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Redness of the eyes
Medical expert of the article
Causes of redness in the eyes
The causes of reddening of the eyes are varied, some of them threaten vision, and therefore the patient needs a specialist examination (to eliminate acute glaucoma, acute iritis, ulceration of the cornea). Other causes of redness of the eyes (episcleritis, conjunctivitis, spontaneous conjunctival hemorrhage) are eliminated easier. Thoroughly examine the reddened eyes and assess the visual acuity, the condition of the cornea (use fluorescein eye drops), check the pupillary reflexes.
Sharp angle-closure glaucoma
It is a disease of middle-aged or elderly people. An acute attack of glaucoma in one eye is usually preceded by reddening of the eyes, reduced clarity of vision or the appearance of a halo around luminous objects, especially at night. This is due to the blockade of drainage of the aquatic environment from the anterior chamber of the eye through the helmet canal. The dilatation of the pupils at night aggravates this drainage block. Intraocular pressure thus rises to 60-70 mm Hg, in norm it makes 15-20 mm Hg. The patient experiences pain of varying degrees (it can be very severe, with concomitant nausea and vomiting), vision deteriorates, the cornea becomes somewhat turbid due to its swelling, the eye blushes mainly around the cornea, the pupil is fixed, enlarged, oval in shape. In connection with increased intraocular pressure, the eyeball becomes hard to the touch. In the other eye, the anterior chamber of the eye can be "shallow", which is considered as a predisposing factor (light the eye with a light source from the side, with half the iris in the shade). If you suspected the disease, the patient should be sent to the eye department.
Acute iritis (anterior uveitis)
The disease is characterized by a sharp onset - pain in the eyes, photophobia, blurred vision (due to the presence of precipitates in the aquatic environment of the eye), tearing, the appearance of redness around the cornea (ciliary stasis), the pupil is reduced (at first it is caused by spasm of the iris, and later - pupil or its irregular shape due to the formation of adhesions). The Talbot test is positive (the pain increases with convergence of the eyes, and the pupils contract when the patient looks at the tip of his finger approaching the nose). Using a slit lamp, white precipitates on the back of the cornea and the presence of pus in the anterior chamber of the eye (hypopion) can be seen. People are more often young or middle-aged. Causes of the disease are different: anterior uveitis occurs in lesions of joints, such as ankylosing spondylitis or Still's disease, with ulcerative colitis, sarcoidosis, Behcet's disease and Stevens-Johnson syndrome. The disease can recur.
More about the reddened eye - the cornea and conjunctiva
Eye redness associated with corneal disease
Keratitis is an inflammation of the cornea (it is recognized by the appearance of white dots, which indicates the accumulation of leukocytes in the cornea).
Ulceration of the cornea is a violation of the integrity of the epithelial cover of the cornea, it can occur in the absence of keratitis (for example, as a result of trauma); In such cases, a prophylactic ointment with antibiotics is used (for example, 1% ointment with chloramphenicol). Ulceration of the cornea against the background of keratitis is called ulcerative keratitis and must be treated in an emergency. The disease is manifested by pain, photophobia and sometimes blurred vision. It can result from the use of contact lenses, trauma and previous corneal diseases.
Ulcerative keratitis: to confirm the diagnosis should use fluorescein. The affected areas of the cornea are colored green (the drops themselves are orange). Ulceration can be of various origins: bacterial (especially be vigilant towards Pseudomonas, as the lesion rapidly progresses), viral (Herpes simplex, Herpes zoster),
In such cases it is necessary to go to the hospital on the same day, because the treatment depends on the etiology of ulcerative keratitis, and delay in treatment can cause loss of vision. Any patient with ulceration of the cornea or stromal suppuration needs urgent diagnosis, for which diagnostic smears are made (for Gram staining) or scraping is performed (the procedure should be performed by an experienced specialist). It is also necessary to contact a microbiologist to obtain the results of a microbiological study.
Conjunctivitis, as a rule, is bilateral, if the process is one-sided, think about other diagnoses, for example, acute glaucoma. Conjunctiva thus reddened. Visual acuity, the pupils' reaction to light and the gloss of the cornea are not violated. In the eyes there are itching, burning, they are watering. Sometimes there is photophobia. Purulent discharge from the eyes glue the eyelids. The disease may have a viral etiology (adenovirus is highly contagious), while tiny lymphoid aggregations appear to be follicles on the conjunctiva; bacterial (with a particularly pronounced purulent discharge from the eyes) or allergic nature. The lesion is usually of a self-limiting nature (however, allergic reactions may be more prolonged). In cases of prolonged conjunctivitis, especially in young people, or in patients with sexually transmitted diseases, chlamydial infection should be considered.
