The most likely cause of a red eye in patients who present to general practice is conjunctivitis. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes. Differential diagnosis of conjunctivitis and the red eye. Diagnosis, differential diagnosis, and treatment of diseases. It can occur either unilaterally or bilaterally and generally develops before the first five years of life. The differential diagnosis for red eye is broad because many ophthalmic conditions masquerade as conjunctivitis table. While the physical examination is important, a good history is critical in separating the benign causes of a red eye from those associated with increased morbidity. Red eye is a common presenting complaint in ambulatory practice. Covid19 is an emerging, rapidly evolving situation. Differential diagnosis of red eye red eyes are commonly encountered in optometric practice and it is imperative that the eyecare practitioner is able to formulate an appropriate differential diagnosis in order to manage patients effectively and expeditiously. The red eye has an extensive differential diagnosis. Authored by susan lightman posted on may 14, 2010 topic.
In addition, the inappropriate use of antibacterial. The differential diagnosis includes both benign and sightthreatening conditions. Anamnesis systemic disease eye disease devolopment of difficulties character of diffuculties. Because conjunctivitis is caused by various etiologies, clinicians must derive a differential diagnosis. A focused history can help make a definitive diagnosis. After generating a differential, you may decide that you would like to expand upon it. For the clinician, this stems from the fact that the underlying diagnosis may range from innocuous, minor problems to potentially sightthreatening etiologies.
Differential diagnosis of pediatric conjunctivitis red. Despite using the eye drops for 5 days, there has been no improvement in his symptoms. Mar 15, 2015 published march 15, 2015 differential diagnosis of retinal disease many retinal conditions can be easily confused. If so, share your ppt presentation slides online with. However, some etiologies require urgent referral to an ophthalmologist. Red eye severe pain in, around eye frontal headache blurred vision, halos seen around lights nausea, vomiting pupil fixed, middilated, slightly larger than contralateral side elevated iop corneal haze anterior segment disorders. Differential diagnosis of the red eye in small animals. Eye education for emergency clinicians 20 conclusion remember beware of the red eye. Recognise cases of red eye that require prompt referral to an ophthalmologist suggested reading ophthalmology. The author, who is professor of ophthalmology at dusseldorf, west germany, has used an interesting and novel approach for the discussion of ocular diseases. Conjunctiva pupil cornea anterior chamber iop subconjunctival haemorrhage. Have access to a differential diagnosis every time. Primary care physicians typically see 410 patients per week who complain of ocular symptoms.
Allergic rhinoconjunctivitis and differential diagnosis of. These images are a random sampling from a bing search on the term acute red eye. Differential diagnosis of red eye conjunctiva pupil cornea anterior chamber iop subconjunctival haemorrhage bright red normal normal normal normal conjunctivitis injected vessels, fornices. Discharge normal normal normal normal iritis injected around cornea small, fixed, irregular normal, kps turgid, deep normal. Understand the diagnostic approach to the acute red eye 2. Symptoms red eye unilateral sharp and severe pain, tearing photophobia blurred vision due to irregular and less transparent corneal surface signs red eye circumcorneal injection dense grayish to whitish corneal infiltrate opacity of different degree with overlying epithelial defect, variable corneal thinning mucopurulent discharge. The diagnostic approach to the red or painful eye begins with identifying a history of caustic exposure where immediate and copious irrigation even before detailed. It is important to differentiate whether the person presenting with red eye needs same day assessment by an ophthalmologist, or if they can be safely managed in primary care. By mohammad rafieetary, od, stephen huddleston, md, and eric sigler, md. History can help narrow the differential diagnosis for the red eye. The differential diagnosis ranges from routine subconjunctival hemorrhage to immediately sightthreatening diagnoses acute angle closure. Pdf differential diagnosis of red eye researchgate. The first page of the pdf of this article appears above.
Differential diagnosis and management of acute follicular. Most causes of a red eye are benign or selflimited and can be managed by a primary care physician. A symptom common to eye impairments is conjunctivitis, or red eye, a commonly seen manifestation in an ambulatory pediatric population. The acute red eye is a common clinical challenge for general practitioners. Posteriorly, it merges with the meninges at the optic nerve. Cornea appearance focally hazy stromal keratitis clear epithelial keratitis pupil larger on red eye side acute angleclosure glaucoma pupil same size or smaller on red eye side is photophobia present. Mar 28, 2019 the red or painful eye is a common presentation in the emergency department and the rapid identification and management of potentially sightthreatening causes is critical.
