At times the differential diagnosis includes more serious conditions that potentially threaten vision. Reprinted in ivis with the permission of wsava close this window to return to ivis 36th world small animal veterinary congress 2011 jeju, korea. Pdf differential diagnosis of red eye researchgate. 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. Subconjunctival haemorrhage diffuse or localised area of blood under. Journal of pediatric ophthalmology and strabismus differential diagnosis of eye diseases, by hans pau, m. Urgent ophthalmological referral is also advisable for pain free chronic unilateral red eye with lagophthalmos. Differential diagnosis for conjunctival hyperemia red eye.
Conjunctivitis papillae follicles purulent discharge redness chemosis. Conjunctivitis can affect one or both eyes and is the most likely diagnosis. The red eye challenge litfl ophthalmology befuddler. Viral conjunctivitis most common cause of red eye allergic irritant conjunctivitis bacterial conjunctivitis neonatal conjunctivitis ophthalmia neonatorum blepharitis.
Allergic rhinoconjunctivitis and differential diagnosis of. Most causes of a red eye are benign or selflimited and can be managed by a primary care physician. Pdf on may 1, 2011, khathutshelo percy mashige and others published differential diagnosis of red eye find, read and cite all the research you need on researchgate. Diagnosis and management of red eye in primary care american. A detailed history of the presenting symptoms and previous ophthalmic and medical. Macleods clinical diagnosis pdf 2nd edition free download.
The challenge lies in discerning one from the other. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis. Eye education for emergency clinicians 20 conclusion remember beware of the. Conjunctivitis is the most common cause of red eye and is one of the leading indica tions for antibiotics. Understand the principles of management of the acute red eye 3. You check the triage note of the next patient red eye is written capitals. However, some etiologies require urgent referral to an ophthalmologist. Differential diagnosis of conjunctivitis and the red eye. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated. Assessment of red eye differentials bmj best practice. 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.
Acute red eye is a common presenting complaint to primary care physicians. A small proportion of red eye cases are serious and need urgent treatment. Red eye is a common presentation in primary care and is a sign of inflammation. 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. The differential diagnosis includes both benign and sightthreatening conditions. A symptom common to eye impairments is conjunctivitis, or red eye, a commonly seen manifestation in an ambulatory pediatric population.
Red eye is the most common eye disorder seen in primary care. These can be classified according which structure is abnormal. The condition is usually benign and can be managed by primary care physicians. A thorough history and clinical assessment should enable you to rule out concerning features and narrow the differential diagnosis.
The differential diagnosis of the red eye the differential diagnosis of the red eye by stacey singerleshinsky rpac the red eye the most common cause of red eye is conjunctivitis always check visual acuity. 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. Red flag warnings for eye redness include pain not discomfort or irritation, decreased vision, profuse discharge, and corneal defect grossly visible. Dacryocystitis differential diagnoses medscape reference. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes.
The author, who is professor of ophthalmology at dusseldorf, west germany, has used an interesting and novel approach for the discussion of ocular diseases. A red eye is a nonspecific term to describe an eye that appears red due to illness or. Differential diagnosis of red eye conjunctiva pupil cornea anterior chamber iop subconjunctival haemorrhage bright red normal normal normal normal conjunctivitis injected vessels, fornices. Macleods clinical diagnosis 2nd edition pdf download free. Most cases will be due to relatively benign problems. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis is in doubt.
A detailed history of the presenting symptoms and previous ophthalmological and medical history can narrow the differential diagnosis. Evaluation of red eye differentials bmj best practice. In the emergency department, 75% of ophthalmologic complaints are due to conjunctivitis, corneal abrasions, or foreign bodies. There is a wide differential diagnosis for red eye. Practioners are often confronted with a patient who presents with the red eye. Jan 15, 2010 red eye is the cardinal sign of ocular inflammation.
Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. 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. Things are humming along nicely in the fast track area of the emergency department. A red eye is an eye that appears red due to illness or injury. A red eye is a cardinal sign of ocular inflammation, which can be caused by several conditions eg, subconjunctival hemorrhage see the image. Assessment of red eye differential diagnosis of symptoms. The diagnosis of the cause of red eye can be a challenge for the pediatrician because the differential diagnosis includes a. Differential diagnosis of eye diseases jama ophthalmology. This should be an easy and excellent way of diagnosing any. Differentiating urgent and emergent causes of acute red eye for. Although the exact incidence of diagnoses presenting as a red eye is not well defined, most are benign. Mar 17, 2009 differential diagnosis of red eye slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Mar 11, 2008 read the differential diagnosis of the red eye, international ophthalmology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Acute red eye differential diagnosis conjunctivitis keratitis uveitisiritis acute angle closure glaucoma scleritis episcleritis subconjunctival haemorrhage ocular trauma. Common causes of red eye and their clinical presentations are summarized in. Conjunctivitis is the most common cause of red eye. This small handbook was meant to provide a differential diagnosis for those who provide eye care. Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics. When in doubt ophthalmology consult 64091 please, please, pleasecheck the vision prior to calling. 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. Jul 27, 2015 red eye is a common presentation in primary care and is a sign of inflammation. The presence of eye pain and reduced visual acuity are red flags for sinister ophthalmological diagnoses. Red eye red eye is sign of pathology of anterior or posterior ocular segment, of orbit or of ocular adnexa. 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. Diagnosis and management of pediatric conjunctivitis. Painless red eye causes ophthalmology geeky medics.
