Chemical burn]]
* [[Chemical burn]]
* Traumatic eye injury
* Traumatic eye injury
* [[Scleritis]]
* [[Scleritis]]
* Corneal ulcer
* [[Corneal]] [[ulcer]]
* Hyper acute conjunctivitis
* Hyperacute conjunctivitis


===Common Causes===
===Common Causes===
Line 26: Line 49:


==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of [[red eye]].<ref name="pmid20921253">{{cite journal| author=Noble J, Lloyd JC| title=The red eye. | journal=CMAJ | year= 2011 | volume= 183 | issue= 1 | pages= 81 | pmid=20921253 | doi=10.1503/cmaj.090379 | pmc=3017259 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20921253  }} </ref><ref name="pmid20082509">{{cite journal| author=Cronau H, Kankanala RR, Mauger T| title=Diagnosis and management of red eye in primary care. | journal=Am Fam Physician | year= 2010 | volume= 81 | issue= 2 | pages= 137-44 | pmid=20082509 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20082509  }} </ref>
In the assessment of a [[patient]] with [[red eye]], taking a precise history and examination and identifying red flags is essential.
{{familytree/start}}
<br> Red flags include:
{{familytree | | | | | | | | A01 | | | | | | A01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Patients with [[red eye]]''' </div>}}
* Reduced [[visual acuity]]
* Deep [[pain]] within the eye
* Unilateral red eye
* [[Contact lens]] use
* [[Photophobia]]
<br>Taking history includes:
* Onset and duration
* [[Unilateral]] or [[bilateral]] [[symptoms]]
* [[Visual]] changes
* [[Pain]]
* Eye [[discharge]]
* [[Photophobia]]
* Whether the person wears [[contact lenses]]
* Similar episodes in the past
* [[Medication]]
<br> Examination includes:
* Check the person's [[visual acuity]].
* Assess for evidence of [[facial trauma]].
* Check for any [[discharge]] from the eyes.
* Examine the [[eyelids]]
* Examine the [[conjunctiva]]
* Check the pattern of redness
* Perform [[fluorescein]] eye stain test. If the [[cornea]] stains this can be an indication that a [[corneal abrasion]] or [[ulcer]] is present.
* Check [[pupillary reaction]]
* Check patient's [[blood pressure]] if [[subconjunctival hemorrhage]] is suspected.
===Mild to Severe===
 
