Red eye

Introduction Red eye refers to the whiteness of the eyes. This is a general concept. When the blood vessels of the bulbar conjunctiva and sclera are dilated, congested, or hemorrhagic under certain conditions, they may appear white and red. Because the blood supply sources of various parts of the eye are different, the red eye morphology is different, and the lesions are not the same. Red eye is therefore a common symptom common to many eye diseases. Clinical diagnosis should be further clarified, to understand the conjunctival hyperemia and ciliary congestion that cause red eye. Conjunctival hyperemia represents a primary or secondary disease of the conjunctiva or surrounding appendages. Ciliary congestion represents the disease of the eye itself. Such as keratitis, scleritis, iridocyclitis, congestive glaucoma and so on. If the blood vessel itself is damaged or the lesion is broken, the bleeding can accumulate under the bulbar conjunctiva, which is called subconjunctival hemorrhage, which is also within the scope of red eye. Local congestion can also cause red eyes.

Cause

The iliac conjunctiva is supplied to the descending branch of the peripheral arterial arch, and the ascending branch is supplied to the temporal conjunctiva and the bulbar conjunctiva, which is called the posterior conjunctival artery. The anterior ciliary artery from the muscle branches of the four rectus muscles (muscle arteries), 3-5 mm from the limbus, perpendicular to the sclera and the suprachoroidal space to reach the ciliary body, and participate in the branch of the long ciliary artery to form the iris-sized arterial ring. . The upper branch of the sclera is distributed on the limbus to form the deep vascular network of the limbus. And the other branches are distributed to the conjunctiva layer. On the one hand, the superficial vascular network is formed on the limbus, and the posterior conjunctival artery is the posterior conjunctival artery. The conjunctival hyperemia is the conjunctival artery (and vein) from the surface layer. It is characterized by large blood vessels, distortion, bright red, clear branches, and the more prominent the crotch, which can move with the conjunctiva. Ciliary congestion is caused by the congestion of two layers of deep and shallow vascular plexus around the limbus from the branch of the anterior ciliary artery. Distributed around the limbus, the position is deep, a circle of purple-red congestion around the cornea, no branching, the clearer the cornea, the movement of the conjunctiva. If conjunctival hyperemia and ciliary congestion are present at the same time, it is called mixed hyperemia. When the pathogenic factor acts on the tissue, it may be the result of the release of proteolytic peptides, histamine and histamine-like substance (H+ substance) on the blood vessels through the nerve reflex, so that the blood supply of the small artery first There is a temporary contraction, and then small arteries and veins and capillaries continue to expand, causing local congestion, resulting in red eye. The second is due to local circulatory disorders, venous fibrosis with conjunctival edema, and a state of congestion can also cause red eye. The third is that the blood vessel itself is damaged or the lesion is broken. The bleeding accumulates under the conjunctiva and is called subconjunctival hemorrhage. Therefore, red eye symptoms may also occur. Since red eye is caused by various eye diseases, the causes of red eye are also diverse.

Generally summarized as:

(a), inflammation

1. Infectivity such as bacteria, rickettsia, viruses, fungi, parasites and the like. Can cause keratitis, corneal ulcer, uveitis, purulent iridocyclitis, endophthalmitis, total ocular inflammation, eyelid cellulitis, and various types of conjunctivitis.

2. Allergic reactions such as allergy to allogeneic antigens, allergies to autoantigens or autoimmune diseases. Commonly, there are drug allergies such as atropine, vesicular keratoconjunctivitis, spring cardioid conjunctivitis, corneal stroma inflammation, scleritis, and iridocyclitis.

(B), trauma, various eye injuries, foreign bodies, sympathetic ophthalmia.

(C), pressure in the eye or intraorbital pressure increased, leading to blood circulation disorders, local congestion. Found in acute angle-closure glaucoma, sacral space-occupying lesions.

(4) New biological active wing-shaped meat, corneal and conjunctival malignant mass.

