1.
MANAGEMENT OF ACUTE
PAINLESS RED EYE
Dr. Tehreem Tanveer
PGT-2, FCPS, ASTEH

2.
ACUTE RED EYE
► Most common ocular complaint
► Common in both children and adults
► Careful history is vital to establish the cause
► Thorough clinical examination including visual acuity, slit lamp examination
fluorescein staining is necessary.

3.
HISTORY
• Onset, duration (acute, subacute, chronic, recurrent)
• Location (unilateral /bilateral /sectoral/diffuse)
• Pain/ discomfort (gritty, FB sensation, itch, deep ache)
• Photosensitivity
• Watering +/or discharge ( purulent/clear)
• Change in vision (blurring, halos etc)
• Exposure to person with red eye
• Trauma
• Contact lens wear
• Previous ocular history

4.
EXAMINATION
► Visual acuity for both eyes
► Eye lids (swelling, redness, crusting or matting of lashes)
► Pupillary reaction ( shape/ reaction to light/ accommodation)
► Conjunctiva (bulbar and palpebral) ( follicles ,papillae, subtarsal foreign body)
► Conjunctival hyperemia, ciliary congestion
► Cornea (clarity, sensation, fluorescein staining )
► Anterior chamber (cells/flare/depth of ac)
► Fundal examination
► Eye movements
► Lymphadenopathy ( pre-auricular lymphnodes)

5.
CAUSES OF PAINLESS RED EYE
 Blepharitis
 Trichiasis
 Subtarsal foreignbody
 Pinguecula
 Pterygium
 Episcleritis
 Viral conjunctivitis
 Allergic conjunctivitis
 Bacterial conjunctivitis

6.
BLEPHARITIS
 Inflammation of lid margin
 Meibomian gland dysfunction
 Characterized by
 lid crusting and redness
 Capping of meibomian
glands
 Frequently associated
with dry eyes, styes and
chalazion
 Staphylococcus and other skin
flora major causes.
 Mainstays of treatment
 Lid hygiene
 Topical antibiotics
 Lubricants
 Doxycycline- meibomian
gland disease.

7.
TRICHIASIS
• Inward turning lashes
• Aetiology: Idiopathic/ Secondary to
chronic blepharitis
• Symptoms- foreign body sensation,
tearing
• Treatment
• Lubricants
• Epilation with forceps
• Electrolysis- few lashes
• Cryotherapy- many lashes

8.
SUBTARSAL FOREIGN BODY
• History of foreign body
• Must evert eyelid and ask the
patient to look down
• Remove with cotton bud
• Stain with fluorescein for
corneal abrasions
• Treatment
Lubricants
+/- antibiotics

9.
SUBCONJUNCTIVAL HEMORRHAGE
Aetiology:
 Idiopathic
 Coughing/straining
 Hypertension
 Bleeding disorder
 Trauma
Symptoms:
 Painless red eye, asymptomatic
 VA not affected
 Clear demarcationborders
 Masks conjunctival vessels
Treatment:
 Check BP
 No treatment (lubricants)
 10-14 days to resolve
 If recurrent: clotting,FBC

10.
PTERYGIUM
• Triangular fold of conjunctiva that usually grows
from the medial portion of the palpebral
fissure towards & invades the cornea
• Non-malignant fibrovascular growth
• Predisposing factors:
– Hot climates
– Chronic dryness
– Exposure to sun
• Management
• Topical fluorometholone for inflamed
ptrygium
definitive treatment is surgical removal
Recurrence is common.

11.
PINGUECULA
• Yellow-white deposits on bulbar
conjunctiva adjacent to the nasal or
temporal limbus
• May become acutely inflamed-
pingueculitis
• Treatment:
• Normally unnecessary as growth is slow or
absent
• Topical fluorometholone for pingueculitis

12.
EPISCLERITIS
► Episcleral inflammation
► Localized (sectoral) or diffuse
► Symptoms/Signs:
 Often asymptomatic
 Mild tearing/ irritation
 Tender to touch
 Vessels blanch with
phenylephrine
► Self-limiting (may last for
months)
► Treatment
 Lubricants
 NSAIDS
 Low dose steroids

13.
VIRAL CONJUNCTIVITIS
Adenovirus (commonest, highly contagious
(epidemic), Coxsackie, Herpes Simplex.
Systemic infection – influenza virus, Epstein-
Barr virus, measles, mumps & rubella.
Conjunctiva is often intensely hyperemic
May be associated:
 Follicles
 Hemorrhages, chemosis
 Inflammatory membranes
 Lymphadenopathy (esp. preauricular
node)

14.
Symptoms
 Acute onset
 Bilateral
 Waterydischarge
 Soreness, FB sensation
 History of URTI
 H/o contact
► Treatment:
 No specific therapy, self resolving, up to
two weeks
 Advice cold compresses, frequent
hand washing(very contagious)
 Lubricants for symptomatic relief.
 Antibiotic eye drops to prevent secondary
bacterial infection.

15.
BACTERIAL CONJUNCTIVITIS
• Aetiology:
– Staphylococcus, Streptococcus, Pneumococcus,
Haemophilus
• Patient presents with:
– red eye, purulent discharge yellow crusts,
ocular irritation (gritty, burning & pain
sensation).
– History of contact with infected person. Usually,
unilateral bilateral.
• Treatment
– 1) Broad spectrum Antibiotic drops  hasten
resolution (used during daytime, e.g moxifloxacin,
ofloxacin,chloramphenicol, gentamicin)
– 2)Antibiotic ointment (used at night, during sleep).

16.
ALLERGIC CONJUNCTIVITIS
Two thirds have Family History atopy
► Symptoms/Signs:
 Itch+++
 Bilateral
 Watery discharge
 Chemosis (oedema)
 Papillary hypertrophy and giant
papillae

17.
► Treatment (severity dependent)
 cold compresses
 antihistamines
 mastcell stabilizers (sodium
cromoglycate)
 topical corticosteroids
 Immunosuppressants (cyclosporin) for
steroid resistant cases
 Tacrolimus 0.03% eye ointment

18.
THANKYOU.