Aetiology

Aetiology

The causes of acute red eye can be considered within the following categories:[4]

Adnexal causes

  • Trichiasis: posterior misdirection of the eyelashes from the normal site of origin com.bmj.content.model.assessment.Caption@4597c117[Figure caption and citation for the preceding image starts]: TrichiasisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Entropion: inward turning of the eyelid margin com.bmj.content.model.assessment.Caption@652b485f[Figure caption and citation for the preceding image starts]: EntropionPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Ectropion: outward turning of the eyelid margin com.bmj.content.model.assessment.Caption@77fcb30d[Figure caption and citation for the preceding image starts]: EctropionPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Blepharitis: inflammation of the eyelid margin com.bmj.content.model.assessment.Caption@7697c127[Figure caption and citation for the preceding image starts]: BlepharitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Dry eye: symptoms or signs consistent with a deficiency of the precorneal tear film. com.bmj.content.model.assessment.Caption@d73399b[Figure caption and citation for the preceding image starts]: Dry eye (stained with rose bengal)Private collection - courtesy of Mr Hugh Harris [Citation ends].

Conjunctival causes

  • Bacterial conjunctivitis: inflammation of the conjunctiva caused by bacterial infection com.bmj.content.model.assessment.Caption@3225f1da[Figure caption and citation for the preceding image starts]: Bacterial conjunctivitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Viral conjunctivitis: inflammation of the conjunctiva caused by viral infection com.bmj.content.model.assessment.Caption@20535848[Figure caption and citation for the preceding image starts]: Viral conjunctivitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Allergic (vernal) conjunctivitis: inflammation of the conjunctiva occurring during an allergic response com.bmj.content.model.assessment.Caption@68852b9c[Figure caption and citation for the preceding image starts]: Allergic (vernal) keratoconjunctivitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Neonatal conjunctivitis: inflammation of the conjunctiva within the first month of life

  • Subconjunctival haemorrhage com.bmj.content.model.assessment.Caption@7c2e68f6[Figure caption and citation for the preceding image starts]: Subconjunctival haemorrhagePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Subtarsal foreign body com.bmj.content.model.assessment.Caption@6118fd88[Figure caption and citation for the preceding image starts]: Subtarsal foreign body: vertical corneal abrasions seen with fluorescein stainPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Conjunctival foreign body.

Corneal causes

  • Bacterial corneal ulcer: corneal epithelial defect caused by bacterial infection com.bmj.content.model.assessment.Caption@5bb378fb[Figure caption and citation for the preceding image starts]: Corneal ulcer seen with fluorescein stainPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Viral corneal ulcer: corneal epithelial defect caused by viral infection com.bmj.content.model.assessment.Caption@1aab61da[Figure caption and citation for the preceding image starts]: Dendritic ulcer seen with fluorescein stainPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Fungal corneal ulcer: corneal epithelial defect caused by fungal infection

  • Contact lens-related

  • Corneal foreign body com.bmj.content.model.assessment.Caption@154dc3a1[Figure caption and citation for the preceding image starts]: Corneal foreign bodyPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Corneal abrasion: corneal epithelial defect usually caused by trauma. com.bmj.content.model.assessment.Caption@331f883d[Figure caption and citation for the preceding image starts]: Corneal abrasion seen with fluorescein stainPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

Inflammatory causes

  • Anterior uveitis: inflammation of the anterior portion of the uveal tract com.bmj.content.model.assessment.Caption@73ab4a05[Figure caption and citation for the preceding image starts]: Anterior uveitis with posterior synechiaePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Scleritis: inflammation of the sclera com.bmj.content.model.assessment.Caption@32cf501b[Figure caption and citation for the preceding image starts]: ScleritisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Episcleritis: inflammation of the episclera. com.bmj.content.model.assessment.Caption@49e4dd28[Figure caption and citation for the preceding image starts]: EpiscleritisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

Traumatic causes

  • Physical com.bmj.content.model.assessment.Caption@6f5fa49[Figure caption and citation for the preceding image starts]: Penetrating corneal injury with iris prolapsePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Chemical.

Other

  • Angle-closure glaucoma: closure of the iridocorneal angle leading to an acute rise in intra-ocular pressure. com.bmj.content.model.assessment.Caption@2f2773f0[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal oedema with an oval-shaped mid-dilated pupil.Private collection - courtesy of Mr Hugh Harris [Citation ends].