(5) Chronic stimulation to regulate fatigue, stimulation of wind, dust, smoke and heat.

an examination

Related inspection

Chlamydia trachomatis

First, medical history

First, understand whether red eye is single or both eyes occur simultaneously or sequentially. With or without secretions, the nature of the secretions is purulent, mucous, watery with or without shame, tearing, eye pain and other irritating symptoms. Whether vision is affected or not. If the red eye is onset, bilaterally accompanied by secretions, no irritation, and does not affect vision, consider acute conjunctivitis. If there is no secretion in the eyes, there are no other symptoms, which may be subconjunctival hemorrhage. If there is redness, visual impairment, accompanied by obvious irritation, it may be inflammation of the cornea or iris ciliary body. If the eye is acute, with eye pain, eyesight, rainbow vision, sharp vision loss, and even nausea and vomiting, may be acute angle-closure glaucoma. Also ask in detail whether there is a history of drug allergy and history of trauma surgery.

Second, physical examination

First, pay attention to the whole body examination, whether there is a systemic infectious disease, whether there is fever, hypertension, cardiovascular disease, blood disease, etc. Eye examination, first measure vision to find out whether red eye is an external eye disease or a anterior segment of the eye. Further check whether the red eye is congested, bruised or bleeding. Subconjunctival hemorrhage is easily identifiable. Under normal circumstances, the cause is unclear, which may be related to factors such as trauma, cough, blinking, constipation, and drinking. However, attention should be paid to the presence or absence of hypertension, blood diseases, and acute infectious diseases. If it is congested with conjunctival edema, you should consider the eyeball and eyelids, pay attention to the intraocular pressure, pay attention to the eyelids with or without swelling and inflammation. If it is hyperemia, it should be distinguished whether it is conjunctival hyperemia or ciliary congestion. Conjunctival hyperemia represents a lesion of the conjunctiva or surrounding appendages. Attention should be paid to the presence or absence of cleft palate, varus, blepharitis, conjunctival hyperemia, nipple follicular hyperplasia, scarring, granulation and so on. The conjunctiva is free of herpes, pterygium or new life. Ciliary congestion represents the anterior segment of the eye. Slit lamp microscope to examine the cornea, anterior chamber, iris, pupil, and if necessary, combined with intraocular pressure and fundus to identify keratitis and foreign bodies. Ulcer, iridocyclitis, acute angle-closure glaucoma, endophthalmitis, etc.

Third, laboratory inspection

Smear, scraping and culture are useful for the diagnosis of conjunctival and corneal lesions. The etiology of uveitis is often difficult to diagnose. Laboratory tests can help detect systemic diseases. Such as white blood cells and their classification. ESR and tuberculin tests should be routine. Anti-streptolysin "O", rheumatoid factor (RF), antinuclear antibody (ANA), C-reactive protein (CRP) and the like.

Fourth, equipment inspection

Slit lamp microscopy can understand the shape, size and depth of corneal lesions. Fluorescein staining is combined as necessary. The depth of the anterior chamber, fibrin exudation, empyema, hemorrhage, KP. Tyndall phenomenon, anterior chamber floating cells, iris adhesion, atrophy, crystal changes, etc., are all examined by slit lamp microscope. When the protein content of aqueous humor increases, the aqueous humor appears turbid, that is, there is a phenomenon of Tyn-dall. But this phenomenon does not mean that the cells are floating. There is no Typdall phenomenon in cell floating. KP and anterior chamber floats are non-pigmented, suggesting iridocyclitis. Acute angle-closure glaucoma is dominated by pigmented KP and floats. The Koeppe nodules on the surface of the iris and the Busacca nodules are visible in the inflammation of the iris ciliary body. On the surface of the iris, the diameter is 0.2-0.5 mm. Therefore, slit lamp microscopy will obtain a reliable diagnosis and differential diagnosis basis. X-ray examination can exclude tuberculosis and sarcoidosis. Ankle and bone and joint examinations are helpful in the diagnosis of arthritis, especially ankylosing spondylitis. Fundus fluorescein angiography, ultrasonography, and CT scan have diagnostic significance for some special cases.

Differential diagnosis

The concept of general congestion of the eyes is that the eyes are red. The blood vessels of the bulbar conjunctiva and sclera are in some cases dilated, congested, stagnant or bleeding. It can be white and red. Because the blood supply of different parts of the eye is different, the appearance of the eye congestion is different, and the lesions are not the same. Therefore, eye congestion is a common symptom common to many eye diseases. Conjunctival hyperemia is limited to conjunctival disease or related superficial stimulation, while ciliary congestion includes diseases of the cornea, sclera, and anterior pigmentation, often with certain severity. Scleral congestion refers to the expansion and congestion of the blood vessels of the conjunctiva and sclera in some cases, showing whitening and redness. Fever with eye congestion refers to symptoms of elevated body temperature and congested eyes due to illness. Common in measles, epidemic hemorrhagic fever, typhus, etc., similar to rabbit eye performance.

