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Acute Red Eye
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The Acute Red eye

This is a common exam question. The causes are usually one of the following:

Conjunctivitis

This manifests as a "gritty" red eye. There may be a sticky discharge (especially after sleep), if the infection is bacterial. There is normal visual acuity, the pupil is normal. Causes include S aurues, H influenzae, Pseudomonas, Chlamydia, and viruses such as herpes simplex.

The treatment is topically 2 hourly antibiotics. Advice to give to patients is that it is very infectious, so don't share towels.

Uveitis

This is inflammation of all or part of the uveal tract. It manifests as a red eye with circumcorneal injection and constant "aching" pain. The pupil is small and fixed. There may be loss of visual acuity in severe cases. Uveitis is associated with retinal detachment. The condition is associated with ankylosing spondylitis, psoriasis, sarcoidosis, Crohn's, ulcerative colitis, syphilis and TB.

Treatment is with topical steroids and pupillary dilators, as well as treatment of the underlying cause.

Episcleritis

This is a common condition which is benign and self-limiting. It may be associated with collagen diseases, herpes zoster, gout and syphilis. It manifests as a localised inflamed patch on the sclera.

A non-steroidal anti-inflammatory should be given.

Scleritis

This is more serious than scleritis and presents with severe pain. Vision may be affected and there may be focal or diffuse redness of the sclera. The same associations, such as a strong connection to rheumatoid arthritis, are also true of scleritis.

The condition is resistant to treatment, but non-steroidal are tried.

Conjunctival haemorrhage

A blood level is seen. It is usually due to trauma. Treatment is not required.

Foreign body

A painful "gritty" eye. The pupil is normal and vision is not impaired. There may be a history of trauma. Topical anaesthesia to examine the eye, and eversion of the upper lid is tried. It may be necessary to remove foreign bodies in the cornea with drill tips.

Acute Glaucoma

This is discussed in this section .
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