Red eye resident survival guide: Difference between revisions

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==Treatment==
==Treatment==
The management of the [[red eye]] will depend on the underlying cause.
The management of the [[red eye]] will depend on the underlying cause.
* Life-threatening causes
{| class="wikitable" border="1"
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| AACG}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Endophthalmitis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Necrotizing Scleritis}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| Herpetic keratitis}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF|  Chemical injury}}
|-
|
*'''Lowering of [[IOP]]''': [[Acetazolamide]] 500mg IV or PO + topical [[Beta blockers]], [[Alpha 2 agonists]], [[Prostaglandin analogue]]<ref name="pmid30487684">{{cite journal| author=Murray D| title=Emergency management: angle-closure glaucoma. | journal=Community Eye Health | year= 2018 | volume= 31 | issue= 103 | pages= 64 | pmid=30487684 | doi= | pmc=6253313 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30487684  }} </ref>
*'''Reduce pain''': Topical [[steroids]] ([[prednisolone]])
*'''Reduce nausea and vomiting''': [[Anti emetics]] ([[Metoclopramide]])
|
*[[intravitreal]] injections of [[vancomycin]] and [[ceftazidime]]<ref name="pmid21572565">{{cite journal| author=Novosad BD, Callegan MC| title=Severe bacterial endophthalmitis: towards improving clinical outcomes. | journal=Expert Rev Ophthalmol | year= 2010 | volume= 5 | issue= 5 | pages= 689-698 | pmid=21572565 | doi=10.1586/eop.10.52 | pmc=3092298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21572565  }} </ref>
**Or combination of vancomycin and [[amikacin]]
*Topical [[Fluoroquinolones]] (levofloxacin)
*[[Vitrectomy]] in severe cases
|
* Oral [[Corticosteroids]]<ref name="pmid27734292">{{cite journal| author=Lawuyi LE, Gurbaxani A| title=Refractory necrotizing scleritis successfully treated with adalimumab. | journal=J Ophthalmic Inflamm Infect | year= 2016 | volume= 6 | issue= 1 | pages= 37 | pmid=27734292 | doi=10.1186/s12348-016-0107-y | pmc=5059540 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27734292  }} </ref><br>Or
* [[(TNF)-inhibiting]] anti-inflammatory ([[adalimumab]]) or ([[infliximab]])
|
* [[Ganciclovir]] 0.15% ophthalmic gel
* Topical steroid
* Surgical [[debridement]] in severe cases
|
* Emergency treatment<ref name="pmid24082664">{{cite journal| author=Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD| title=Ocular chemical injuries and their management. | journal=Oman J Ophthalmol | year= 2013 | volume= 6 | issue= 2 | pages= 83-6 | pmid=24082664 | doi=10.4103/0974-620X.116624 | pmc=3779420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24082664  }} </ref>
** Irrigation with [[isotonic saline]] or [[lactate ringer]]
** tear substitutes
* Further treatment
** Collagenase inhibitors  [[acetylcysteine]]
** Topical steroids
** [[Ascorbate]]


==Do's==
==Do's==

Revision as of 17:29, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Overview

Red eye is an essential sign of eye inflammation. Although it is usually benign and can be managed by primary care physician, It is important to distinguish between benign and sight-threatening diagnoses. Its most common cause is conjunctivitis. However, the other common causes are subconjunctival hemorrhage, blepharitis, scleritis, corneal abrasion, glaucoma and foreign body. Red eye can be concomitant photophobia, eye discharge, pain, itiching and visual changes.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[1]

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of red eye.[3][2]

{{
 
 
 
 
 
 
 
Patients with red eye
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild or no pain with mild blurring or normal vision
 
 
 
 
 
 
 
Moderate to severe pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Local
 
Diffuse
 
 
 
 
 
Vesicular rash, Corneal ulcer, Iritis, Acute angle gluacoma, Chemical burn, Traumatic eye injury
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discharge
 
 
 
 
 
Emergency Ophthalmology referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intermittent
 
 
 
Continuous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dry eye
 
Watery or Serous
 
 
Mucopurulent to Purulent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ItichingClamydial Conjunctivitis
 
Acute bacterial conjunctivitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild to non
 
 
 
Moderate to severe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral Conjunctivitis
 
 
 
Allergic Conjunctivitis
 
 
 
 

Treatment

The management of the red eye will depend on the underlying cause.

  • Life-threatening causes
AACG Endophthalmitis Necrotizing Scleritis Herpetic keratitis Chemical injury

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. ↑ Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M (2017). "Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician". West J Emerg Med. 18 (3): 509–517. doi:10.5811/westjem.2016.12.31798. PMC 5391903. PMID 28435504.
  2. ↑ 2.0 2.1 Cronau H, Kankanala RR, Mauger T (2010). "Diagnosis and management of red eye in primary care". Am Fam Physician. 81 (2): 137–44. PMID 20082509.
  3. ↑ Noble J, Lloyd JC (2011). "The red eye". CMAJ. 183 (1): 81. doi:10.1503/cmaj.090379. PMC 3017259. PMID 20921253.
  4. ↑ Murray D (2018). "Emergency management: angle-closure glaucoma". Community Eye Health. 31 (103): 64. PMC 6253313. PMID 30487684.
  5. ↑ Novosad BD, Callegan MC (2010). "Severe bacterial endophthalmitis: towards improving clinical outcomes". Expert Rev Ophthalmol. 5 (5): 689–698. doi:10.1586/eop.10.52. PMC 3092298. PMID 21572565.
  6. ↑ Lawuyi LE, Gurbaxani A (2016). "Refractory necrotizing scleritis successfully treated with adalimumab". J Ophthalmic Inflamm Infect. 6 (1): 37. doi:10.1186/s12348-016-0107-y. PMC 5059540. PMID 27734292.
  7. ↑ Singh P, Tyagi M, Kumar Y, Gupta KK, Sharma PD (2013). "Ocular chemical injuries and their management". Oman J Ophthalmol. 6 (2): 83–6. doi:10.4103/0974-620X.116624. PMC 3779420. PMID 24082664.


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