The anterior segment of the eye is composed of the cornea , anteriorchamber and iris , behind wich lie the lens and ciliary body . Of thesestructures, the cornea and anterior chamber are most likely to be the sourcesof red eye conditions .
a ) Corneal Abrasion
Acute corneal disorders are typically associated with pain , photofobia, blurred vision , tearing , and the patient may experience a foreign -bodysensation . The corneal epithelium tends to regenerate rapidly , and healingis usually complete within 24 to 48 hours .
Irregular corneal reflection can be observed with a penlight , and fluoresceindye also can be used to detect denudment of the corneal epithelium as seenin abrasions .
Treatment is designed to foster rapid healing , restore patient comfort, and prevent secondary infections . Specific treatment includes topicalcycloplegics drops to relieve the pain caused by reflex spasm of the ciliarybody muscles . Oral analgesics with codeine may occasionally be prescribed. A topical ophtalmic antibiotic also can be applied followed by a pressurepatch .
The patch should remain on the eye for at least 24 hours .
Under no condition should topical anesthetic solutions be prescribed tothe patient for pain relief because of their toxic effects on the cornealepithelium .
b ) Chemical Injury
A chemical burn to the eye with acid or alkali is a true ocular emergencyrequiring immediate irrigation with the nearest source of water . The managementdepends on the nature of the chemical .
Most acids produce the extent of their damage immediately upon contacts.
An alkali burn , can be more devastating to the eye because it costumesto cause damage long after the initial contact . The alkali burns requireemergency referral to an ophthalmologist after immediate irrigation , otherchemical burns may be managed as a corneal abrasion .
c ) Contact Lens Overwear
Patients suffering from contact lens overwear syndrome have worn theirlenses longer than usual and typically awaken in the early morning hourswith severe pain and tearing . In response to the prolonged wear , thecornea has become swollen and has developed epithelial defects . Contactlens overwear is managed similarly to corneal abrasion .
d ) Keratitis
Viral Keratitis Primary herpes simplex ocular infection presents asa unilateral or bilateral blepharoconjunctivitis with watery discharge, skin vesicles on the lids , and enlarged preauricular lymph nodes . Cornealinvolvement is usually unilateral and typically presents with a foreign-body sensation . Singled or multiple branching extensions , or dendrites, are characteristic of this condition .
Bacterial Keratitis Bacterial infection of the cornea presents as a red, painful , eye with purulent discharge . E xamination by penlight mayreveal a discrete corneal opacity , associated with decreased vision .
a ) Hyphema
Blunt trauma to the eye can cause injury to the iris and to other intraocularstructures and may result in hyphema ( or hemorrhage into the anteriorchamber ) .
b ) Iritis
A patient with iritis may present with circumcorneal redness , pain, photophobia , decreased vision and the pupil is usually smaller thanthe normal.
Iritis frequently accompanies other inflammatory conditions , includinginfections , arthritis , sarcoidosis , urethritis , bowel disorders andmay also occur as a result of trauma to the eyes .
Early recognition of this clinical picture and prompt referral are essentialbecause untreated iritis can be complicated by development of glaucomaand cataracts .
c ) Acute Angle - Closure Glaucoma
Acute angled - closure glaucoma is characterized by a sudden rise inthe intraocular pressure in a susceptible individual . An attack may occurfollowing dilatation of the pupil in dim lighting or after installationof dilatation eyedrops.
A patient with an acute attack of angle - closure glaucoma complains ofsevere ocular pain , frontal head -ache , blurred vision , and the appearanceof halos around lights . Nausea and vomiting are often present .
The eye is usually red , the pupil mid - dilated and oval , and the corneacloudy . Simultaneous palpation of both eyes reveals the affected sideto be appreciably harder . Generally , the symptoms are displayed in oneeye only , although both eyes are usually predisposed to this serious condition.
An acute episode of angle - closure glaucoma is an ocular emergency andrequires immediate ophthalmologic treatment .The initial treatment includeadministration of topical 2% pilocarpine drops in two doses , 15 minutesapart , and acetazolamide , 500 mg orally or parenterally . Either oralglycerine or isosorbide , 1 cc/kg body weight , served over ice and drunkslowly by the patient , will assist in breaking the acute attack . A 20%solution of EV mannitol is sometimes necessary . The longer the intraocularpressure remains high , the greater the risk of permanent visual loss .
Managing the Red Eye
A slide script program
Copyright 1988 , 1994 , American Academy of Ophthalmology
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