However, extreme redness, light sensitivity and discomfort are the driving symptoms. This should be an easy and excellent way of diagnosing any. Conjunctivitis is the most common cause of red eye. Clinical evaluation of red eyes in pediatric patients. The differential diagnosis is so large that the caregiver must be comfortable with all diagnoses and must be able to distinguish between them. Managing the red eye 4 introduction slide 1 physicians frequently encounter patients who complain of a red eye. Mar 11, 2008 the differential diagnosis of the red eye. A red eye is a nonspecific term to describe an eye that appears red due to illness or. The most common cause of red eye presenting in a primary care setting is conjunctivitis. If youre stuck for a differential diagnosis, fall back on working. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis is in doubt. Although most red eyes seen in the primary care setting are a result of.
Jan 15, 2010 red eye is the cardinal sign of ocular inflammation. Understand the principles of management of the acute red eye 3. Request pdf on jul 1, 2010, glenda smith and others published differential diagnosis of red eye find, read and cite all the research you need on researchgate. A painful red eye answer 1 the differential diagnosis of a unilateral red eye is shown in table 1.
Conjunctivitis can affect one or both eyes and is the most likely diagnosis. The acute red eye in the elderly an acute red eye often causes much anxiety for patients and physicians alike. Click on the image or right click to open the source website in a new browser. A detailed history of the presenting symptoms and previous ophthalmological and medical history can narrow the differential diagnosis and aid in the interpretation of key examination findings. With a simple basic anamnesis, the pediatrician can guide the origin of hyperemia. Reprinted in ivis with the permission of wsava close this window to return to ivis 36th world small animal veterinary congress 2011 jeju, korea.
Eye education for emergency clinicians 10 bacterial viral usually adenoviral allergic symptoms redness fb sensation itching is less irritating superficially sore itching burning fb sensation may have recent urti starts one eye within 2days fellow eye affected itchy watery discharge history of allergies. Acute red eye differential diagnosis conjunctivitis keratitis. Patients with unilateral anterior uveitis have ocular ache in the affected eye if light is shined in the unaffected eye true photophobia, which is uncommon in conjunctivitis differential diagnosis any cause of a red eye or visual disturbance should be included in the differential diagnosis. Iritis injected around cornea small, fixed, irregular normal, kps turgid, deep normal. When a patient presents with a red eye, include these questions. These can be classified according which structure is abnormal. The challenge lies in discerning one from the other. Most cases will be due to relatively benign problems. Jun 11, 2019 the differential diagnosis is so large that the caregiver must be comfortable with all diagnoses and must be able to distinguish between them. Differential dx strategies university of massachusetts. Viral conjunctivitis most common cause of red eye allergic irritant conjunctivitis bacterial conjunctivitis neonatal conjunctivitis ophthalmia neonatorum blepharitis hordeolum stye chalazion bacterial endophthalmitis fungal endophthalmitis keratitis corneal inflammation bacterial or viral. The erythema in a red eye is often caused by conjunctival inflammation but also may result from dilated scleral or episcleral vessels or inflammation of the deeper structures of the eye and surrounding tissues. Differential diagnosis of common causes of the inflamed eye.
There are little epidemiologic data on the red eye, and there are no evidencebased data to guide us in the management of these patients. This pocket sized book summaries the key points in the ophthalmology curriculum complied by the task force of the international council of ophthalmology and is a format that is very portable. Serious and potentially sightthreatening causes of red eye include. There is a wide differential diagnosis for red eye.
Differential diagnosis of red eye slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. All red eyes must be evaluated for 3 key ocular diseases that may cause vision loss. Question 6 what is the treatment for jasons ocular condition and general condition. Misdiagnosis is a major medicolegal pitfall, in that the truly emergent conditions that may cause red eye have major visionthreatening sequelae.
Acute red eye differential diagnosis conjunctivitis keratitis uveitisiritis acute angle closure glaucoma scleritis episcleritis subconjunctival haemorrhage ocular trauma. Diagnosis refer urgently no corneal staining are pupil sizes different. The most likely cause of a red eye in patients who present to general practice is. Blepharitis, hordeolum, and chalazion are associated with a localized red, swol len, tender eyelid. Diagnosis and management of pediatric conjunctivitis.
Viral conjunctivitis viral conjunctivitis is a common condition characterized by conjunctival redness and inflammation. Red eye red eye is sign of pathology of anterior or posterior ocular segment, of orbit or of ocular adnexa. It is usually injection and prominence of the superficial blood vessels of the conjunctiva, which may be caused by disorders of these or adjacent structures. Ophthalmologists in germany should be aware of the differential diagnosis of oriental cutaneous leishmaniasis in patients suffering from chronic granulomatous lid lesions of patients from. Eye education for emergency clinicians 3 aims and objectives to have an understanding of the causes of the red eye objectives to be able to differentiate between common. Although the exact incidence of diagnoses presenting as a red eye is not well defined, most are benign. Practioners are often confronted with a patient who presents with the red eye. This article examines possible causes of conjunctivitis after the neonatal period in this population. Diagnosis and management of red eye in primary care. Additionally, the audience will learn how to recognize more. Eye education for emergency clinicians 4 introduction normally the eye has a strong resistance. The red eye is one of the most frequent presenting complaints in the emergency department setting. Red eye differential diagnosis masarykova univerzita.
