Understanding Different Types of Red Eye

Viral conjunctivitis is a common cause of red eye, characterized by inflamed conjunctiva and itchiness. It is often caused by adenovirus and can follow an upper respiratory tract infection. Anterior uveitis or iritis, on the other hand, presents with unilateral inflamed conjunctiva, pain, and light sensitivity. It can be associated with systemic inflammatory disease and a past medical history of inflammatory arthropathy. Bacterial conjunctivitis, on the other hand, results in purulent discharge with no pre-auricular lymphadenopathy. Episcleritis is usually unilateral and causes segmental injection with no discharge and minimal discomfort. Lastly, scleritis is an inflammatory disease that causes severe ocular pain and is often associated with rheumatoid arthritis or vasculitis. It causes redness of the sclera and conjunctiva. Understanding these different types of red eye can help in proper diagnosis and treatment.

Subconjunctival haemorrhages typically clear up on their own within two weeks and do not require any treatment. However, it is important to check the patient’s blood pressure as these haemorrhages can be linked to high blood pressure. Additionally, it should be noted that the cornea is not affected by a subconjunctival haemorrhage.

Subconjunctival haemorrhages occur when blood vessels in the subconjunctival space bleed. These vessels typically supply the conjunctiva or episclera. Trauma is the most common cause, followed by spontaneous idiopathic cases, Valsalva manoeuvres, and several systemic diseases. While subconjunctival haemorrhages can look alarming, they are rarely an indicator of anything serious. They are more common in women than men, and the risk increases with age. Newborns are also more susceptible. The incidence of both traumatic and non-traumatic subconjunctival haemorrhages is 2.6%.

Risk factors for subconjunctival haemorrhages include trauma, contact lens usage, idiopathic causes, Valsalva manoeuvres, hypertension, bleeding disorders, certain drugs, diabetes, arterial disease, and hyperlipidaemia. Symptoms include a red eye, usually unilateral, and mild irritation. Signs include a flat, red patch on the conjunctiva with well-defined edges and normal conjunctiva surrounding it. The patch’s size can vary depending on the size of the bleed and can involve the whole conjunctiva. Traumatic haemorrhages are most common in the temporal region, with the inferior conjunctiva as the next most commonly affected area. Vision should be normal, including acuity, visual fields, and range of eye movements. On examination, the fundus should be normal.

The diagnosis of a subconjunctival haemorrhage is clinical. If there is no obvious traumatic cause, check the patient’s blood pressure. If raised, refer the patient appropriately. If the patient is taking warfarin, check the INR. If raised, refer for appropriate adjustments to the dose to bring the INR back into the target range. If you cannot see the whole border of the haemorrhage, it may be associated with an intracranial bleed or an orbital roof fracture. Further appropriate investigations should then be done, including a full cranial nerve exam looking for neurological signs as well as a CT head, after discussion with a senior. Recurrent or spontaneous, bilateral subconjunctival haemorrhages warrant investigations for bleeding disorders or other pathology.

Reassure the patient that subconjunctival haemorrhages are a benign condition that will resolve on their own in 2 to 3 weeks.

Common Symptoms of Nerve Palsies

A nerve palsy is a condition that affects the function of a specific nerve. There are different types of nerve palsies, each with their own set of symptoms. Here are some common symptoms associated with different types of nerve palsies:

Third Nerve Palsy: This type of palsy is characterized by ptosis (drooping of the eyelid), a dilated and unreactive pupil, and downward and outward displacement of the eyeball. The affected eye may also have a divergent squint.

Seventh Nerve Palsy: In this type of palsy, increased lacrimation (tearing) may be seen. The affected eye may also have difficulty closing, resulting in dryness and irritation.

Horner’s Syndrome: This type of palsy is characterized by enophthalmos (sunken appearance of the eye) and miosis (constriction of the pupil). Other symptoms may include ptosis and decreased sweating on one side of the face.

By understanding the common symptoms associated with different types of nerve palsies, individuals can seek appropriate medical attention and treatment.

Common Eye Conditions and Their Symptoms

Blepharitis: This condition is commonly seen in adults and can be divided into anterior and posterior blepharitis. Anterior blepharitis affects the skin and eyelashes, while posterior blepharitis involves the meibomian glands. Symptoms include red and swollen eyelids, crusts at the base of eyelashes, a gritty or burning sensation in the eyes, and excessive watering. Regular lid cleaning with baby shampoo is key to effective management, and topical antibiotics may be used if there is an infection.

Viral Conjunctivitis: Those with viral conjunctivitis typically have a recent history of upper respiratory tract infection or contact with a sick individual. Symptoms include redness, watering, and discharge from the eyes. This condition usually settles in 1-2 weeks and is not chronic.

Chlamydial Conjunctivitis: This condition is characterized by chronic low-grade conjunctivitis that may persist for 3-12 months if left untreated. Symptoms include a green stringy discharge in the morning. Recurrent conjunctivitis in sexually active patients should raise the possibility of chlamydia.

Contact Dermatitis: Excessive eye makeup use can lead to contact dermatitis. Symptoms include redness, itching, and swelling in the periorbital area. A history of new cosmetics or makeup use should be explored.

Meibomianitis: Symptoms of meibomianitis include dry and gritty eyes, skin flaking around the eyes, and crusty eyes after sleeping. This condition responds to long courses of systemic antibiotics. However, the symptoms described here are more consistent with blepharitis than meibomianitis.