First, medical history

First, understand whether red eye is single or both eyes occur simultaneously or sequentially. Whether there is secretion, the nature of the secretion, is purulent, mucinous, or watery; there are no irritating symptoms such as shame, tearing, and eye pain. Whether vision is affected or not. If the red eye is onset, bilaterally accompanied by secretions, no irritation, and does not affect vision, consider acute conjunctivitis. If there is no secretion in the eyes, there are no other symptoms, which may be subconjunctival hemorrhage. If there is redness, visual impairment, accompanied by obvious irritation, it may be inflammation of the cornea or iris ciliary body. If the eye is acute, with eye pain, eyesight, rainbow vision, sharp vision loss, and even nausea and vomiting, may be acute angle-closure glaucoma. Also ask in detail whether there is a history of drug allergy and history of trauma surgery.

Second, physical examination

First, pay attention to the whole body examination, whether there is a systemic infectious disease, whether there is fever, hypertension, cardiovascular disease, blood disease, etc. Eye examination, first measure vision to find out whether red eye is an external eye disease or a anterior segment of the eye. Further check whether the red eye is congested, bruised or bleeding. Subconjunctival hemorrhage is easily identifiable. Under normal circumstances, the cause is unclear, which may be related to factors such as trauma, cough, blinking, constipation, and drinking. However, attention should be paid to the presence or absence of hypertension, blood diseases, and acute infectious diseases. If it is congested with conjunctival edema, you should consider the eyeball and eyelids, pay attention to the intraocular pressure, pay attention to the eyelids with or without swelling and inflammation. If it is hyperemia, it should be distinguished whether it is conjunctival hyperemia or ciliary congestion. Conjunctival hyperemia represents a lesion of the conjunctiva or surrounding appendages. Attention should be paid to the presence or absence of cleft palate, varus, blepharitis, conjunctival hyperemia, nipple follicular hyperplasia, scarring, granulation and so on. The conjunctiva is free of herpes, pterygium or new life. Ciliary congestion represents the anterior segment of the eye. Slit lamp microscope to examine the cornea, anterior chamber, iris, pupil, if necessary, combined with intraocular pressure and fundus conditions to identify keratitis, foreign bodies, ulcers, iridocyclitis, acute angle-closure glaucoma, endophthalmitis.

Third, laboratory inspection

Smear, scraping and culture are useful for the diagnosis of conjunctival and corneal lesions. The etiology of uveitis is often difficult to diagnose. Laboratory tests can help detect systemic diseases. Such as white blood cells and their classification. ESR and tuberculin tests should be routine. Anti-streptolysin "O", rheumatoid factor (RF), antinuclear antibody (ANA), C-reactive protein (CRP) and the like.

Fourth, equipment inspection

Slit lamp microscopy can understand the shape, size and depth of corneal lesions. Fluorescein staining is combined as necessary. The depth of the anterior chamber, fibrin exudation, empyema, hemorrhage, KP, Tyndall phenomenon, anterior chamber floating cells, iris adhesion, atrophy, crystal changes, etc., all need to be examined by slit lamp microscope. When the protein content of aqueous humor increases, the aqueous humor appears turbid, that is, there is a phenomenon of Tyn-dall. But this phenomenon does not mean that the cells are floating. There is no Typdall phenomenon in cell floating. KP and anterior chamber floats are non-pigmented, suggesting iridocyclitis. Acute angle-closure glaucoma is dominated by pigmented KP and floats. The Koeppe nodules on the surface of the iris and the Busacca nodules are visible in the inflammation of the iris ciliary body. On the surface of the iris, the diameter is 0.2-0.5 mm. Therefore, slit lamp microscopy will obtain a reliable diagnosis and differential diagnosis basis. X-ray examination can exclude tuberculosis and sarcoidosis. Ankle and bone and joint examinations are helpful in the diagnosis of arthritis, especially ankylosing spondylitis. Fundus fluorescein angiography, ultrasonography, and CT scan have diagnostic significance for some special cases.

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