{{familytree/start}}<ref name="pmid20921253">{{cite journal| author=Noble J, Lloyd JC| title=The red eye. | journal=CMAJ | year= 2011 | volume= 183 | issue= 1 | pages= 81 | pmid=20921253 | doi=10.1503/cmaj.090379 | pmc=3017259 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20921253  }} </ref><ref name="pmid20082509">{{cite journal| author=Cronau H, Kankanala RR, Mauger T| title=Diagnosis and management of red eye in primary care. | journal=Am Fam Physician | year= 2010 | volume= 81 | issue= 2 | pages= 137-44 | pmid=20082509 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20082509  }} </ref>
{{familytree | | | | | | | | A01 | | | | | | A01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''[[Patients]] with [[red eye]]''' </div>}}
{{familytree | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
{{familytree | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
{{familytree | | | B01 | | | | | | | | B02 | | | | B01= <div style="float: left; text-align: center; width: 14em; padding:1em;"> '''Mild or no pain with mild [[blurring]] or normal vision''' </div> | B02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Moderate to severe pain''' </div>}}
{{familytree | | | B01 | | | | | | | | B02 | | | | B01= <div style="float: left; text-align: center; width: 14em; padding:1em;"> '''Mild or no [[pain]] with mild [[blurring]] or normal [[vision]]''' </div> | B02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Moderate to severe [[pain]]''' </div>}}
{{familytree | | | |!| | | | | | | | | |!| | | | | |}}
{{familytree | | | |!| | | | | | | | | |!| | | | | |}}
{{{{familytree | | | C01 | | | | | | | | C02 | | | | |C01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Hyperemia]]'''</div> | C02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''[[Vision loss]], [[Distorted pupil]], [[Corneal involvement]]''' </div> }}
{{familytree | | | C01 | | | | | | | | C02 | | | | |C01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Hyperemia]]'''</div> | C02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''[[Vision loss]], [[Distorted]] [[pupil]], [[Corneal]] involvement''' </div> }}
{{familytree | |,|-|^|-|.| | | | | | | |!| | | | |}}
{{familytree | |,|-|^|-|.| | | | | | | |!| | | | |}}
{{familytree | D01 | | D02 | | | | | | D03 | | |D01= '''Local''' | D02= '''Diffuse''' | D03=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Vesicular]] rash, [[Corneal]] ulcer, [[Iritis]], Acute angle [[gluacoma]], Chemical burn, Traumatic eye injury''' </div>}}
{{familytree | D01 | | D02 | | | | | | D03 | | |D01= '''Local''' | D02= '''Diffuse''' | D03=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Vesicular]] [[rash]], [[Corneal]] ulcer, [[Iritis]], Acute angle [[gluacoma]], Chemical burn, Traumatic eye injury''' </div>}}
{{familytree | |!| | | |!| | | | | | | |!| | | | |}}
{{familytree | |!| | | |!| | | | | | | |!| | | | |}}
{{familytree | E01 | | E02 | | | | | | E03 | |E01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Episcleritis]]''' | E02= '''Discharge''' | E03=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''Emergency Ophthalmology referral'''</div>}}
{{familytree | E01 | | E02 | | | | | | E03 | |E01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Episcleritis]]''' | E02= '''Discharge''' | E03=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''Emergency Ophthalmology referral'''</div>}}
Line 41: Line 92:
{{familytree | |!| | | | |,|-|-|^|-|-|.| |}}
{{familytree | |!| | | | |,|-|-|^|-|-|.| |}}
{{familytree | G01 | | | G02 | | | | G03 | | |G01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Subconjunctival hemorrhage]]''' | G02='''Intermittent''' | G03='''Continuous''' </div>}}
{{familytree | G01 | | | G02 | | | | G03 | | |G01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''[[Subconjunctival hemorrhage]]''' | G02='''Intermittent''' | G03='''Continuous''' </div>}}
{{familytree | | | | | | |!| | | |,|-|^|-|-|.| |}}
{{familytree | | | | | | |!| | | |,|-|-|^|-|-|.| |}}
{{familytree | | | | | | H01 | | H02 | | | H03 | | |H01='''[[Dry eye]]''' |H02='''Watery or [[Serous]]''' |H03='''[[Mucopurulent]] to [[Purulent]]''' </div>}}
{{familytree | | | | | | H01 | | H02 | | | H03 | | |H01='''[[Dry eye]]''' |H02='''Watery or [[Serous]]''' |H03='''[[Mucopurulent]] to [[Purulent]]''' </div>}}
{{familytree | | | | | | | | | | |!| | |,|-|^|-|.| | |}}
{{familytree | | | | | | | | | | |!| | | |,|-|^|-|.| | |}}
{{familytree | | | | | | | | | | I01 | I02 | | I03 | | |I01='''[[Itiching]]''' |I02='''Clamydial [[Conjunctivitis]]''' |I03='''Acute bacterial [[conjunctivitis]]''' </div>}}
{{familytree | | | | | | | | | | I01 | | I02 | | I03 | | |I01='''[[Itching]]''' |I02='''[[Clamydial]] [[Conjunctivitis]]''' |I03='''Acute [[bacterial]] [[conjunctivitis]]''' </div>}}
{{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | |}}
{{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | |}}
{{familytree | | | | | | | J01 | | | | J02 | | | | | | |J01='''Mild to non''' |J02='''Moderate to severe''' </div>}}
{{familytree | | | | | | | J01 | | | | J02 | | | | | | |J01='''Mild to non''' |J02='''Moderate to severe''' </div>}}
{{familytree | | | | | | | |!| | | | | |!| | | | | |}}
{{familytree | | | | | | | |!| | | | | |!| | | | | |}}
{{familytree | | | | | | | K01 | | | | K02 | | | | |K01='''Viral [[Conjunctivitis]]''' |K02='''Allergic [[Conjunctivitis]]''' </div>}}
{{familytree | | | | | | | K01 | | | | K02 | | | | |K01='''[[Viral]] [[Conjunctivitis]]''' |K02='''[[Allergic]] [[Conjunctivitis]]''' </div>}}
 
