Advertisement

Evaluation of the Red Eye

  • Paul Basel
Chapter

Abstract

The red eye is a heterogeneous complaint with numerous causes including allergic, autoimmune, environmental, infectious, and traumatic causes. Infectious complications (including viral, bacterial, fungal, or parasitic) make up the majority of complaints presenting to the emergency department. A thorough history and physical exam will differentiate these conditions. Conditions can be defined by the area of the eye they affect including conjunctivitis, keratitis, uveitis, etc. These conditions range from benign to ocular emergencies. It is the emergency physician’s job to identify and treat these conditions as well as determine the urgency in which expert consultation is needed.

Keywords

Conjunctivitis Keratitis Herpes simplex keratitis Herpes zoster ophthalmicus Epidemic keratoconjunctivitis Kawasaki disease Reiter’s syndrome Acanthamoeba Neonatal conjunctivitis Steven-Johnson syndrome 

References

  1. 1.
    Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310(16):1721–9.  https://doi.org/10.1001/jama.2013.280318.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Geloneck M, Binenbaum G. Conjunctivitis of the newborn. In: Lambert SR, Lyons CJ, editors. Taylor and Hoyt’s pediatric ophthalmology and strabismus. 5th ed. London: Elsevier; 2017. p. 109–12.Google Scholar
  3. 3.
    Kircher J, Dixon A. Eye emergencies in infants and children. In: Tintinalli JE, Stephan Stapczynski J, John Ma O, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill Education; 2016. p. 770–3.Google Scholar
  4. 4.
    Rose PW, Harnden A, Brueggemann AB, et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9479):37–43.  https://doi.org/10.1016/S0140-6736(05)66709-8.CrossRefPubMedGoogle Scholar
  5. 5.
    Buznach N, Dagan R, Greenberg D. Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era. Pediatr Infect Dis J. 2005;24(9):823–8.  https://doi.org/10.1097/01.inf.0000178066.24569.98.CrossRefPubMedGoogle Scholar
  6. 6.
    Rietveld RP, ter Riet G, Bindels PJE, Sloos JH, van Weert HCPM. Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. BMJ. 2004;329(7459):206–10.  https://doi.org/10.1136/bmj.38128.631319.AE.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sheikh A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2006;2:CD001211.  https://doi.org/10.1002/14651858.CD001211.pub2.CrossRefGoogle Scholar
  8. 8.
    Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137–45.PubMedGoogle Scholar
  9. 9.
    Burns JC, Glode MP. Kawasaki syndrome. Lancet. 2004;364(9433):533–44.  https://doi.org/10.1016/s0140-6736(04)16814-1.CrossRefPubMedGoogle Scholar
  10. 10.
    Ohno S, Miyajima T, Higuchi M, et al. Ocular manifestations of Kawasaki’s disease (mucocutaneous lymph node syndrome). Am J Ophthalmol. 1982;93(6):713–7. http://www.ncbi.nlm.nih.gov/pubmed/7201245.CrossRefPubMedGoogle Scholar
  11. 11.
    Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin N Am. 2009;35(1):21–44.  https://doi.org/10.1016/j.rdc.2009.03.010.CrossRefGoogle Scholar
  12. 12.
    Kvien TK, Gaston JSH, Bardin T, et al. Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study. Ann Rheum Dis. 2004;63(9):1113–9.  https://doi.org/10.1136/ard.2003.010710.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Barber CE, Kim J, Inman RD, Esdaile JM, James MT. Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis. J Rheumatol. 2013;40(6):916–28.  https://doi.org/10.3899/jrheum.121192.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Collier SA, Gronostaj MP, MacGurn AK, et al. Estimated burden of keratitis – United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(45):1027–30.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Walker RA, Adhikari S. Eye emergencies. In: Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill Education; 2016. p. 1543–78.Google Scholar
  16. 16.
    Keenan JD, Mcleod SD. 4.12—bacterial keratitis. 4th ed. Philadelphia: Elsevier; 2016.  https://doi.org/10.1016/B978-1-4557-3984-4.00121-4.CrossRefGoogle Scholar
  17. 17.
    Tuli SS, Kubal AA. 4.15—herpes simplex keratitis. 4th ed. Philadelphia: Elsevier; 2016.  https://doi.org/10.1016/B978-1-4557-3984-4.00124-X.CrossRefGoogle Scholar
  18. 18.
    Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2015;1(12):CD002898.  https://doi.org/10.1002/14651858.CD002898.pub5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Barron BA, Beck RW, Asbell PA, Cohen EJ, Dawson CR, Hyndiuk RA, Jones DB, Kaufman HE, Kurinij N, Moke PS, Doyle Stulting R, Sugar J, Wilhelmus KR. A controlled trial of oral acyclovir for the prevention of stromal keratitis or iritis in patients with herpes simplex virus epithelial keratitis. The epithelial keratitis trial. The Herpetic Eye Disease Study Group. Arch Ophthalmol (Chicago, Ill 1960). 1997;115(6):703–12.  https://doi.org/10.16373/j.cnki.ahr.150049.CrossRefGoogle Scholar
  20. 20.
    Barron BA, Gee L, Hauck WW, et al. Herpetic eye disease study. Ophthalmology. 1994;101(12):1871–82.  https://doi.org/10.1016/S0161-6420(13)31155-5.CrossRefPubMedGoogle Scholar
  21. 21.
    Vrcek I, Choudhury E, Durairaj V. Herpes zoster ophthalmicus: a review for the internist. Am J Med. 2016;130(1):21–6.  https://doi.org/10.1016/j.amjmed.2016.08.039.CrossRefPubMedGoogle Scholar
  22. 22.
    Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia (review) summary of findings for the main comparison. 2013;3.  https://doi.org/10.1002/14651858.CD005582.pub4. www.cochranelibrary.com.
  23. 23.
    Report MW. Adenovirus-associated epidemic keratoconjunctivitis outbreaks—four states, 2008–2010. MMWR Morb Mortal Wkly Rep. 2013;62(32):637–41.Google Scholar
  24. 24.
    Pihos AM. Epidemic keratoconjunctivitis: a review of current concepts in management. J Optom. 2013;6(2):69–74.  https://doi.org/10.1016/j.optom.2012.08.003.CrossRefGoogle Scholar
  25. 25.
    Dart JKG, Saw VPJ, Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009. Am J Ophthalmol. 2009;148(4):487–499.e2.  https://doi.org/10.1016/j.ajo.2009.06.009.CrossRefPubMedGoogle Scholar
  26. 26.
    Lorenzo-morales J, Khan NA, Walochnik J. An update on acanthamoeba keratitis: diagnosis, pathogenesis and treatment. Parasite. 2015;22:10.  https://doi.org/10.1051/parasite/2015010.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Page MA, Mathers WD. Acanthamoeba keratitis: a 12-year experience covering a wide spectrum of presentations, diagnoses, and outcomes. J Ophthalmol. 2013;2013:2–7.  https://doi.org/10.1155/2013/670242.CrossRefGoogle Scholar
  28. 28.
    Jurkunas U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea. 2009;28(6):638–43.  https://doi.org/10.1097/ICO.0b013e318191695b.CrossRefPubMedGoogle Scholar
  29. 29.
    Liesegang TJ, Forster RK. Spectrum of microbial keratitis in South Florida. Am J Ophthalmol. 1980;90(1):38–47. http://www.ncbi.nlm.nih.gov/pubmed/7395957.CrossRefPubMedGoogle Scholar
  30. 30.
    Keenan JD, Mcleod SD. 4.13—fungal keratitis. 4th ed. Philadelphia: Elsevier; 2016.  https://doi.org/10.1016/B978-1-4557-3984-4.00122-6.CrossRefGoogle Scholar
  31. 31.
    Thomas PA. Fungal infections of the cornea. Eye (Lond). 2003;17(8):852–62.  https://doi.org/10.1038/sj.eye.6700557.CrossRefGoogle Scholar
  32. 32.
    Mascarenhas J, Lalitha P, Prajna NV, et al. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Ophthalmol. 2014;157(1):56–62.  https://doi.org/10.1016/j.ajo.2013.08.032.CrossRefPubMedGoogle Scholar
  33. 33.
    McIntosh SE, Guercio B, Tabin GC, Leemon D, Schimelpfenig T. Ultraviolet keratitis among mountaineers and outdoor recreationalists. Wilderness Environ Med. 2011;22(2):144–7.  https://doi.org/10.1016/j.wem.2011.01.002.CrossRefPubMedGoogle Scholar
  34. 34.
    Finn LE, Gutowski J, Alles S, et al. Photokeratitis linked to metal halide bulbs in two gymnasiums—Philadelphia, Pennsylvania, 2011 and 2013. MMWR Morb Mortal Wkly Rep. 2016;65(11):282–5.  https://doi.org/10.15585/mmwr.mm6511a4.CrossRefPubMedGoogle Scholar
  35. 35.
    Swaminathan A, Otterness K, Milne K, Rezaie S. The safety of topical anesthetics in the treatment of corneal abrasions: a review. J Emerg Med. 2015;49(5):810–5.  https://doi.org/10.1016/j.jemermed.2015.06.069.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Calder LA, Balasubramanian S, Fergusson D. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials. Acad Emerg Med. 2005;12(5):467–73.  https://doi.org/10.1197/j.aem.2004.10.026.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Waldman N, Densie IK, Herbison P. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014;21(4):374–82.  https://doi.org/10.1111/acem.12346.CrossRefPubMedGoogle Scholar
  38. 38.
