RED EYE

• is a catch-all term for the inflamed or injected external appearance of the eye, for which there are many causes.

• down into 3 groups:
  • extra-ocular causes
    • orbital cellulitis
    • cavernous sinus thrombosis
    • carotid-cavernous fistula
    • cluster headache
  • external eye disease
    • eyelid and conjunctival disease
  • internal eye disease
    • iritis
    • glaucoma
• Once an extra-ocular cause is excluded:

Painless		Painful
Diffuse	Localised redness	Abnormal cornea	Abnormal eyelid	Diffuse conjunctival injection	Ciliary injection/ scleral involvement	Anterior chamber involvement
Blepharitis Ectropion Entropion Trichiasis Eyelid LesionTumour Stye	Pterygium Corneal Foreign Body w/out abrasion Ocular Trauma Subconjunctival Hemorrhage	HSV Keratitis Corneal Ulcer Marginal Keratitis Foreign body 🡪 Corneal Abrasion	Chalazion Stye Acute  Blepharitis Herpes Zoster Ophthalmicus	Viral Conjunctivitis Allergic Conjunctivitis Bacterial Conjunctivitis Dry Eyes Acute Glaucoma	Scleritis	Acute Anterior Uveitis (Iritis) Hypopyon Hyphema

features on history or examination	serious causes of a RED EYE
Severe eye aching	IritisKeratitis Acute Angle-Closure Glaucoma Scleritis Orbital Cellulitis Cavernous Sinus Thrombosis (CST)
Prominent photophobia	Iritis Keratitis
Impaired vision	IritisKeratitis Acute Angle-Closure Glaucoma Orbital Cellulitis CST
Cloudy cornea	Keratitis Acute Angle-Closure Glaucoma
Corneal opacification	Keratitis – Chemical Or Infectious
Circumcorneal conjunctival injection	IritisKeratitis
Cloudy anterior chamber	Iritis
Pain on eyeball palpation	Scleritis (+++) Orbital Cellulitis CST
Proptosis	Orbital Cellulitis CST Posterior Scleritis
Impaired, or painful, extraocular eye movements	Orbital Cellulitis
Fever, toxic appearance	Orbital Cellulitis (+)CST (++)
Hyper purulent discharge from an “angry” eye	Gonococcal Conjunctivitis/Endophthalmitis
Prominent nausea and vomiting	Acute Angle-Closure Glaucoma
Small, irregular, poorly-reactive pupil	Iritis
Fixed mid-dilated pupil	Acute Angle-Closure Glaucoma
Increased intra-ocular pressure	Acute Angle-Closure Glaucoma Iritis (Secondary Complication)
History of connective tissue disease, or granulomatous disease	Iritis Scleritis