{{familytree/end}}
 
===Acute or Chronic===
{{familytree/start}}<ref name="pmid28530180">{{cite journal| author=Frings A, Geerling G, Schargus M| title=Red Eye: A Guide for Non-specialists. | journal=Dtsch Arztebl Int | year= 2017 | volume= 114 | issue= 17 | pages= 302-312 | pmid=28530180 | doi=10.3238/arztebl.2017.0302 | pmc=5443986 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28530180  }} </ref>
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | | | | | | | | | | A01 | | | | | | A01= <div style="float: left; text-align: center; width: 10em; padding:1em;">'''[[red eye]]''' </div>}}
{{familytree | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | |}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | | | B01 | | | | | | | | | | | | B02 | | | | B01= <div style="float: left; text-align: center; width: 10em; padding:1em;"> '''Chronic''' </div> | B02= <div style="float: left; text-align: center; width: 10em; padding:1em;">'''Acute''' </div>}}
{{familytree | | | | | |,|-|-|^|-|-|-|.| | | | | | |,|-|-|^|-|-|.| | |}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | C01 | | | | | C02 | | | | | C03 | | | | C04 | | | C01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''[[Bilateral]]'''</div> | C02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Unilateral''' </div> | C03= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''[[Bilateral]]'''</div> | C04= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Unilateral''' </div> }}
{{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''':
<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}}


==Treatment==
==Treatment==
The management of the [[red eye]] will depend on the underlying cause.
The management of the [[red eye]] will depend on the underlying [[cause]].
* '''Life-threatening causes'''
===Life-threatening causes===


