Red Eye Picture Quiz Answers

Quiz by David Yorston, Marcia Zondervan

	1. A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6. Vernal keratoconjunctivitis (Vernal catarrh) The lumpy appearance of the conjunctiva is caused by swelling of the conjunctiva due to the chronic inflammation. In most cases allergic conjunctivitis will improve in adulthood and does not require intensive treatment. Topical steroids should only be used during acute attacks if there is evidence of corneal damage.
	2. 45-year-old female. Complains of painful eye and discomfort in bright light with watery discharge. VA 6/12. Acute anterior uveitis Photophobia is typical in these patients as the pupil’s constriction in the response to light causes pain. The redness is maximum near the limbus (ciliary injection) and the pupil is irregular where it is stuck to the front of the lens. Acute anterior uveitis should be managed with atropine to keep the pupil dilated. Topical steroids may be useful in severe cases.
	3. Five-year-old girl. Severe pain and loss of vision for three days. Used traditional eye medicines one week ago. VA CF. Suppurative keratitis The eye is very red and the iris cannot be seen clearly which suggests the cornea is cloudy. This eye requires hourly topical antibiotics. If facilities are available then a cornea scraping and gram stain should be performed before starting topical treatment. In some regions fungi are a common case of corneal ulcer and anti-fungal treatment will be required. The white line inferiorly is a hypopyon caused by pus formation in the anterior chamber. It indicates severe inflammation. Traditional eye medicines are not sterile and may cause severe infections.
	4. Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60. Herpes simplex keratitis Not all cases of herpetic simplex keratitis present with a typical dendritic/geographic ulcer. A useful sign of herpes is reduced sensitivity of the cornea. This is thought to be due to damage to the sensory nerves. Herpes keratitis is sometimes associated with febrile illness. Herpes keratitis is managed with a topical antiviral such as acyclovir or trifluorothymidine.
	5. 25-year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6. Sub-conjunctival haemorrhage The lack of pain and discharge imply that there is no inflammation. The very sharply defined edge is typical of a sub-conjunctival haemorrhage. No treatment is required and redness will clear over a course of 2 weeks.
	6. 19-year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9. Bacterial conjunctivitis The entire conjunctiva is red and eye is discharging pus on the lower lid and on the eyelashes. This should be treated with intensive topical antibiotics for one week. In very severe cases, particularly in young men, you should consider doing a gram stain to look for Gonococcus, and you should ask specifically about symptoms of urethritis.

1. A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6.

Vernal keratoconjunctivitis (Vernal catarrh)
The lumpy appearance of the conjunctiva is caused by swelling of the conjunctiva due to the chronic inflammation. In most cases allergic conjunctivitis will improve in adulthood and does not require intensive treatment. Topical steroids should only be used during acute attacks if there is evidence of corneal damage.

2. 45-year-old female. Complains of painful eye and discomfort in bright light with watery discharge. VA 6/12.

Acute anterior uveitis
Photophobia is typical in these patients as the pupil’s constriction in the response to light causes pain. The redness is maximum near the limbus (ciliary injection) and the pupil is irregular where it is stuck to the front of the lens. Acute anterior uveitis should be managed with atropine to keep the pupil dilated. Topical steroids may be useful in severe cases.

3. Five-year-old girl. Severe pain and loss of vision for three days. Used traditional eye medicines one week ago. VA CF.

Suppurative keratitis
The eye is very red and the iris cannot be seen clearly which suggests the cornea is cloudy. This eye requires hourly topical antibiotics. If facilities are available then a cornea scraping and gram stain should be performed before starting topical treatment. In some regions fungi are a common case of corneal ulcer and anti-fungal treatment will be required. The white line inferiorly is a hypopyon caused by pus formation in the anterior chamber. It indicates severe inflammation. Traditional eye medicines are not sterile and may cause severe infections.

4. Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60.

Herpes simplex keratitis
Not all cases of herpetic simplex keratitis present with a typical dendritic/geographic ulcer. A useful sign of herpes is reduced sensitivity of the cornea. This is thought to be due to damage to the sensory nerves. Herpes keratitis is sometimes associated with febrile illness. Herpes keratitis is managed with a topical antiviral such as acyclovir or trifluorothymidine.

5. 25-year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6.

Sub-conjunctival haemorrhage
The lack of pain and discharge imply that there is no inflammation. The very sharply defined edge is typical of a sub-conjunctival haemorrhage. No treatment is required and redness will clear over a course of 2 weeks.

6. 19-year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9.

Bacterial conjunctivitis
The entire conjunctiva is red and eye is discharging pus on the lower lid and on the eyelashes. This should be treated with intensive topical antibiotics for one week. In very severe cases, particularly in young men, you should consider doing a gram stain to look for Gonococcus, and you should ask specifically about symptoms of urethritis.