Unilateral red eye: Difference between revisions

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==Diagnosis==
==Background==
#Evert lens and look for foreign body
#Remove contacts
#Photophobia suggests inflammation i.e. uveitis and abrasions
#Pupil: irregular with positive sidel's suggests penetrating injury


==Trauma==
==Clinical Features==
# Obvious [[Ruptured Globe]]^
*Unilateral red/painful eye
# No obvious ruptured globe
## Epithelial defect
### [[Corneal Abrasion]]
### [[Corneal Ulcer]]^
### [[Caustic Keratoconjunctivitis]]^^
### Occult [[Ruptured Globe]]^
####(positive Sidel's)
## No defect
### [[Subconjunctival Hematoma]]
### [[Traumatic Iritis]]
### Hypema^
####(?occult open globe)
### [[Endophthalmitis]]^
#### (old occult open globe)


==Nontraumatic==
==Differential Diagnosis==
# Epithelial defect
{{Unilateral red eye DDX}}
## [[Corneal Abrasion]]
## [[Corneal Ulcer]]^
## [[Herpes Zoster Ophthalmicus]] (dendrite)
## Corneal erosion
###(morning pain)
## UV/welders keratitis
### (SPK)
## Scleral penetration^
# No defect
## No pain relief w/ tropicamide
### [[Acute Angle Glaucoma]]^
####dilated
####closed angle
####inc pressure
### Nontraumatic Iritis
### [[Scleritis]]^
####(localized; no move Q-tip)
### Anterior [[Uveitis]]
####(hypopyon, cilliary flush)
## No pain/pain relief w/ tropicamide
### Foreign body
### Conjunctivitis
#### Viral
#### Bacterial^
#####(purulent-->?GC)
#### Allergic
#### Contact
#### Toxic
#### Chlamydial
### Keratoconjunctivits
### [[Episcleritis]]
####(localized; move w/ Q-tip)
## Non-uptake finding (no pain/pain relief w/ tropicamd)
### [[Subconjunctival Hematoma]]
### Inflamed pingueculum
### Inflamed [[Pterygium]]
### Keratoconus (protrude)


^Emergent diagnosises
==Evaluation==
*Evert lid and look for [[ocular foreign body|foreign body]]
*Remove contacts
*Photophobia suggests inflammation i.e. [[uveitis]] and [[corneal abrasion|abrasions]]
*Pupil: irregular with positive sidel's suggests [[globe rupture|penetrating injury]]


^^Critical diagnosises
===Diagnostic Algorithm===
====Traumatic====
*Obvious [[Ruptured Globe]]^
*No obvious ruptured globe
**Epithelial defect
***[[Corneal Abrasion and Foreign Body]]
***[[Conjunctival laceration]]
***[[Corneal Ulcer]]^
***[[Caustic Keratoconjunctivitis]]^^
***Occult [[Ruptured Globe]]^
****(positive Sidel's)
**No defect
***[[Subconjunctival Hematoma]]
***[[Traumatic Iritis]]
***[[Hyphema]]^
****(?occult open globe)
***[[Endophthalmitis]]^
****(old occult open globe)


====Nontraumatic====
*Epithelial defect
**[[Corneal Abrasion]]
**[[Corneal Ulcer]]^
**[[Herpes Zoster Ophthalmicus]] (dendrite)
**Corneal erosion
***(morning pain)
**[[UV keratitis]]
***(SPK)
**Scleral penetration^
*No defect
**No pain relief with [[tropicamide]]
***[[Acute Angle Glaucoma]]^
****dilated
****closed angle
****inc pressure
***Nontraumatic [[Iritis]]
***[[Scleritis]]^
****(localized; no move Q-tip)
***Anterior [[Uveitis]]
****([[hypopyon]], ciliary flush)
**No pain '''OR''' pain relief with [[tropicamide]]
***[[ocular foreign body|Foreign body]]
***[[Conjunctivitis]]
***[[Keratoconjunctivitis]]
***[[Episcleritis]]
****(localized; move with Q-tip)
**Non-uptake finding (no pain/pain relief with tropicamide)
***[[Subconjunctival Hematoma]]
***Inflamed [[pinguecula]]
***Inflamed [[Pterygium]]
***Keratoconus (protrude)


^Emergent diagnoses


^^Critical diagnoses


===Painful===
==Management==
#Corneal Abrasion
*By diagnosis
#Corneal Ulcer
#Foreign Body
#Trauma
 
Endophthalmitis following prior surgery, with Hypopyon or pus in anterior chamber
 
====Less Common====
#Periorbital/orbital Cellulitis
#Acute Glaucoma: corneal clouding
#Scleritis
#Uveitis (recurrent in AS): keratic precipitates
##photophobia, perilimbal injection
#Hyphema/Hypopyon
#Shingles (look for concurrent skin findings)
#Thyroid Eye Dz
 
===Painless===
#Conjunctivitis
#Subconjunctival Hemorrhage: h/o trauma or valsalva, DM, HTN
#Episcleritis
#Allergic Reaction


==See Also==
==See Also==
*[[Corneal Abrasion vs Ulcer]]
{{Eye algorithms}}
*[[Red Eye (Unilateral) 2]]
*[[Red Eye (Bilateral)]]
*[[Red Eye (by Sx)]]
 
==Source==
DONALDSON (adapted from Rosen, WMS Practic Guidelines 2000)


Pani
==References==
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:Symptoms]]

Latest revision as of 15:45, 23 October 2019

Background

Clinical Features

  • Unilateral red/painful eye

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

Diagnostic Algorithm

Traumatic

Nontraumatic

^Emergent diagnoses

^^Critical diagnoses

Management

  • By diagnosis

See Also

Eye Algorithms

References