Read also: What is conjunctivitis and how to fight it?
Inflammation under conjunctiva, in the episcler is often accompanied by the formation of inflammatory nodules, reddening of the eyes is observed. The patient experiences dull pain in the eye, soreness when touched, especially in the area of inflammation. Effectively instill in the eyes of steroid eye drops [eg, clobetasone butyrate (0.1% solution every 6 hours).
Sometimes the inflammation spreads to the sclera. This is more generalized inflammation with edema of the conjunctiva and thinning of the sclera (in severe cases there is a risk of perforation of the eyeball). Scleritis can be combined with a systemic lesion of connective tissue (collagenoses). In such cases, you should contact specialists.
This harmless, albeit disturbing-looking cluster under the conjunctiva of the blood that has poured from a small blood vessel, is usually not required for treatment. Such a hematoma resolves itself. If this is repeated often, exclude a patient from hemorrhagic diathesis, check blood pressure.
Diagnosis of dangerous eye redness
Answer the following questions.
- Is visual acuity disturbed? This can be quickly and accurately assessed by checking the readability of the newspaper text to patients. Refractive errors are corrected with the help of glasses or a stenopaque hole. Decreased visual acuity may indicate a dangerous pathology.
- Is the eyeball painful? The presence of pain is always an unfavorable symptom. In the eye can also be a foreign body. Simple irritation rarely causes pain in the eyeball.
- Does the pupil react to light? The absence of this reaction or its sharp deceleration serve as unfavorable signs.
- Is the cornea affected or not? To do this, use fluorescein eye drops. The defeat of the cornea may be due to trauma or ulceration.
Ask the patient for a trauma, discharge from the eyes, health status and those medications that he takes; do not forget to measure blood pressure.
If you have any doubt, immediately consult a patient with a specialist.
Treatment of redness of the eyes
Treatment of redness of the eyes with conjunctivitis
Usually, antibiotics are used, for example chloramphenicol in the form of 0.5% drops, which are instilled in the eye every 3 hours, and at night I% ointment is used. With chlamydial infection, the patient is prescribed tetracycline 250 mg every 6 hours inside, and also in the form of 1% ointment, which is poured for eyelids every 6 hours for at least 1 month. When allergic conditions should be used cromolyn sodium in the form of 2% eye drops, which are instilled after every 6 hours.
Treatment of eye redness in keratitis
At infection with Herpes zoster, acyclovir is indicated. In regard to branching ulceration with Herpes simplex infection . Cycloplegic drugs can help reduce the pain associated with ciliary spasm and prevent the development of adhesions with the iris.
Treatment of redness of eyes with closed angle glaucoma
Pilocarpine - 4% solution is instilled in the eye every hour (with a blocked drainage angle opens); orally acetazolamide, 500 mg immediately (and when vomiting intramuscularly), and then 250 mg every 8 hours. Acetazolamide reduces the formation of water in the anterior chamber of the eye. After lowering the intraocular pressure, peripheral iridectomy is performed by medications (sometimes it is performed as an emergency intervention, if it is not possible to reduce intraocular pressure by drugs). In this operation, remove a small piece of the iris in the "12 hours" section in both eyes, which helps restore normal circulation of the liquid.
Treatment of redness of the eyes with acute iritis
The goals of the treatment are to prevent damage to the eye due to a prolonged inflammatory process. In the latter case, there is a possibility of disturbance of the fluid current inside the eye, which can be caused by the appearance of glaucoma, as well as the presence of adhesions formed between the iris and the lens. Treatment of redness of the eyes is carried out by glucocorticoid hormones: for example, a 0.5% solution of prednisolone is instilled in the eye every 2 hours, which leads to a reduction in inflammatory changes (pain, redness, exudate formation). To prevent the appearance of adhesions (synechiae) between the lens and the iris, the pupil is kept in the dilated state with a 0.5% solution of cyclopentolate (Cyclopentolate) 1-2 drops per hour until the signs of iritium decrease. The degree of inflammatory changes is assessed with a regular examination of the eye with a slit lamp.