Ojo Rojo Como no confundirse con todos los diagnósticos diferenciales - Por: Dr. Santiago Dueñas

Understanding Red Eye: Causes and Differential Diagnosis

Introduction to Red Eye

• The speaker introduces themselves as Anteagodudeñas, a specialist in Ostramología, emphasizing that red eye is a common reason for emergency consultations and general practice.

Causes of Red Eye

• The causes of red eye range from benign conditions to serious issues that can lead to significant visual impairment or overall health risks. The presentation will cover differential diagnoses based on etiology, clinical features, and risk factors.

Classification of Red Eye

• Red eye is clinically referred to as hyperemia with various patterns:

• Generalized pattern affecting the entire conjunctiva.

• Ciliary pattern characterized by a band around the cornea.

• Mixed pattern combining both social and individual aspects.

Hemorrhagic Conditions

• One differential diagnosis discussed is subconjunctival hemorrhage, defined as blood extravasation in the conjunctival space. Most cases are benign and can result from increased intraocular pressure due to activities like coughing or straining.

Clinical Features of Subconjunctival Hemorrhage

• Key characteristics include:

• A well-defined red spot that does not cross the limbus.

• Generally painless with no impact on vision.

• Typically self-limiting within one to two weeks; artificial tears may be recommended for symptom relief.

Infectious Causes of Red Eye

Conjunctivitis Overview

• Conjunctivitis accounts for approximately 80% of infectious cases. It can be viral or allergic in nature, with viral conjunctivitis being particularly prevalent.

Viral Conjunctivitis Details

• Adenovirus is identified as the primary causative agent in about 65% to 90% of viral conjunctivitis cases. Its high transmissibility means nearly half of affected individuals may spread it.

Symptoms and Signs

• Common symptoms include:

• Red eyes with discharge (often watery).

• Sensation of foreign body presence.

• Photophobia and moderate tearing; signs often include diffuse redness and follicular response in preauricular lymph nodes.

Management Strategies

Understanding Allergic Conjunctivitis and Its Management

Key Symptoms and Clinical Presentation

• Allergic conjunctivitis presents with symptoms such as itching, redness, foreign body sensation, photophobia, and is often bilateral from the onset.

• The condition can lead to chemosis (swelling of the conjunctiva), which is a significant indicator in clinical diagnosis.

• Patients may experience papillary conjunctivitis characterized by cobblestone-like lesions on the eyelids.

Differential Diagnosis and Treatment Options

• Differentiating allergic conjunctivitis from other conditions like viral conjunctivitis is crucial; symptoms include red eyes and discharge that tends to be more watery in allergic cases.

• Common treatments include antihistamines like olopatadine, which stabilizes mast cells and alleviates symptoms when applied regularly for several weeks.

Antibiotic Use in Bacterial Conjunctivitis

• In cases of bacterial conjunctivitis, yellow-green purulent discharge is typical; treatment involves antibiotics such as aminoglycosides (e.g., tobramycin).

• Fluoroquinolones like ciprofloxacin or levofloxacin are also effective options for broader coverage against resistant strains.

Managing Severe Cases

• For severe bacterial infections, intravenous antibiotics may be necessary; ciproflaxin can be administered alongside treatment for potential chlamydial infection.

• Rapid onset infections require immediate attention; distinguishing between mild and severe cases helps guide appropriate antibiotic therapy.

Important Considerations in Treatment Protocol

• When treating ocular infections, it’s essential to consider co-infections (e.g., chlamydia); dual therapy may be warranted based on clinical presentation.

Corneal Infections and Management

Overview of Corneal Infections

• Corneal infections can arise from various pathogens, including viral, bacterial, fungal, and parasitic sources. The management may involve oral or topical antiviral medications such as acyclovir or erythromycin.

Viral Infections: Herpes Simplex Virus

• Herpes simplex virus type 1 is a common cause of corneal infections. It typically reactivates rather than being a primary infection, often triggered by stress or other factors that lower the immune response.

Symptoms and Diagnosis

• Key symptoms include acute pain, photophobia (light sensitivity), decreased vision, conjunctival erythema (redness), and characteristic dendritic ulcers visible with fluorescein staining.

Treatment Approaches for Epithelial Keratitis

• For epithelial keratitis caused by herpes simplex, treatment involves topical antivirals like acyclovir five times daily for 14 days. Systemic antivirals may also be prescribed in severe cases.

Stromal Keratitis Management

• Stromal keratitis affects the deeper layers of the cornea and requires oral antivirals along with topical steroids to manage inflammation. Topical antivirals are ineffective here due to their inability to penetrate the stroma.

Bacterial Infections: Risk Factors and Symptoms

• Bacterial infections are often associated with contact lens use or ocular surface diseases like severe dry eye or blepharitis. Symptoms include severe ocular pain, redness, and well-defined yellowish-white ulcers on the cornea.

Treatment for Bacterial Ulcers

• Management depends on ulcer characteristics; small peripheral ulcers may be treated with antibiotics like fluoroquinolones every 1–2 hours. Larger or more serious ulcers require fortified antibiotics prepared specifically for treatment.

