Etiology

Etiology

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@50e6fbe[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@7b3be3c1[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@5a731821[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@1c093ddc[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@6a0cd27c[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@4e8d1117[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@c7daaf7[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@59cf8179[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 hemorrhage com.bmj.content.model.assessment.Caption@555c370e[Figure caption and citation for the preceding image starts]: Subconjunctival hemorrhagePrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Subtarsal foreign body com.bmj.content.model.assessment.Caption@73ff811b[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@12b4b781[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@37d538e7[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@3058d54[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@c7d3376[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@3bc285c7[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@25ce8058[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@a0ed698[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@6f0db22c[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 intraocular pressure. com.bmj.content.model.assessment.Caption@404efeb7[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal edema with an oval-shaped mid-dilated pupilPrivate 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@11537aa6[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@6d95c402[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@6f8b974e[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@5807674e[Figure caption and citation for the preceding image starts]: EntropionPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@528ba0a2[Figure caption and citation for the preceding image starts]: TrichiasisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@117dcb25[Figure caption and citation for the preceding image starts]: BlepharitisPrivate collection - courtesy of Mr Hugh Harris [Citation ends].com.bmj.content.model.assessment.Caption@227f1fa3[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@412131b5[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal edema with an oval-shaped mid-dilated pupilPrivate collection - courtesy of Mr Hugh Harris [Citation ends].

  • Chemical injuries

  • Conditions affecting the cornea

  • Trauma

  • Anterior uveitis. com.bmj.content.model.assessment.Caption@4ea00783[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@317bc991[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@6b235a1a[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@23c76252[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 disease, and pauciarticular juvenile chronic arthritis.

  • Scleritis: com.bmj.content.model.assessment.Caption@6d15e5b6[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 granulomatosis), systemic lupus erythematosus (SLE), and relapsing polychondritis.

  • Episcleritis: com.bmj.content.model.assessment.Caption@24d9ec4[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 granulomatosis), and SLE.

  • Angle-closure glaucoma: com.bmj.content.model.assessment.Caption@73cfe71d[Figure caption and citation for the preceding image starts]: Angle-closure glaucoma: central corneal edema with an oval-shaped mid-dilated pupilPrivate collection - courtesy of Mr Hugh Harris [Citation ends]. hypermetropia, mydriatics, and systemic anticholinergic medications.

  • Subconjunctival hemorrhage: com.bmj.content.model.assessment.Caption@6b02cec4[Figure caption and citation for the preceding image starts]: Subconjunctival hemorrhagePrivate collection - courtesy of Mr Hugh Harris [Citation ends]. hypertension, systemic anticoagulation, bleeding abnormalities (leukemia, clotting disorders), conjunctival vascular lesion, trauma (including contact lens-related injury), and diabetes.

  • Dry eye: com.bmj.content.model.assessment.Caption@29f8ae47[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 syndrome, rheumatoid arthritis, and SLE.

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