Eye conditions

• Red Eye exam and history

  • Recent trauma or surgery?
  • Contact lens wearer?
  • Discharge from the eye?
  • Visual changes?
  • Pain/ discomfort?
  • Duration and other symptoms?
  • Previous eye problems?
  • Medical history?
  • Family history?
• Simple eye exam


  1. Always wash your hands before doing an eye exam

  2. Ask patient to look straight and view pupil, cornea and sclera

  3. Gently pull down the lower lid and ask the patient to look up

  4. Examine conjunctiva

  5. Ask patient to look at a near light then back at you

  6. Examine pupil reaction to light (pen-torch)

  7. Ask them to read print from a book

  8. Assess if visual acuity has changed
• Red Eye – Red Flags


  • Trauma or recent surgery/ eye injection
  • Contact lens use
  • Changes in vision
  • Any abnormal pupil reaction
  • Pain
  • Photophobia
  • Nausea and vomiting
  • Systemic diseases that have ocular symptoms
  • Chronic infiltrative/inflammatory diseases
• Conjunctivitis


  • Most common cause for red eye – "Pink eye"
  • 3 main types: Allergy, Viral, Bacterial
  • Beware the Unilateral red eye
  • Do not make a diagnosis of a monocular conjunctivitis until more serious eye disease is excluded
• The conjunctiva

  • The conjunctiva starts on the eye then goes to the back of the eye lid
  • Should be red in conjunctivits
• Allergic conjunctivitis


  • Most mild conjunctivitis is allergic or irritative
  • Avoid trigger
  • Symptoms: Itchy, burning sensation and watery eyes
  • Bilateral - but can be unilateral on direct contact with allergen
  • Treat with sodium chloride 0.9% - remove allergen
  • Lubricant + Cool compresses for discomfort
  • if symptoms unresolved by above: Topical NSAIDs, antihistamines or mast cell stabilizers
  • Avoid vasoconstrictors - does not treat the allergy
  • >14 days - rebound hyperaemia
• Viral conjunctivitis


  • Mainly caused by adenovirus
  • Usually associated with viral upper respiratory tract
  • Can also be herpes conjunctivitis - Cold sore/shingle history?
  • Symptoms: Burning sensation and watery discharge
  • Classically starts in one eye with rapid spread to the other
  • Highly contagious - Wash hands, don't share towels
  • No longer contagious when redness and weeping resolve
  • Usually 10 – 12 days
  • Children should stay away from school during this time
  • Treatment: Cool compresses & lubricants (preservative free) q 2 hrly
• Bacterial conjunctivitis


  • Unilateral initially but quickly spreads to the other eye
  • Has purulent discharge stuck to the eyelid
  • Can wake up with eyelids stuck together by the discharge
  • ~ 65% people have clinical cure in 2-5 days without treatment
  • Symptoms may last up to 14 days
  • Bacterial conjunctivitis is highly contagious
  • Wash hands regularly
  • Use separate tissues to avoid infection of the other eye or others
  • Use separate towels
  • Children should stay away from school until discharge has stopped
  • Chloramphenicol drops or ointment (S3 – Pharmacist only)
• Conjunctivitis is the most common cause for red eye – "Pink eye"
• Dry eyes


  AKA. Keratoconjunctivitis sicca
• Eye Lid Conditions


  • Blepharitis
  • Chalazions
  • Meibomian abscess (internal hordeolum)
  • Stye (external hordeolum)
  • Entropion
  • Ectropion
• Blepharitis


  • Inflammation of the eyelid margins
  • Numerous types: Seborrhoeic blepharitis, Staphylococcal blepharitis
  • Either can become chronic blepharitis
• Seborrhoeic blepharitis


  • Presents with greasy, easily removed scales on the lid margin
  • Mainly caused by seborrhoeic dermatitis
  • Often associated with seborrhoea of the scalp and eyebrows
  • Treatment: Lid hygiene - Warm compresses to soften crusts, Gentle scrubbing of the affected lid margins bd, Use a mild soap (1:10 diluted baby shampoo) or sodium bicarbonate, Lid-Care - sterile wipes
• Staphylococcal blepharitis


  • Less common
  • Presents with adherent crusts with shallow ulceration of eyelash base
  • Treatment: Same as seborrhoeic dermatitis - Warm compress and gently scrub the lids, Also add chloramphenicol 1% eye ointment to lid margins
• Chronic blepharitis


  • Some patients have chronic blepharitis often associated with rosacea
  • Treatment: Warm compress and gently scrub the lids, Long-term tetracyclines used for their anti-inflammatory effect and to inhibit bacterial lipase and prevent production of irritating free fatty acid, Doxycycline 50-100 mg daily for 1 to 2 months or on clinical response
• Chalazions


  • Granulomatous inflammatory lesions that occur from obstruction of the meibomian glands
  • Generally non-tender, Self-limiting - may take a few weeks
  • Treatment: Warm compresses and massage, Refer if patient finds it bothersome of it affects the vision - surgical removal
• Meibomian abscess


  • A staphylococcal abscess of a meibomian gland
  • Generally tender, Seldomly spontaneously discharge
  • Treatment: Warm compresses, di/flucloxacillin 500 mg orally, 6-hourly for at least 5 days, If persistent or recurrent - surgical removal
• Stye


  • A staphylococcal abscess of the small sebaceous glands
  • Symptoms: Swollen eye lid, Tender to touch, Develops to pus-filled lesion, Either shrink or burst
  • Treatment: Antibiotics are not needed, Most respond to warm compresses 3-4xday, Removal of the eyelash involved is often helpful
• Entropion


  • Eye lid/s turning inwards with eyelids abrading cornea
  • Treatment: No irritation/intact cornea - Topical lubrication with non-urgent referral, If the eye feels irritated/painful - Tape back eyelid away from the cornea and immediate referral to doctor
• Ectropion


  • Eye lid/s turning outwards with exposure of conjunctival sac
  • Treatment: Can often cause watery eye - Topical lubrication with non-urgent referral