Differential Causes of Red Eye:

Uveitis
The uvea is the pigmented middle layer of the eye (the outermost being the sclera and the innermost the retina). It is made up of the iris = anterior = 90% ciliary body = intermediate choroid = posterior Uveitis refers to inflammation of the uvea. It is somewhat complex because the uvea is made up of so multiple constituent parts and so inflammation can be in any of these, as well as in other parts of the eye at the same time (e.g. retina). As a result the term intraocular inflammation is used to describe the spectrum of conditions. Causes: INFECTION by a virus herpes, fungus or parasite toxoplasmosis AUTOIMMUNITY SLE, MS, sarcoidosis TRAUMA to the eye or even the other eye in the past Symptoms: Redness diffuse or localised to limbus Visual Blurring Pain Dark Floating Spots Photophobia Pain Relief Glucocorticoids Atropine Methotrexate (more severe)

Glaucoma
This is a disease in which there is progressive damage to the optic nerve, resulting in progressive, irreversible loss of vision. It is not necessarily caused by raised intraocular pressure, although it is frequently associated with it and is a significant risk factor. There are 2 main categories open angle reduced flow through the trabecular meshwork closed angle iris pushed forward to prevent a.h. from draining

Of the two, closed angle is more acute and pain and discomfort often cause the patient to seek medical attention. Open angle tends to progress more slowly so that the patient may not notice a deterioration in their vision until the disease has progressed quite far aka sneak thief of sight In the case of acute glaucoma, a sudden severe rise in intraocular pressure caused by reduced anterior chamber aqueous fluid drainage may result in the following symptoms: Symptoms: Sudden onset of severe eye pain Visual Blurring Rainbow-like haloes around lights Nausea and Vomiting Reduced Visual Acuity Diffuse Ocular Redness Pupil = semi-dilated and not reactive to light The raised pressure can be caused either by increased production or decreased absorption through the trabecular meshwork. This can be detected using tonometry (e.g. air puff)

posterior chamber aqueous humour

Conjunctivitis
This is a disease characterised by acute inflammation of the conjunctiva (the outermost layer or the eye and the inside of the eyelids). It may be bacterial, viral, allergic or chemical. All 4 of these are characterised by: redness (hyperaemia) watering (epiphora) irritation (chemosis) Note that there are no pupillary or corneal abnormalities. There is also no change in visual acuity, pain or any photophobia

Bacterial This is characterised by a purulent discharge produced by pyogenic bacteria. This may cause the lids to stick together after sleeping or crusting of the eye and surrounding skin. Whilst pus is a hallmark feature of this form of conjunctivitis, it is not essential. The eye may feel gritty, and acute infection can be painful. Like viral conjunctivitis, it only affects one eye but often spreads to the other. Viral aka pink eye This is often associated with an upper respiratory tract infection, common cold or a sore throat. Symptoms include a watery discharge and itching. Redness appears as fine and diffuse within the conjunctiva, and resembles anterior uveitis (or iritis). Allergic This tends to be very itchy, with characteristic swelling of the conjunctiva and eyelid. There is often a ropy, non-purulent mucoid discharge.

Subconjunctival Haemorrhage
This is bleeding underneath the conjunctiva where blood collects between the outer conjunctiva and the sclera beneath it. It is caused by the rupture of small, fragile blood vessels within it and has a typically bright red initially, before turning green or yellow. It should disappear within 2 weeks. It is characterised by the rapid and spontaneous appearance of blood underneath the conjunctiva with no changes in visual acuity, pupils or the cornea. Whilst it may appear quite dramatic, it is usually not painful or harmful. However, it may be associated with one of the more severe of the following causes: minor eye trauma eye rubbing blood thinners severe coughing straining strenuous exercise vomiting severe hypertension This condition usually requires no treatment if there is no obvious cause (e.g. trauma). increased venous pressure Patients should be discouraged from taking NSAIDs or aspirin until the condition is resolved.

Episcleritis
This is inflammation of the episclera, which is the thin membrane which covers the sclera and lies between the sclera and conjunctiva. It is frequently idiopathic. There are two types 1. Simple This comes on quickly but is characterised by mild inflammation. It lasts for 7-10 days. People with this condition often have bouts, typically occurring every 1-3 months. The redness is often diffuse and this condition is commonly painless.

2. Nodular

This is more painful and lasts longer. The redness & inflammation is commonly localised to one part of the eye and there are often raised lumps in this area. This is frequently associated with underlying health conditions including SLE and rheumatoid arthritis. In both forms, visual acuity, the pupils and the cornea are normal. It usually clears up by itself but artificial tears may make the patient more comfortable.

Corneal Ulcer

aka ulcerative keratitis

This is an inflammatory or infective condition of the cornea, characterised by disruption of its epithelial layer and with frequent involvement of the corneal stroma. Causes: Trauma Contact Lenses Infection bacterial, viral, fungal Chemical Injury Dry Eye = keratoconjunctivitis sicca Pain Foreign Body Sensation Blurred Vision Photophobia Reduced Visual Acuity Redness often maximal around the edge of the cornea ciliary injection

Symptoms:

Diagnosis is made using a slit-lamp examination in conjunction with a fluorescein stain. This stain is taken up by the exposed corneal stroma and makes it appear green. Infective causes can be elucidating using corneal scraping and culture testing. Treatment is directed at the cause.

Scleritis
This is inflammation of the sclera and is often associated with underlying vasculitis. Symptoms include mild to sever eye pain, normal or decreased visual acuity, diffuse or localised redness and normal pupillary and corneal appearances.

Endopthalmitis
This is infection of the internal coats of the eye after eye surgery, injury or spread via the bloodstream. It is a dreaded consequence of eye surgery and often results in visual loss or loss of the affected eye altogether. Causes: Infection Trauma Retained Intraocular Foreign Bodies Haematogenous (spread via the bloodstream)

Symptoms include blurred vision, eye pain, photophobia and floaters. There is decreased visual acuity, diffuse or localised redness, a small, fixed pupil and a cloudy cornea