THE ACUTE RED EYE

History: Trauma? Contact lens use? Previous surgery? Ocular self-medication? Is it one eye or both? Is it painful or sensitive to light rather than unconfortable? Is the vision blurred to an extent that is doesnt clear on blinking?

ONE EYE, NO PAIN, GOOD VISION

Spontaneous subconjunctival haemorrhage Episcleritis (irritation rather than pain ) Pterygia Papillomata Infective conjunctivitis(in its early stage) Acute dacryocystitis Molluscum contagiosum Carotico - Cavernous Sinus fistula Haemorrhagic teleangiectasia Sickle cell disease

ONE EYE, PAIN, GOOD VISION

With corneal staining Herpes simplex keratitis Marginal ulceration Exposure keratitis (from lagophthalmos) Moorens ulcer Without corneal staining Anterior uveitis (iritis) Scleritis (nodular, diffuse, necrotizing) Herpes zoster ophthalmicus

ONE EYE, PAIN, REDUCED VISION

With corneal staining: Herpes simplex: dendritic ulcer (geographic ulcer, corneal perforation) Acute keratitis (from bacteria, fungi ) Herpes zoster ophthalmicus

ONE EYE, PAIN, REDUCED VISION

Without corneal staining Anterior uveitis (secondary corneal oedema) Sympathetic ophthalmia Acute angle closure glaucoma Rubeotic glaucoma Disciform keratitis Phacolytic glaucoma Metastatic endophthalmitis (HIV positive status Candida endophthalmitis Septic foci elsewher in the body) Preseptal cellulitis Orbital cellulitis Acute gonococcal conjunctivitis

BOTH EYES, NO PAIN, GOOD VISION

Acute bacterial conjunctivitis Viral conjunctivitis Acute allergic conjunctivitis Iatrogen conjunctivitis

BOTH EYES, PAIN, WITH OR WITHOUT VISION EFFECTED

Viral keratoconjunctivitis (Photophobia - APC.) Adult inclusion conjunctivitis (Chlamidial inf.) Vernal catarrh Erythema multiforme (Stevens-Johnson sy) ARC eye (after exposure to an arc welding flash)

Red eye(s) following the use of contact lenses

Overwear Inadequate cleaning Sensitivity to the cleaning solutions Symptoms: diffusely red eyes with punctate keratopathy discomfort with itching excessive mucus blurring of vision small sterile corneal ulcers Amoebic keratitis Symptoms: painful watery eye central corneal clouding epithelial defect

RED EYE following ocular surgery

Cataract surgery irritation from sutures localised redness around the wound site endophthalmitis chronic uveitis late corneal decompensation Glaucoma surgery bleb infection Retinal detachment surgery extruding explant Corneal graft surgery graft rejection

CHRONIC OCULAR UNEASE AND ASSOCIATED HEADACHE

ACHING EYES
Optical causes Refractive errors: Uncorrected astigmatic errors Hypermetropia (Reading vision!) Myopia (Undercorrected/overcorrected) Extraocular muscle balance (strong latent squints)

Non-optical causes: Debility Systemic viral infection muscle myositis) Infections (mononucleosis) Dry eye sy.

(extraocular

HEAD AND EYE ACHE

Chronic exess alcohol ingestions (toxic amblyopia) Drugs (nifedipine) Raised intracranial pressure (BIH) Chronic paranasal sinus disease Cranial arteritis Herpes zoster (in its prodromal phase)

SORE FEELING
Dry eye syndrome Sjgrens sy Ocular pemphigoid Superior limbic keratitis Chronic eyedrop usage Chronic blepharitisStaphylococcal blepharitis Seborrheic blepharitis Ocular rosacea Other causes: Post rival keratoconjunctivitis Corneal epithelial dystrophies

Monocular sore feeling exlude : Intermittent entropion Ingrowing lash(es) Chronic foreign body Molluscum contagiosum Postoperative problems Recurrent erosion / abrasion sy.

TWITCHES FEELING
Lid twitching Sign of stress in the patient Facial dystonia (recovery from VII. nerve palsy) Globe twitching Nystagmus: involuntary, rhythmical oscillation of the eye(s) present in any or all positions of gaze Intermittent eye twitching (stress) Rhithmical uniocular torsional nystagmoid-type movement superior oblique myokymia Intrusory oscillations (disease if the midbrain and/or cerebellum)

EYES WATER
Epiphora Restricted lacrimal drainage Delayed opening of the nasolacrimal duct Medial ectropion: poorly fitting spectacles VII. nerve palsy injudicious lid surgery Punctal occlusion Canalicular occlusion Nasolacrimal duct obstruction Functional blockage Reflex tearing (symptom of many acute and chronic ocular conditions)