    Ball IM, Seabrook J, Desai N, Allen L, Anderson S. Dilute proparacaine for the management of acute corneal injuries in the emergency department. Can J Emerg Med. 2010;12(5):389–94.Google Scholar
  39. 39.
    Upadhyay MP, Karmacharya PC, Koirala S, et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol. 2001;85(4):388–92.  https://doi.org/10.1136/bjo.85.4.388.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lim CHL, Turner A, Lim BX. Patching for corneal abrasion. Cochrane Database Syst Rev. 2016;2016(7):10–3.  https://doi.org/10.1002/14651858.CD004764.pub3.CrossRefGoogle Scholar
  41. 41.
    Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician. 2004;70(1):123–30.PubMedGoogle Scholar
  42. 42.
    Brahma AK, Shah S, Hillier VF, et al. Topical analgesia for superficial corneal injuries. J Accid Emerg Med. 1996;13(3):186–8.  https://doi.org/10.1136/emj.13.3.186.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hu DN, Mou CH, Chao SC, et al. Incidence of non-traumatic subconjunctival hemorrhage in a nationwide study in Taiwan from 2000 to 2011. PLoS One. 2015;10(7):1–10.  https://doi.org/10.1371/journal.pone.0132762.CrossRefGoogle Scholar
  44. 44.
    Tarlan B, Kiratli H. Subconjunctival hemorrhage: risk factors and potential indicators. Clin Ophthalmol. 2013;7:1163–70.  https://doi.org/10.2147/OPTH.S35062.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sotozono C, Ueta M, Koizumi N, et al. Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. Ophthalmology. 2009;116(4):685–90.  https://doi.org/10.1016/j.ophtha.2008.12.048.CrossRefPubMedGoogle Scholar
  46. 46.
    Kohanim S, Palioura S, Saeed HN, et al. Stevens-Johnson syndrome/toxic epidermal Necrolysis – a comprehensive review and guide to therapy. I. Systemic disease. Ocul Surf. 2016;14(1):2–19.  https://doi.org/10.1016/j.jtos.2015.10.002.CrossRefPubMedGoogle Scholar
  47. 47.
    Kohanim S, Palioura S, Saeed HN, et al. Acute and chronic ophthalmic involvement in Stevens-Johnson syndrome/toxic epidermal necrolysis – a comprehensive review and guide to therapy. II. Ophthalmic disease. Ocul Surf. 2016;14(2):168–88.  https://doi.org/10.1016/j.jtos.2016.02.001.CrossRefPubMedGoogle Scholar
  48. 48.
    Gritz DC, Wong IG. Incidence and prevalence of uveitis in northern California: the northern California epidemiology of uveitis study. Ophthalmology. 2004;111(3):491–500.  https://doi.org/10.1016/j.ophtha.2003.06.014.CrossRefPubMedGoogle Scholar
  49. 49.
    Suhler EB, Lloyd MJ, Choi D, Rosenbaum JT, Austin DF. Incidence and prevalence of uveitis in veterans affairs medical centers of the Pacific northwest. Am J Ophthalmol. 2008;146(6):890–6.  https://doi.org/10.1016/j.ajo.2008.09.014.CrossRefPubMedGoogle Scholar
  50. 50.
    Acharya NR, Tham VM, Esterberg E, et al. Incidence and prevalence of uveitis. JAMA Ophthalmol. 2013;131(11):1405.  https://doi.org/10.1001/jamaophthalmol.2013.4237.CrossRefPubMedGoogle Scholar
  51. 51.
    Read R. General approach to the uveitis patient and treatment strategies. In: Yanoff M, editor. Ophthalmology. 4th ed. Philadelphia: Elsevier; 2014. p. 694–9.Google Scholar
  52. 52.
    Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80(9):844–8.  https://doi.org/10.1136/bjo.80.9.844.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    McCannel CA, Holland GN, Helm CJ, et al. Causes of uveitis in the general practice of ophthalmology. Am J Ophthalmol. 1996;121(1):35–46.  https://doi.org/10.1016/S0002-9394(14)70532-X.CrossRefPubMedGoogle Scholar
  54. 54.
    Herr RD, White GL, Bernhisel K, Mamalis N, Swanson E. Clinical comparison of ocular irrigation fluids following chemical injury. Am J Emerg Med. 1991;9(3):228–31. http://www.ncbi.nlm.nih.gov/pubmed/1850282CrossRefPubMedGoogle Scholar
  55. 55.
    Fish R, Davidson RS. Management of ocular thermal and chemical injuries, including amniotic membrane therapy. Curr Opin Ophthalmol. 2010;21(4):317–21.  https://doi.org/10.1097/ICU.0b013e32833a8da2.CrossRefPubMedGoogle Scholar
  56. 56.
    Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am. 2008;26(1):125–36.  https://doi.org/10.1016/j.emc.2007.11.002.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Paul Basel
    • 1
  1. 1.Department of Emergency MedicineSan Antonio Uniformed Services Health Education ConsortiumSan AntonioUSA

Personalised recommendations