The Infected Red Eye

Simon Taylor MA PhD FRCOphthClinical Senior Lecturer & Consultant Ophthalmologist

Affected ocular structures

Conjunctiva Cornea Intraocular contents Lids and orbit

Symptoms and signs

SYMPTOMS

Pain Watering Redness Photophobia Diplopia Poor vision

SIGNS

Reduced visual acuity Lid swelling/redness Conjunctival

swelling/injection Corneal ulceration Hypopyon

Restricted eye movements

Relative afferent pupillary defect

Fever

Bacterial conjunctivitis

Very common Bilateral Redness Grittiness Morning stickiness Normal visual

acuity Staph &

Streptococcus

Severe conjunctivitis

HAEMORRHAGIC

Enterovirus 70 Highly contagious Self-limiting

GONOCOCCAL

Hyperacute onset Profuse creamy pus Periocular oedema

Viral Conjunctivitis

Adenovirus Acute onset Bilateral in 60% Watering, redness,

discomfort, photophobia

Follicular response Very contagious

Neonatal Conjunctivitis

5-14 days after birth

Mainly chlamydial Could be

gonococcal Purulent discharge Papillary reaction Sup. corneal

pannus Conjunctival

scarring

Corneal infections Contact lens wear

Bacterial Acanthamoeba

Gardening injury or Organic FB Bacterial Fungal

Wooden foreign body

scedosporium

Corneal infetions

Elderly, diabetic, use of expired eyedrops

Use of contact lenses

History of foreign body/trauma

Ask about cold sores Marginal

ulcer

Dendritic ulcers

Viral in origin Pain & Watering Photophobia Treat with Oc.

Aciclovir

Dendritic ulcers

Dendritic ulceration

AVOID STEROIDS!

Crystalline keratopathy

Viridans streptococci

Exogenous endophthalmitis

Following any intraocular procedure Cataract surgery Intravitreal injection

Pain, eyelid swelling, reduced vision and vitritis are all compelling signs

Endogenous endophthalmitis

BACTERIAL FUNGAL

Dacryocystitis

Lacrimal Sac Abscess

Acute or chronic Secondary to

blockage of nasolacrimal duct

Watering & discharge

Red, tense, painful swelling

Orbital cellulitis

Systemically unwell

Restricted eye movements

Optic nerve compromise Colour vision RAPD Distance acuity