The Red Eye
Marc A. Booth, M.D.
10 April 2013
Objectives
 Obtain a pertinent history for patients
presenting with a red eye
 Formulate a differential diagnosis for a patient
with a red eye based on history and exam
 Know when to begin therapy versus refer/defer
management
 Identify patients with red eye problems which
require immediate referral to an
ophthalmologist for treatment
Pre-Lecture Quiz Question 1
 Which is/are in the differential diagnosis for
red eye?





A) Conjunctivitis
B) Scleritis
C) Ocular foreign body
D) Angle Closure Glaucoma
E) All of the Above
Pre-Lecture Quiz Question 2
 Which is not associated with acute
viral conjunctivitis?





A) Mucoid or serous discharge
B) Preauricular adenopathy
C) Photophobia
D) Palpebral (conjunctival) papillae
E) Blurry vision
Pre-Lecture Quiz Question 3
 Which is not associated with preorbital/pre-septal cellulitis?





A) Decreased visual acuity
B) Lid erythema and edema
C) Ptosis
D) Fever
E) Full ocular motility
Pre-Lecture Quiz Question 4
 Which of the following has no role in
treating HSV epithelial keratitis?





A) Superficial debridement
B) Topical ganciclovir (Zirgan)
C) Topical steroids (Pred Acetate)
D) Oral Antivirals (acyclovir)
E) Topical trifluridine (Viroptic)
The Red Eye
 Infectious
 Preseptal Cellulitis
 Anterior to orbital septum
 globe and orbit not involved




S.aureus likely if traumatic
Eyelid swollen, red, ptosis, pain, mild fever
No change: vision, pupil, motility, proptosis
D/Dx: Orbital cellulitis, idiopathic orbital
inflammation, abscess, dacryoadenitis,
dacryocystitis,
 rhabdomyosarcoma (peds)
 rapid, painful, progressive. 7yr old boy
The Red Eye
 Infectious
 Preseptal Cellulitis




History: sinus surgery/disease, trauma
Exam: External, Va, EOM, pupils.
Ancillary tests: Orbital CT, CBC, blood cx.
Treatment: Oral vs IV antibiotics
 <5yr old, 48 hour po not improved --> IV,
compliance, septic patient
The Red Eye
 Infectious
 Dacryocystitis ------------->
 Rhabdo
 Preseptal --------------------->
The Red Eye
 Infectious
 Preseptal vs Orbital Cellulitis
 Orbital (septal): similar to preseptal
 KEY SIGNS: decreased visual acuity, afferent
pupillary defect, limited ocular motility,
proptosis
 Most commonly secondary to ethmoidal
sinusitis
 Beware of Mucormycosis with DM
The Red Eye
 Inflammatory
 Chalazion
 Graves Disease
The Red Eye
 Inflammatory
 Chalazion
 Obstruction and inflammation of meibomian gland with
leakage of sebum into surrounding tissue and resultant
lipogranuloma formation
 “Hordeolum” is secondary to an acute bacterial infection
 Painful red lump on eyelid
 Treat with warm compresses, incise after 4-6 weeks
 If multiple, recurrent, unresponsive to treatment
beware of possible sebaceous carcinoma
The Red Eye
 Inflammatory
 Graves Disease
 Variability
 Asymptomatic to NLP Frozen Globe
 Observation to orbital/muscle/lid surgery
 Lid retraction is most common sign
 Female predilection (5-8:1)
 FBS, decreased vision (acuity or color),
motility disturbance
 Orbital CT to assess EOMs, IMSLO
The Red Eye
 Inflammatory
 Graves Disease
 Unilateral
 Bilateral
Skin and Adnexal Disorders
 Infectious
 Preseptal Cellulitis
 History: sinus surgery/disease, trauma
 Exam: External, Va, EOM, pupils.
 Ancillary tests: Orbital CT, CBC, blood cx.
 Treatment: Oral vs IV antibiotics
 <5yr old, 48 hour po not improved --> IV,
compliance, septic patient
Post-Lecture Quiz Question 1
 Which is/are in the differential diagnosis for
red eye?





A) Conjunctivitis
B) Scleritis
C) Ocular foreign body
D) Angle Closure Glaucoma
E) All of the Above
Post-Lecture Quiz Question 2
 Which is not associated with acute
viral conjunctivitis?





A) Mucoid or serous discharge
B) Preauricular adenopathy
C) Photophobia
D) Palpebral (conjunctival) papillae
E) Blurry vision
Post-Lecture Quiz Question 3
 Which is not associated with preorbital/pre-septal cellulitis?





A) Decreased visual acuity
B) Lid erythema and edema
C) Ptosis
D) Fever
E) Full ocular motility
Post-Lecture Quiz Question 4
 Which of the following has no role in
treating HSV epithelial keratitis?





A) Superficial debridement
B) Topical ganciclovir (Zirgan)
C) Topical steroids (Pred Acetate)
D) Oral Antivirals (acyclovir)
E) Topical trifluridine (Viroptic)