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DIFFERENTIAL DIAGNOSIS OF RED EYE:

 

     

 

SYMPTOMS

ACUTE CONJUNCTIVITIS

ACUTE IRIDOCYCLITIS

ANGLE CLOSURE GLAUCOMA

EPISCLERITIS

SUBCONJUNCTIVAL HAEMORRHAGE

1. PAIN

Discomfort, irritation, itching in allergy

Moderate pain, more localized to eye.

Severe radiating pain.

Mild to moderate pain.

Painless.

2. DISCHARGE

Watery or mucopurulent.

Watery.

Watery.

Nil or Watery.

Nil.

3. PHOTO PHOBIA

Mild.

Severe.

Mild to severe.

Nil.

Nil.

4. VISUAL PROBLEM

Nil

Mild

Marked

nil

Nil

5. ONSET

Gradual

Gradual

Sudden

Gradual

Sudden

6. SYSTEMIC SYMPTOMS

None

Malaise joint pain

Prostration, often vomiting.

Usually none.

Acute straining cough, ↑ BP

7. PREVIOUS HISTORY

Possible previous attack

Similar previous attack

Transient blurring pain

Similar previous attack

Usually none

 

SIGNS

ACUTE CONJUNCTIVITIS

ACUTE IRIDOCYCLITIS

ANGLE CLOSURE GLAUCOMA

EPISCLERITIS

SUBCONJUNCTIVAL HAEMORRHAGE

1. VISUAL ACUITY

Normal

May be little less

May reduce to PL & PR

Normal

Normal

2. CONGESTION

Conjunctival, superficial (pink).

Circumcorneal ciliary (brick red).

Ciliary (purple)

Patch of dilated conjunctival vessel (pink).

Patch of haemorrhage

3. CORNEA

Normal

Keratic precipitates

Steamy, epithelial oedema.

Normal.

Normal.

4. ANTERIOR CHAMBER

Normal

Cloudy cells & flare.

Clear, very shallow.

Normal.

Normal.

5. PUPIL & LIGHT REFLEX

Normal

Small, irregular, sluggish reaction.

Oval, mid dilated, sluggish.

Normal.

Normal.

6. IRIS

Normal

Muddy iris.

Often oedematous

Normal.

Normal.

7. IOP

Normal

High, low or normal

Very high

Normal.

Normal.

8. TENDERNESS

Nontender

Mild to moderate

Marked.

Mild to moderate

Non-tender.

 

MANAGEMENT:

1.       ACUTE CONJUNTIVITIS:

Frequent eye wash with lukewarm water.

Use dark glasses to prevent photophobia.

Broad spectrum antibiotic eye drops: chloramphenicol, ciprofloxacin.

An antibiotic eye ointment like tetracycline, gentamycin or chloramphenicol at bed time.

     2.       ACUTE IRIDOCYCLITIS:

           Non- specific treatment.

A.      LOCAL THERAPY:

a.       CYCLOPEGIC DRUGS: 1% atropine sulphate eye ointment or drop, 2% homatropine, 1% cyclopentolate.

b.       TOPICAL CORTICOSTEROIDS: Dexamethasone, betamethasone, hydrocortisone, prednisolone.

c.       BROAD SPECTRUM ANTIBIOTICS DROPS: To prevent secondary infection.

B.      SYSTEMIC THERAPY:

a.       Corticosteroids.

b.       Non-steroidal anti-inflammatory drugs- aspirin, phenylbutazone & oxyphenbutazone, naproxen.

c.       Immunosuppressive drugs- cyclophosphamide, chlorambucil.

d.       Azithromycin or tetracycline or erythromycin.

C.      PHYSICAL MEASURES:

a.       Hot fomentation.

b.       Dark goggles.

3.       ANGLE CLOSURE GLAUCOMA:

IMMEDIATE MEDICAL THERAPY TO LOWER IOP:

1.       SYSTEMIC HYPEROSMOTIC AGENTS:

a.       IV mannitol.

b.       Oral hyperosmotic agents- glycerol.

2.       SYSTEMIC CARBONIC ANHYDRASE INHIBITORS: Oral acetazolamide tablet.

3.       TOPICAL PILOCARPINE.

4.       TOPICAL ANTI-GLAUCOMA DRUG:

a.       Beta-blocker- timolol or betaxolol.

b.        Alpha-agonist- Brimonidine.

5.       ANALGESIC & ANTIEMETICS.

6.       COMPRESSIVE GONISCOPY.

7.       TOPICAL STEROID- Prednisolone acetate 1% or dexamethasone eye drops.

4.       EPISCLERITIS:

1.       Corticosteroid drops- 4 times.

2.       Oral anti-inflammatory agents, like ibuprofen or diclofenac.

3.       Tab. Salicylate.

5.       SUBCONJUNCTIVAL HAEMORRAHAGE:

1.       No treatment is necessary in most cases as it absorbed automatically.

2.       Cold compress.

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