{| class="wikitable" border="1"
{| class="wikitable" border="1"
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| AACG}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Endophthalmitis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Necrotizing Scleritis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Herpetic keratitis}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Chemical injury}}
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Acute angle closure glaucoma}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Endophthalmitis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Necrotizing Scleritis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Herpetic keratitis}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Chemical injury}}
|-
|-
|  
|  
*'''Lowering of [[IOP]]''': [[Acetazolamide]] 500mg IV or PO + topical [[Beta blockers]], [[Alpha 2 agonists]], [[Prostaglandin analogue]]<ref name="pmid30487684">{{cite journal| author=Murray D| title=Emergency management: angle-closure glaucoma. | journal=Community Eye Health | year= 2018 | volume= 31 | issue= 103 | pages= 64 | pmid=30487684 | doi= | pmc=6253313 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30487684  }} </ref>
*'''Lowering of [[IOP]]''': [[Acetazolamide]] 500mg IV or PO + [[topical]] [[beta blockers]], alpha 2 agonists, [[prostaglandin analogue]] <ref name="pmid30487684">{{cite journal| author=Murray D| title=Emergency management: angle-closure glaucoma. | journal=Community Eye Health | year= 2018 | volume= 31 | issue= 103 | pages= 64 | pmid=30487684 | doi= | pmc=6253313 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30487684  }} </ref>
*'''Reduce pain''': Topical [[steroids]] ([[prednisolone]])
*'''Reduce [[pain]]''': [[topical]] [[steroids]] ([[prednisolone]])
*'''Reduce nausea and vomiting''': [[Anti emetics]] ([[Metoclopramide]])
*'''Reduce [[nausea]] and [[vomiting]]''': [[Anti emetics]] ([[metoclopramide]])
<ref name="pmid24825645">{{cite journal| author=Weinreb RN, Aung T, Medeiros FA| title=The pathophysiology and treatment of glaucoma: a review. | journal=JAMA | year= 2014 | volume= 311 | issue= 18 | pages= 1901-11 | pmid=24825645 | doi=10.1001/jama.2014.3192 | pmc=4523637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24825645  }} </ref>
|
|
*[[intravitreal]] injections of [[vancomycin]] and [[ceftazidime]]<ref name="pmid21572565">{{cite journal| author=Novosad BD, Callegan MC| title=Severe bacterial endophthalmitis: towards improving clinical outcomes. | journal=Expert Rev Ophthalmol | year= 2010 | volume= 5 | issue= 5 | pages= 689-698 | pmid=21572565 | doi=10.1586/eop.10.52 | pmc=3092298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21572565  }} </ref>
*[[Intravitreal]] [[injections]] of [[vancomycin]] and [[ceftazidime]] <ref name="pmid21572565">{{cite journal| author=Novosad BD, Callegan MC| title=Severe bacterial endophthalmitis: towards improving clinical outcomes. | journal=Expert Rev Ophthalmol | year= 2010 | volume= 5 | issue= 5 | pages= 689-698 | pmid=21572565 | doi=10.1586/eop.10.52 | pmc=3092298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21572565  }} </ref>
**Or combination of vancomycin and [[amikacin]]
**Or combination of vancomycin and [[amikacin]]
*Topical [[Fluoroquinolones]] (levofloxacin)
*[[Topical]] [[fluoroquinolones]] ([[levofloxacin]])
*[[Vitrectomy]] in severe cases
*[[Vitrectomy]] in severe cases
|
|
* Oral [[Corticosteroids]]<ref name="pmid27734292">{{cite journal| author=Lawuyi LE, Gurbaxani A| title=Refractory necrotizing scleritis successfully treated with adalimumab. | journal=J Ophthalmic Inflamm Infect | year= 2016 | volume= 6 | issue= 1 | pages= 37 | pmid=27734292 | doi=10.1186/s12348-016-0107-y | pmc=5059540 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27734292  }} </ref><br>Or
* Oral [[Corticosteroids]] <ref name="pmid27734292">{{cite journal| author=Lawuyi LE, Gurbaxani A| title=Refractory necrotizing scleritis successfully treated with adalimumab. | journal=J Ophthalmic Inflamm Infect | year= 2016 | volume= 6 | issue= 1 | pages= 37 | pmid=27734292 | doi=10.1186/s12348-016-0107-y | pmc=5059540 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27734292  }} </ref><br>Or
* [[(TNF)-inhibiting]] anti-inflammatory ([[adalimumab]]) or ([[infliximab]])
* [[(TNF)-inhibiting]] anti-inflammatory ([[adalimumab]]) or ([[infliximab]])
|
|
* [[Ganciclovir]] 0.15% ophthalmic gel
* [[Ganciclovir]] 0.15% ophthalmic gel
* Topical steroid
* [[Topical]] [[steroid]]
* Surgical [[debridement]] in severe cases
* [[Surgical]] [[debridement]] in severe cases
|
|
* Emergency treatment<ref name="pmid24082664">{{cite journal| author=Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD| title=Ocular chemical injuries and their management. | journal=Oman J Ophthalmol | year= 2013 | volume= 6 | issue= 2 | pages= 83-6 | pmid=24082664 | doi=10.4103/0974-620X.116624 | pmc=3779420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082664  }} </ref>
* Emergency treatment <ref name="pmid24082664">{{cite journal| author=Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD| title=Ocular chemical injuries and their management. | journal=Oman J Ophthalmol | year= 2013 | volume= 6 | issue= 2 | pages= 83-6 | pmid=24082664 | doi=10.4103/0974-620X.116624 | pmc=3779420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082664  }} </ref>
** Irrigation with [[isotonic saline]] or [[lactate ringer]]
** Irrigation with [[isotonic saline]] or [[lactate ringer]]
** tear substitutes
** Tear substitutes
* Further treatment
* Further treatment
