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Red eye (Inflammation (Episcleritis (Associated systemic diseases:
RA;…
Red eye
Inflammation
Episcleritis
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Clinical features:
BENIGN and self resolving inflammation of the episcleral tissues
Usually PAINLESS; sudden onset red eye; watering; NORMAL VISION.
2 types: nodular (with nodules) or simple (vascular congestion only)
No nodules with this one
Scleritis
Clinical features
Deep inflammation of the sclera; can be vision compromising.
VERY PAINFUL - wakes at night; watering, REDNESS is in a ciliary injection.
WORRY - can be necrotising, ischaemia.
PHOTOPHOBIA and CHANGE IN VISUAL ACUITY
Associated systemic diseases:
Associated in 50% of cases. Particularly RHEUMATOID arthritis; vasculitis like GPA, and herpes zoster
Treatment: reduce inflammation >> NSAIDs, corticosteroids; immunomodulatory agents
Keratitis
Inflammation of the cornea.
+/- infective keratitis - corneal infection.
Ulceration = break in the epithelial surface of the cornea.
Infective keratitis:
- bacterial: white blobby opacities on cornea
- fungal: fluffy, feathery infiltrate with slower progression
- herpetic (simplex): dendritic ulcer shape
- marginal: associated spread from blepharitis - found on the border of the cornea
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Infection
Conjunctivitis - with discharge
- Viral: watering, follicles, swollen lymph nodes (PRE-AURICULAR)
- Bacterial: creamy discharge, unilateral
- Allergy: bilateral itching and swelling
FOLLICLES - tend to be LOWER tarsal (jelly like lesions; lymphoid collection) VIRAL or CHLAMYDIAL
Usually UPPER tarsal, non specific for inflammation; get giant papillae in CL wear and allergic eye disease.
'cobblestoning' look
External: - DO NOT CAUSE RED EYE necessarily
- blepharitis (anterior - staph infection, crusting along eyelid margin; posterior - plugging of Meibomian glands that can be squeezed out)
- chalazion = obstructed Meibomian gland that forms granuloma
- hordeolum = infected chalazion and forms abscess
- stye = external hordeolum; infected eyelash follicle