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sometimes also the deep intrascleral arterioles). Inflammation in the anterior segment of the eye is most often caused by infection (bacterial, viral or chlamydial), by trauma, by allergy or by dry eyes, but less commonly other aetiologies may be present. Most cases are benign, and can be managed effectively by GPs. The key to the management is the proper diagnosis of the cause of red eye, the administration of adequate and specific treatment, and careful follow up. It is important to keep in mind that questionable, complicated or therapy resistant cases require consultation with an ophthalmologist.

GENERAL SYMPTOMS OF INFLAMED RED EYES

The basic description of the signs of inflammation dates back to the ancient world. In book three of the treatise De Medicina of the roman philosopher and encyclope- dist, Cornelius Celsus (cca. 14 B.C. – 38 A.D.), the famous descriptive sentence is found: “Now there are four dia- gnostic marks of inflammation, redness and swelling, with heat and pain”. A Greek physician, Galen (130 – 200 A.D.), added “loss of function” as the fifth cardinal sign

Figure 1 – A patient with unilateral infla- med red eye

of inflammation. These are still the landmarks of the symptomatology of inflammation in general, and have become the basis of the classic description of the inflam- matory process, as well. [2]

The classical symptoms of inflammation: redness, swelling, pain and disturbed function are also important signs of eye inflammations. The general symptoms of the inflamed red eye, however, are usually described in ophthalmology textbooks as tearing, photophobia, blepha-

rospasm, hyperaemia, oedema and exudation (Figure 1).

BASIC INFORMATION CONCERNING DIFFERENTIAL DIAGNOSIS OF RED EYES

The differential diagnosis of common causes of inflamed red eyes is also a usual part of oph- thalmology text-books, generally presented in the form of tables that give help to differenti-

ate between the most common causes of red eyes: acute conjunctivitis, acute iritis and irido-

cyclitis, glaucomatous attack (acute angle closure glaucoma), and corneal trauma or acute

keratitis. It is suggested that these diverse pathologies can be differentiated based on inci- dence, the nature of discharge (exudates), visual acuity, presence or absence of pain, type of

injection (hyperaemia), the clearness of the cornea, the size of the pupil, whether the pupil constricts to light, intraocular pressure (measured by tonometer or estimated by palpation), and the evaluation of conjunctival smears and cultures. Such a differential diagnostic table can be seen below.

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THE DIFFERENTIAL DIAGNOSIS OF THE RED EYE

TABLE I THE DIFFERENTIAL DIAGNOSIS OF COMMON CAUSES OF INFLAMED RED EYE

Vision

Not affected

Slightly

Markedly

Usually

Significantly

blurred

blurred

blurred

blurred

None

Moderate

Severe

Diffuse, more toward fornices

Mainly circumcorneal

Diffuse

Clear

Usually clear

Steamy

Normal

Small

Moderately dilated and fixed

Watery or

Watery or

purulent

purulent

Pain

Injection

Cornea

Pupil Size

Change in

Change in

clarity related clarity related

to cause

to cause

Moderate

Moderate or severe

Diffuse

Intense

Normal or

Normal or

smaller

smaller

Corneal Trauma

Keratitis

Common

Common

Incidence

or iridocyclitis Glaucoma

None

Conjunctivitis* Anterior uveitis (iritis

Acute Angle Closure

Extremely common

Common Uncommon

Discharge

Moderate to copious

None

Poor

None

Normal

Normal or poor

Normal

High

Normal

Normal

No organisms

No organisms

Organisms only in infec- ted cases

Causative organisms

*See details in Table II. Adapted from: Vaughan D., Asbury T., Tabbara K.F.: General Ophthalmology. A Lange medical book, 12th ed. (1989) [3]

Smear /

Causative

Culture

organisms

Pupillary Light Response

Normal

Intraocular Pressure

Normal

MEDICAL HISTORY

The onset, the duration, the uni- or bilaterality of the disease, possible trauma, former similar

events, environmental factors, the presence of systemic or eye diseases, the main and accessory symptoms, factors that aggravate or alleviate the symptoms, the use of eye or systemic medi- cations are all important.

The doctor not only has to ask specific questions, but also needs to be able to evaluate the answers of the patient. Patients often complain of blurred vision just because they have exu- dates in their eye(s), or even loss of vision just because their eyelids are stuck together by

THE DIFFERENTIAL DIAGNOSIS OF THE RED EYE

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