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The Red Eye Differential Diagnosis

The Red Eye Differential Diagnosis. Differential Diagnosis of “red eye”. Conjunctivitis. Follicles. Purulent discharge. Papillae. Chemosis. Redness. Subconjunctival Haemorrhage. Diffuse or localised area of blood under conjunctiva. Asymptomatic

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The Red Eye Differential Diagnosis

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  1. The Red EyeDifferential Diagnosis

  2. Differential Diagnosis of “red eye”

  3. Conjunctivitis Follicles Purulent discharge Papillae Chemosis Redness

  4. Subconjunctival Haemorrhage • Diffuse or localised area of blood under conjunctiva. Asymptomatic • Idiopathic, trauma, cough, sneezing, aspirin, HT • Resolves within 10-14 days

  5. 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

  6. Corneal Abrasion • Surface epithelium sloughed off. • Stains with fluorescein • Usually due to trauma • Pain, FB sensation,tearing, red eye

  7. 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

  8. Episcleritis • Superficial • Idiopathic, collagen vascular disorder (RA) • Asymptomatic, mild pain • Self-limiting or topical treatment

  9. 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

  10. Uveitis Anterior: acute recurrent and chronic Posterior: vitritis, retinal vasculitis, retinitis, choroiditis Panuveitis: anterior and posterior

  11. 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

  12. Ciliary flush Posterior synechiae Fibrin Flare Hypopyon KPs

  13. Acute Angle-closure Glaucoma • Symptoms • Pain, headache, nausea-vomiting • Redness, photophobia, • Reduced vision • Haloes around lights Ciliary hyperaemia Dilated pupil Corneal oedema

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