Most common conditions

Those commonly presenting to a primary care physician are:

  • Infective conjunctivitis[5]com.bmj.content.model.assessment.Caption@67a0a187[Figure caption and citation for the preceding image starts]: Bacterial conjunctivitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Allergic conjunctivitis com.bmj.content.model.assessment.Caption@8423dc6[Figure caption and citation for the preceding image starts]: Allergic (vernal) keratoconjunctivitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Dry eye and other adnexal problems.[6]com.bmj.content.model.assessment.Caption@214cb935[Figure caption and citation for the preceding image starts]: Dry eye (stained with rose bengal)Private collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@3560e61f[Figure caption and citation for the preceding image starts]: EntropionPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@57aed5ad[Figure caption and citation for the preceding image starts]: TrichiasisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@4e9b7e93[Figure caption and citation for the preceding image starts]: BlepharitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@adaf364[Figure caption and citation for the preceding image starts]: EctropionPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

Sight-threatening causes

Causes of red eye that can threaten vision by leading to reduced visual acuity include:

  • Angle-closure glaucoma com.bmj.content.model.assessment.Caption@38b8bc3e[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal oedema with an oval-shaped mid-dilated pupil.Private collection - courtesy of Mr Hugh Harris [Citation ends].

  • Chemical injuries

  • Conditions affecting the cornea

  • Trauma

  • Anterior uveitis. com.bmj.content.model.assessment.Caption@199a0539[Figure caption and citation for the preceding image starts]: Anterior uveitis with posterior synechiaePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

Causes of red eye that can threaten vision by leading to globe rupture or perforation include: com.bmj.content.model.assessment.Caption@ce08f7f[Figure caption and citation for the preceding image starts]: Penetrating corneal injury with iris prolapsePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Scleritis com.bmj.content.model.assessment.Caption@517c1c54[Figure caption and citation for the preceding image starts]: ScleritisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Physical trauma

  • Corneal ulceration

  • High-velocity foreign bodies.

These are discussed further with initial management in Emergencies: Urgent Considerations.

Risk factors

Risk factors associated with specific causes of red eye include:

  • Anterior uveitis: com.bmj.content.model.assessment.Caption@2cd81309[Figure caption and citation for the preceding image starts]: Anterior uveitis with posterior synechiaePrivate collection - courtesy of Mr Hugh Harris [Citation ends]. human leukocyte antigen-B27 histocompatibility complex-positive patients, tuberculosis, syphilis, Lyme disease, sarcoidosis, Behcet's disease, and pauciarticular juvenile chronic arthritis.

  • Scleritis: com.bmj.content.model.assessment.Caption@65a26866[Figure caption and citation for the preceding image starts]: ScleritisPrivate collection - courtesy of Mr Hugh Harris [Citation ends]. connective tissue disorders including rheumatoid arthritis, granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), systemic lupus erythematosus (SLE), and relapsing polychondritis.

  • Episcleritis: com.bmj.content.model.assessment.Caption@6d3198da[Figure caption and citation for the preceding image starts]: EpiscleritisPrivate collection - courtesy of Mr Hugh Harris [Citation ends]. connective tissue disorders including rheumatoid arthritis, granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), and SLE.

  • Angle-closure glaucoma: com.bmj.content.model.assessment.Caption@5c9ea794[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal oedema with an oval-shaped mid-dilated pupil.Private collection - courtesy of Mr Hugh Harris [Citation ends]. hypermetropia, mydriatics, and systemic anticholinergic medications.

  • Subconjunctival haemorrhage: com.bmj.content.model.assessment.Caption@3032a755[Figure caption and citation for the preceding image starts]: Subconjunctival haemorrhagePrivate collection - courtesy of Mr Hugh Harris [Citation ends]. hypertension, systemic anticoagulation, bleeding abnormalities (leukaemia, clotting disorders), conjunctival vascular lesion, trauma (including contact lens-related injury), and diabetes.

  • Dry eye: com.bmj.content.model.assessment.Caption@4625186d[Figure caption and citation for the preceding image starts]: Dry eye (stained with rose bengal)Private collection - courtesy of Mr Hugh Harris [Citation ends]. connective tissue disorders including Sjogren's syndrome, rheumatoid arthritis, and SLE.

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