The differential diagnosis of progressive conjunctival scarring. The diagnosis of the cause of red eye can be a challenge for the pediatrician because the differential diagnosis includes a wide range of diseases, some potentially serious vision and given that. When a patient presents with a red eye, include these questions in a thorough history to aid in differential diagnosis. Assessment of red eye differential diagnosis of symptoms. Differential diagnosis of eye diseases jama ophthalmology.
Importance of the red reflex test in the diagnosis of eye. For each sign and symptom, the differential diagnosis is discussed in detail. Diagnosis and management of red eye in primary care request. Differential diagnosis of the red eye carol slight nurse practitioner ophthalmology. However, red eye can also be a feature of a more serious eye condition, in which a delay in treatment due to a missed diagnosis can result in permanent visual loss.
Medical student education 1 rating pdf 885 kb download susan lightman, frcp, frcophth, phd, professor of clinical ophthalmology at moorfields eye hospital, london, 2007. Principal causes of unilateral acute red eye, in the absence of. Jul 27, 2015 red eye is a common presentation in primary care and is a sign of inflammation. Differential diagnosis for conjunctival hyperemia red eye because of its location fig. Importance of the red reflex test in the diagnosis of eye cancer abstract retinoblastoma is themost common malignant tumour of eye in children and accounts for 3% of all childhood cancers. Cause and effect symptom cause itching allergy burning lid disorders, dry eye foreign body sensation foreign body, corneal abrasion localized lid tenderness hordeolum, chalazion evaluation. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated by the primary care clinician. What is the likely diagnosis of a red eye in a middleaged woman. Practitioners recorded brief details of every patient seen and detailed information concerning signs and symptoms, differential diagnosis and treatment for all patients presenting with a red eye during 20 consecutive days in the period between may and september 2004. The differential diagnosis of the red eye springerlink. If you continue browsing the site, you agree to the use of cookies on this website. The red eye international council of ophthalmology. Ranelle, fort worth, texas the differential diagnosis of acute follicular conjunctivitis is dependent upon the ability to differentiate follicular and papillary conjunctival responses.
Certain strategies work better for different symptoms. A red eye is an eye that appears red due to illness or injury. The differential diagnosis of red eye can be narrowed down rapidly with simple baseline tests and targeted questioning. Conjunctivitis scratchy or gritty sensation hyperacute bacterial conjunctivitis. An edinburgh red eye diagnostic algorithm questionnaire was designed to evaluate the accuracy of the algorithmic assisted diagnosis in south east.
If youre stuck for a differential diagnosis, fall back on working through the anatomical components of the eye and running through a pathophysiological sieve. A small proportion of red eye cases are serious and need urgent treatment. The condition is usually benign and can be managed by primary care physicians. Differentiating urgent and emergent causes of acute red eye for. Request pdf diagnosis and management of red eye in primary care red. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. This slide program provides an approach to differential diagnosis of conditions that can cause a red eye, helping physicians understand which conditions causing a red eye require immediate treatment, which. The integrity of the conjunctiva and sclera is crucial for healthy eyes, and. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. The diagnosis of the cause of red eye can be a challenge for the pediatrician because the differential diagnosis includes a wide range of diseases, some potentially serious vision and given that the childs eye visual function is developing.
Red eye, a differential diagnosis is the property of its rightful owner. Oct 08, 2019 a hordeolum ie, stye is a localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes ie, external hordeolum or meibomian glands ie, internal hordeolum. Mar 17, 2009 differential diagnosis of red eye slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The differential diagnosis of red eye can be narrowed down rapidly with simple. Assessment of red eye differentials bmj best practice. The red eye hsv keratitis anterior uveitis subconjunctival haemorrhage corneal ulcer episcleritis scleritis acute angle closure glaucoma conjunctivitis red eye. Hordeolum and stye in emergency medicine differential diagnoses. Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics. Managing the red eye 3 a guide to presenting managing the red eye managing the red eye introduces the primary care physician to skills useful in evaluating the red eye and provides a practical clinical approach to diagnosis and treatment of many common red eye disorders. Pdf differentiating urgent and emergent causes of acute red. Acute red eye is a common presenting complaint to primary care physicians. At those times adding a different strategy often reveals more conditions.