Infection Management and Treatment Strategies

Overview of Treatment Protocols

• The treatment involves administering a 5% solution with an additional 2% component, which is expected to be sent every hour, including overnight. This approach aims for gradual improvement over a period of 2 to 3 weeks.

Fungal Infections and Their Characteristics

• Discusses the unique characteristics of fungal infections, particularly in patients with corneal trauma involving plant material. These infections are often associated with prolonged contact lens use and previous ocular conditions.

Symptoms and Diagnosis

• Key symptoms include photophobia, blurred vision, and the presence of a specific type of lesion characterized by fuzzy edges that can be difficult to distinguish from other conditions.

• The presence of hypopyon (pus in the anterior chamber) indicates a severe reaction, suggesting migration towards the chamber due to infection.

Distinguishing Between Infection Types

• Important diagnostic criteria for identifying fungal infections include observing lesions with fuzzy borders that do not respond to standard treatments like vancomycin, indicating potential mixed or fungal infections.

Antifungal Treatments Available

• The most effective antifungal medication noted is natamycin 5%, although it is currently unavailable in Colombia. Alternatives such as boric acid preparations are suggested for managing these infections.

Understanding Dry Eye Syndrome

Causes and Mechanisms

• Dry eye syndrome is linked to various factors affecting tear production, including environmental influences and underlying health conditions. It involves three layers: lipid layer (produced by meibomian glands), aqueous layer (from lacrimal glands), and mucin layer (from conjunctival cells).

Types of Dry Eye Conditions

• Differentiates between types of dry eye based on which layer is affected; evaporative dry eye results from dysfunction in lipid production leading to rapid tear evaporation.

Symptoms Experienced by Patients

• Common symptoms range from mild discomfort to significant visual disturbances during activities like reading or screen use due to inadequate tear film stability.

Recommended Treatments for Dry Eyes

Understanding EPS Cleritis and Its Management

Overview of EPS Cleritis

• EPS Cleritis is an inflammation located above the sclera and below the conjunctiva, with 70% of cases being idiopathic and 30% associated with systemic diseases like lupus and arthritis.

Symptoms and Diagnosis

• Patients may present with sectoral redness in one eye, along with symptoms such as tearing, photophobia, and thickening of the affected area. The use of phenylephrine can help differentiate EPS Cleritis from other conditions.

Treatment Approaches

• Management typically involves a course of treatment lasting two to three weeks, including lubricants and cold compresses. In some cases, topical steroids may be prescribed.

Differentiating Between Conditions

• It’s crucial to avoid using topical steroids indiscriminately; they are appropriate for inflammatory conditions but not for all ocular issues. Non-steroidal anti-inflammatory drugs (NSAIDs) are also used in specific scenarios.

Insights on Scleritis

Characteristics of Scleritis

• Scleritis is characterized by inflammation beneath the episclera layer. Approximately 50% of scleritis cases are idiopathic while others relate to systemic conditions like arthritis or lupus.

Symptoms Presentation

• Severe ocular pain that worsens with movement is common, alongside photophobia and watering. A notable sign includes thinning of the sclera known as scleromalacia.

Managing Severe Cases

Hospitalization Criteria

• For severe cases presenting with significant symptoms or complications, hospitalization may be necessary for intensive management including systemic treatments.

Importance of Comprehensive Evaluation

• Many patients may have underlying conditions like uveitis that require thorough investigation before treatment initiation to ensure proper management strategies are employed.

Uveitis: Anterior vs Generalized

Definition and Causes

• Anterior uveitis primarily affects the iris and ciliary body; it can be idiopathic or linked to systemic diseases such as ankylosing spondylitis or infections like toxoplasmosis which is prevalent in Colombia.

Clinical Features

• Symptoms include deep ocular pain, photophobia, redness around the cornea (ciliary flush), blurred vision due to potential complications affecting visual acuity.

Diagnostic Indicators in Uveitis

Key Diagnostic Signs

• Important indicators include flare (light reflection abnormalities), cells in aqueous humor indicating inflammation, and changes in pupil response due to iris involvement.

Treatment Strategies

Understanding Primary Angle Closure Glaucoma

Overview of Primary Angle Closure Glaucoma

• The most severe cause of red eyes is primary angle closure glaucoma, which can lead to irreversible damage.

• This condition occurs when the pupil becomes blocked, preventing aqueous humor from exiting through the angle between the iris and lens.

Mechanism of Blockage

• In some patients, the iris closes off the drainage pathway, increasing pressure in the posterior chamber and potentially leading to acute symptoms.

• Symptoms include intense ocular pain, headache, nausea, blurred vision, and a red eye with corneal cloudiness due to elevated intraocular pressure.

Clinical Presentation

• Patients may present with fixed dilated pupils and corneal edema; pressures can exceed 40 mmHg.

• Common risk factors include hyperopia and small eyes; women are particularly at risk for this condition.

Management Strategies

• Initial management focuses on reducing intraocular pressure to prevent optic nerve damage.

• Definitive treatment often involves surgical intervention (e.g., iridotomy), creating an alternative pathway for aqueous humor drainage.

Emergency Signs to Recognize