** Collagenase inhibitors  [[acetylcysteine]]
** Collagenase inhibitors  [[acetylcysteine]]
** Topical steroids
** [[Topical]] [[steroids]]
** [[Ascorbate]]
** [[Ascorbate]]
|}
{| class="wikitable" border="1"
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Anterior uveitis}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Subconjunctival hemorrhage}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Neonatal conjunctivitis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Corneal ulcer}}
|-
|
* [[Topical]] [[corticosteroids]] <ref name="pmid30214346">{{cite journal| author=Harthan JS, Opitz DL, Fromstein SR, Morettin CE| title=Diagnosis and treatment of anterior uveitis: optometric management. | journal=Clin Optom (Auckl) | year= 2016 | volume= 8 | issue=  | pages= 23-35 | pmid=30214346 | doi=10.2147/OPTO.S72079 | pmc=6095364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30214346  }} </ref>
** The most common is ]]prednisolone]] acetate 1%
** [[Dexamethasone]] 0.1%
** [[Prednisolone]] sodium phosphate 1%
|
* Treat the [[cause]] <ref name="pmid23843690">{{cite journal| author=Tarlan B, Kiratli H| title=Subconjunctival hemorrhage: risk factors and potential indicators. | journal=Clin Ophthalmol | year= 2013 | volume= 7 | issue=  | pages= 1163-70 | pmid=23843690 | doi=10.2147/OPTH.S35062 | pmc=3702240 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843690  }} </ref>
** [[Contact lens]] usage
** [[Ocular]] [[amylodoisis]]
** [[Conjunctivochalasis]]
** [[Conjunctival]] [[tumors]]
** Systemic [[vascular]] [[diseases]]
** Carotid cavernous fistulas (CCF)
|
* [[Gonococcal conjunctivitis]] <ref name="pmid30007329">{{cite journal| author=Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N| title=Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. | journal=J Pediatric Infect Dis Soc | year= 2018 | volume= 7 | issue= 3 | pages= e107-e115 | pmid=30007329 | doi=10.1093/jpids/piy060 | pmc=6097578 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30007329  }} </ref>
** Third-generation [[cephalosporins]] ([[Ceftriaxone]] 25-50mg/kg)
* [[Chlamydial]] [[conjunctivitis]]
** [[Erythromycin]] for 14 days or [[azithromycin]] 20 mg/kg/day for 3 days
* [[Herpetic]] [[conjunctivitis]]
** [[Topical]] vidarabine or trifluridine for 10 days
** Evaluate and treat for systemic [[herpes]]
|
* [[Corneal]] [[scrap]]
** [[Topical]] [[antibiotics]] ([[chloramphenicol]] 1%)
|}
===Other causes===
{| class="wikitable" border="1"
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Foreign body}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Conjunctivits}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Blepharitis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Scleritis}}
|-
|
* Foreign body removal emergently <ref name="pmid17344985">{{cite journal| author=Macedo Filho ET, Lago A, Duarte K, Liang SJ, Lima AL, Freitas Dd| title=Superficial corneal foreign body: laboratory and epidemiologic aspects. | journal=Arq Bras Oftalmol | year= 2005 | volume= 68 | issue= 6 | pages= 821-3 | pmid=17344985 | doi=10.1590/s0004-27492005000600019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17344985  }} </ref>
* [[Pain]] control ([[cycloplegic]] [[eye drops]] or [[topical]] [[tetracaine]])
* [[Antibiotics]] (anti-[[pseudomonas]] coverage)
|
* [[Bacterial]] <ref name="pmid30214351">{{cite journal| author=Putnam CM| title=Diagnosis and management of blepharitis: an optometrist's perspective. | journal=Clin Optom (Auckl) | year= 2016 | volume= 8 | issue=  | pages= 71-78 | pmid=30214351 | doi=10.2147/OPTO.S84795 | pmc=6095371 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30214351  }} </ref>
** [[Chloramphenicol]] 0.5% [[eye drops]], [[gentamicin]] 0.3% [[eye drops]], [[tetracycline]] 1% eye [[ointment]] <ref name="pmid17491982">{{cite journal| author=Wood M| title=Conjunctivitis: diagnosis and management. | journal=Community Eye Health | year= 1999 | volume= 12 | issue= 30 | pages= 19-20 | pmid=17491982 | doi= | pmc=1706007 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17491982  }} </ref>
* [[Viral]]
** Self-limiting just cold compresses to relieve discomfort
* [[Allergic]]
** [[Antihistamines]] ([[eye drops]] or orally), [[steroid]] [[eye drops]] can be added by [[cromolyn sodium]] 4% [[eye drops]] and lodoxamide 0.1% [[eye drops]]
|
* [[Bacterial]]
** [[Topical]] [[antibiotic]], [[Topical]] [[corticosteroid]]
* [[HSV]]
** [[Topical]] [[ganciclovir]] or Oral [[acyclovir]] or [[valacyclovir]] if non-resolving
|
* First line
** [[Topical]] [[corticosteroid]] [[eye drops]] ([[prednisolone]] acetate 1.0%)
** Oral [[NSAIDs]] ([[Ibuprofen]] 600 mg)
* Second line
** Oral [[corticosteroids]]
*** Prescribed when oral [[NSAID]] treatment fails
|}
|}


==Do's==
==Do's==
* Using artificial tears in patients with [[dry eye]].
* Using artificial tears in [[patients]] with [[dry eye]].
* Protection against UV rays.
* Protection against [[ultraviolet]] rays.
* Observe hygiene protocols.
* Observe hygiene protocols.


==Don'ts==
==Don'ts==
* Avoid wearing contact lenses.
* Avoid wearing [[contact lenses]].
* Avoid using sharp equipment specially in children.
* Avoid using sharp equipment especially in children.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 13:52, 30 September 2020

Red eye Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Mild to Severe
Acute or Chronic
Treatment
Do's
Don'ts


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

Other causes

Foreign body Conjunctivits Blepharitis Scleritis

Do's

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.