The differential diagnosis of the red eye springerlink. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. The differential diagnosis of the red eye, international. The most common cause of red eye presenting in a primary care setting is conjunctivitis. Differential diagnosis armed with clues from the clinical history and physical examination, we can proceed to a logical anatomical and mechanistic breakdown of the causes of the red eye clinical entities summarised in table 2. Managing the red eye 4 introduction slide 1 physicians frequently encounter patients who complain of a red eye. Viral conjunctivitis can be treated with supportive care and preservativefree artificial tears up to eight times per day. The red eye hsv keratitis anterior uveitis subconjunctival haemorrhage corneal ulcer episcleritis scleritis acute angle closure glaucoma conjunctivitis red eye. Misdiagnosis is a major medicolegal pitfall, in that the truly emergent conditions that may cause red eye have major visionthreatening sequelae. Differential diagnosis of pediatric conjunctivitis red. Red eye is a common presenting complaint in ambulatory practice. If you continue browsing the site, you agree to the use of cookies on this website. The differential diagnosis of red eye can be narrowed down rapidly.
A unique book allowing a reader to apply the skills of clinical examination in the formulation of a differential diagnosis and placing a patients symptoms in context. The differential diagnosis is so large that the caregiver must be comfortable with all diagnoses and must be able to distinguish between them. 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. 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 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. Essentials of anatomy and physiology, examinations of the visual system, the child with suspected eye disease, chronic loss of vision, acute painless visual disturbance, the acute red eye, abnormal looking eyes, chronic ocular unease and associated. There are little epidemiologic data on the red eye, and there are no evidencebased data to guide us in the management of these patients. There are six serious causes of red eye, which can result in visual loss. The red eye in children is a frequent complaint in general practice. Springer nature is making sarscov2 and covid19 research free. Mar 11, 2008 springer nature is making sarscov2 and covid19 research free.
Knowledge of the various causes of conjunctivitis is important for pediatric clinicians to determine if the child requires specific treatment and if referral to an ophthalmologist is warranted. Apr 28, 2017 any patient with nonpainful acute unilateral red eye should be seen by an ophthalmologist within 24 h for exclusion of a carotidcavernous sinus fistula. Takes a problembased approach to diagnostic reasoning, reflecting both modern medical and current educational practices. In addition, a discussion of the most common differential diagnoses for the presentation of red eye and its treatment is provided. Macleods clinical diagnosis demonstrates how to apply the core clinical skills learned from the companion textbook macleods clinical examination to maximum advantage.
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. The differential diagnosis for red eye is broad because many ophthalmic conditions masquerade as conjunctivitis table. Medical student education 1 rating pdf 885 kb download susan lightman, frcp, frcophth, phd, professor of clinical ophthalmology at moorfields eye hospital, london, 2007. Oct 08, 2019 the lacrimal excretory system is prone to infection and inflammation for various reasons. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree. The red eye international council of ophthalmology. Differential diagnosis of pediatric conjunctivitis red eye. 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. The differential diagnosis of red eye can be narrowed down rapidly with simple baseline tests and targeted questioning.
For each sign and symptom, the differential diagnosis is discussed in detail. With a discussion of important aspects to include in the patient history as well as a systematic guide to examination of the eye for generalists and allergists, this article provides a plan of action in the examination protocol for red eye patients. Understand the diagnostic approach to the acute red eye 2. Diagnosis and management of red eye in primary care. 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. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis. This mucous membranelined tract is contiguous with 2 surfaces conjunctival and nasal mucosal that are normally colonized with bacteria. Differential diagnosis of red eye slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Modules originally designed for emergency nurses as a component of the eye emergency manual project. A worrisome sign that a red eye is caused by a serious intraocular cause is the presence of perilimbal injection otherwise known as a ciliary flush. The red eye has an extensive differential diagnosis. Diagnosis refer urgently no corneal staining are pupil sizes different. Concerning features of a red eye include pain and reduce visual acuity. Because conjunctivitis is caused by various etiologies, clinicians must derive a differential diagnosis. Clinical evaluation of red eyes in pediatric patients. Red eye no injury this a2 size poster covers the differential diagnosis and primary level management of red eyes with no injury. 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. Differential diagnosis of the red eye carol slight nurse practitioner ophthalmology. Serious and potentially sightthreatening causes of red eye. This article examines possible causes of conjunctivitis after the neonatal period in this population. 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. Small, fixed, irregular normal, kps turgid, deep normal acute glaucoma entire eye red fixed, dilated, oval hazy shallow high.
A red eye is a cardinal sign of ocular inflammation, which can be caused by several conditions eg, subconjunctival hemorrhage see the image below, defined as blood between the. 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. Common causes of a painless red eye include subconjunctival haemorrhage, episcleritis, conjunctivitis and blepharitis. Essentials of anatomy and physiology, examinations of the visual system, the child with suspected eye disease, chronic loss of vision, acute painless visual disturbance, the acute red eye, abnormal looking eyes. From a mechanistic viewpoint, the eye will assume a red. Discharge normal normal normal normal iritis injected around cornea small, fixed, irregular normal, kps turgid, deep normal. Common causes of red eye and their clinical presentations are. Authored by susan lightman posted on may 14, 2010 topic.
1060 1551 951 1196 764 1596 63 1172 196 1669 1143 1659 1100 271 1007 83 1501 176 1100 1545 1071 358 1327 242 62 1281 798 921 1378 784 642 1366 993 970 154 1123 307 1300 603 837 659 1060 310 1301 329 111