Understanding Common Eye Conditions and Their Symptoms

Optic Disc Examination and Common Findings

Optic disc examination is a crucial assessment for patients with primary open-angle glaucoma as it directly indicates disease progression. The optic disc is evaluated by observing the vertical ratio of the pale center (cup) to the overall size of the disc. The pink rim of the disc contains nerve fibers, while the white cup is a pit without nerve fibers. A normal ratio is 0.3 or less, with a small cup and a thick pink neuroretinal rim. However, some people may have a cup-to-disc ratio up to 0.6, but anything beyond that is pathological. As glaucoma progresses and retinal damage occurs, the cup enlarges until it occupies most of the disc area.

Dot and blot hemorrhages are forms of intraretinal hemorrhage often noted in background (non-proliferative) diabetic retinopathy, branch retinal vein occlusion, carotid occlusive disease, and child abuse. Arteriovenous nipping is constriction of a vein at an artery-vein crossing-point and is found in hypertension. Drusen are very small yellow or white spots that appear in Bruch’s membrane and are associated with age-related macular degeneration. A pale disc is characteristic of longstanding optic neuropathy, and causes include optic neuritis and ischemia.

Understanding Optic Disc Examination and Common Findings

Retinal Detachment: Causes, Symptoms, and Treatment

Retinal detachment is a serious condition that can lead to permanent vision loss if left untreated. It occurs when the retina, the thin layer of tissue at the back of the eye responsible for transmitting visual information to the brain, separates from its underlying support tissue. Here are some important facts about retinal detachment:

Causes: Retinal detachment can result from a variety of factors, including a posterior vitreous detachment, myopia, severe acute hypertension, inflammation, or neoplastic effusions.

Symptoms: Symptoms of retinal detachment include sudden onset of floaters, flashes of light, and a curtain-like shadow over the visual field. However, some patients may not experience any symptoms at all.

Treatment: Retinal tears and holes are treated with cryotherapy or laser photocoagulation. Most actual detachments require surgery to flatten the retina. Patients who do not have immediate surgery may have strict bedrest and to hold the head in a particular position to prevent progression of the detachment. The retina is successfully reattached in around 85% of cases. In cases where the macula is not involved, 90% of patients have 20/40 vision or better after reattachment surgery.

Understanding Retinal Detachment: Causes, Symptoms, and Treatment

Visual Field Defects and Their Causes

Central scotoma is a condition where there is a reduced vision in the central area, which can interfere with daily activities such as reading and driving. This condition is often caused by a lesion between the optic nerve head and the chiasm and is commonly associated with retrobulbar neuritis and optic atrophy.

Tunnel vision, on the other hand, is a condition where there is a loss of peripheral vision, resulting in a narrow field of vision. This condition is often seen in patients with glaucoma, retinitis pigmentosa, and those who have undergone retinal panphotocoagulation.

Papilloedema, which is an increase in pressure around the optic nerve, can cause an increased blind spot, which may lead to optic atrophy. Finally, optic chiasma compression can cause bitemporal hemianopia, which is a condition where there is a loss of vision in both temporal fields. Understanding these visual field defects and their causes is crucial in diagnosing and treating patients with visual impairments.

Antimicrobial treatment is often unnecessary for most cases of infective conjunctivitis, regardless of whether it is caused by a virus or bacteria. It can be challenging to differentiate between the two, although bacterial conjunctivitis may present with purulent discharge instead of watery discharge. Patients can alleviate symptoms with self-care measures such as cold compresses and ocular lubricants. If symptoms persist after seven days, patients should seek further medical attention. In severe cases of suspected bacterial conjunctivitis, chloramphenicol ointment can be purchased over the counter, while fusidic acid may be used as a second-line antimicrobial. Herpetic conjunctivitis, which causes a painful red eye with vesicular eyelid lesions, can be treated with aciclovir. Swabs are not useful in diagnosing conjunctivitis.

Infective conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes that are accompanied by a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.

In most cases, infective conjunctivitis is a self-limiting condition that resolves on its own within one to two weeks. However, patients are often offered topical antibiotic therapy, such as Chloramphenicol or topical fusidic acid. Chloramphenicol drops are given every two to three hours initially, while chloramphenicol ointment is given four times a day initially. Topical fusidic acid is an alternative and should be used for pregnant women. For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. It is important to advise patients not to share towels and to avoid wearing contact lenses during an episode of conjunctivitis. School exclusion is not necessary.

The most probable diagnosis for this description is age-related macular degeneration (ARMD). In the initial stages, patients may experience difficulty in reading or identifying details. A common symptom of ARMD is the perception of straight lines appearing bent or distorted, as mentioned in the description. This can be assessed in a clinical setting using an Amsler grid.

Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by degeneration of the central retina (macula) and the formation of drusen. The risk of ARMD increases with age, smoking, family history, and conditions associated with an increased risk of ischaemic cardiovascular disease. ARMD is classified into dry and wet forms, with the latter carrying the worst prognosis. Clinical features include subacute onset of visual loss, difficulties in dark adaptation, and visual hallucinations. Signs include distortion of line perception, the presence of drusen, and well-demarcated red patches in wet ARMD. Investigations include slit-lamp microscopy, colour fundus photography, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Treatment options include a combination of zinc with anti-oxidant vitamins for dry ARMD and anti-VEGF agents for wet ARMD. Laser photocoagulation is also an option, but anti-VEGF therapies are usually preferred.

Understanding Dry Eyes

Dry eyes occur when there is a deficiency in tear production or excessive evaporation. This can lead to inflammation and is a common condition, especially in older individuals. Symptoms include a dry and gritty feeling in the eyes, which worsens throughout the day. Mild light sensitivity may also be present, along with redness and a punctate pattern on fluorescein staining. Treatment involves using tear substitutes, with eye ointment used at night to supplement this. If blepharitis is present, eyelid massage, warm compresses, and hygiene measures may also be necessary.