Under a red eye means a red appearance of the open eye that reflects an extension of the superficial Okulargefäße. Pathophysiology is an extension of the superficial Okulargefäße resulting from infection allergic inflammation (infectious) elevated intraocular pressure (less häuig) Several ocular components may be involved, most often the conjunctiva, but also the uvea, the episclera and the sclera. Etiology The most common causes of red eye include Infectious conjunctivitis Allergic conjunctivitis corneal abrasions and foreign bodies are common causes (see Table: Some causes of a red eye). Although the eye is red, the patients present typically with an injury complaint, eye pain, or both. In young children and infants, such information may not be available. Some causes of a red eye cause suspicious findings diagnostic approach conjunctival diseases and episcleritis * Allergic or seasonal conjunctivitis Bilateral, prominent itching, possibly bulging of the conjunctiva (chemosis) Known allergies or other features of allergies (eg. As seasonal recurrences, runny nose) sometimes use topical ophthalmic drugs (especially neomycin) Clinical evaluation Konjunktiviti s (by chemical (irritant) substances Exposure to potential irritants z. As dust, smoke, ammonia, chlorine, phosgene) Clinical evaluation episcleritis Unilateral focal redness, slight irritation, minimal eye tears Clinical Evaluation Infectious conjunctivitis scratchy sensation, photosensitivity sometimes mucopurulent discharge, eyelid edema or follicular subconjunctival on tarsal conjunctiva Clinical evaluation hemorrhage Unilateral, asymptomatic focal red spot or confluent redness may trauma or Valsalva maneuver in prehistory Often anamnestic use of anticoagulants or antiplatelet agents (eg. As aspirin, NSAIDs, warfarin) Clinical evaluation conjunctivitis vernal Severe itching, stringy discharge Usually prepubertal or adolescent men Other atopic diseases increase in the spring and decrease in winter Clinical evaluation diseases of the cornea contact lens keratitis Prolonged wearing of contact lenses, eye tears, corneal edema Clinical Rating corneal erosion or debris Occur after an injury (this history occurs in infants and young children but may not be in evidence) foreign body sensation lesion by fluorescein staining apparent Clinical evaluation corneal ulcer is followed Often gray haze on the cornea, by a visible crater (shapeless defect of the corneal stroma) may Sleeping with contact lenses in the history culture of the ulcer (smears are performed by an ophthalmologist) Epidemic keratoconjunctivitis (adenovirus keratitis) if moderate or severe watery discharge Abundant Often eyelid edema, preauricular lymphadenopathy, Ch emosis (swelling of the conjunctiva) Occasionally, severe temporary loss of vision dotted pattern in fluorescein staining Clinical Evaluation Herpes simplex keratitis occurrence after conjunctivitis, blisters on the eyelid Classical dendritic corneal lesion by fluorescein staining seen Unilateral Clinical evaluation virus cultivation, if diagnosis is unclear zoster ophthalmicus unilateral bubbles and crusts on an erythematous base in a V1 coverage area, sometimes the tip of the nose is affected eyelid edema Red eye is uveitis associated possibly with possibly severe pain Clinical evaluation virus cultivation, if diagnosis is unclear Other diseases Acute Angle-Closure Glaucoma Severe eye pain headache, nausea, vomiting, halos (rings) around lights Opaque cornea, significant conjunctival redness (due to edema caused) Decreased visual acuity intraocular pressure typically> 40 mmHg tonometry and gonioscopy anterior uveitis eye pain, photophobia Ciliary injection (redness is most concentrated around the cornea and there often confluent) often a risk factor (eg. B. autoimmune disease, blunt trauma in the previous days) Possibly decreased visual acuity or pus (in the anterior chamber hypopyon) cells and positive Tyndall (flare) at slit lamp examination Clinical evaluation scleritis severe pain, often described as boring photophobia, lacrimation red or purple stains Clinical evaluation Further tests not described with the bulbar conjunctiva Skleralödem pain sensitivity of the globe with palpitation often anamnestic autoimmune disease by or in consultation with an ophthalmologist * Unless otherwise usually by Juckr itzerland or scratchy sensation, lacrimation, diffuse redness and often characterized by photosensitivity, but no Visusänderung and no pain or real photophobia. Unless otherwise stated, generally characterized by watery eyes, pain and photophobia real. The eyesight is affected when the lesion involves the visual axis. V1 = ophthalmic coverage area of ??the trigeminal nerve. Assessment Most diseases can be diagnosed by a medical practitioner. Medical history questions about the current course of the disease should be the beginning and the duration of redness and the presence of any change in vision, an itching, pain or notice of discharge of a scratching feeling. Type and severity of pain, including the question of whether the pain worse by light (photophobia) are found. The physician should determine if the discharge is watery or purulent. Other questions assess the injury history, including exposure to irritants and the use of contact lenses (eg. As possible excessive use, such as wearing during sleep). Preliminary episodes of eye pain or redness and their time course be obtained. The review of organ systems should look for symptoms that suggest possible causes, such as headache, nausea, vomiting and halos (rings) around lights (acute angle-closure glaucoma), runny nose and sneezing (allergies, infections of the upper respiratory tract) and cough, sore throat and malaise (infections of the upper respiratory tract). The medical history includes questions about known allergies and autoimmune diseases. The drug history should ask especially after the recent use of topical ophthalmic medications (including nonprescription drugs) that may sensitizing sind.Körperliche study the general investigation should be a head and neck examination (signs associated diseases such. As infections of the upper respiratory tract, allergic rhinitis include zoster rash). The eye examination includes a formal measurement of visual acuity and usually requires a pin lamp, a fluorescein staining as well as a slit lamp. The best corrected visual acuity will be measured. The pupil size as well as their reactivity to light are evaluated. True photophobia (sometimes called consensual photophobia called) is when a light that is directed into the unaffected eye, causing pain in the affected eye when the affected eye is closed. Extraocular movements are assessed and the eye and the periorbital tissues are examined for lesions and swelling. The tarsal surface is inspected for follicle. Corneas are stained with fluorescein and examined under magnification. If a corneal erosion is detected, the lid is everted and examined for hidden debris. The inspection ocular structures and the cornea is best done using a slit lamp. A slit lamp is also used to examine the anterior chamber on cells positive Tyndall (flare) and pus (hypopyon). The eye pressure is measured by tonometry, although it may be acceptable to skip this test if there are no symptoms or complaints that nahelegen.Warnzeichen a fault except conjunctivitis The following findings are of particular importance: Sudden, severe pain and vomiting zoster rash Decreased visual acuity cornea crater branching, dendritic corneal lesion eye pressure are not faded> 40 mmHg skill by phenylephrine eyedrops interpretation of the results diseases of the conjunctiva and episcleritis are differential diagnosis distinguished from other causes of red eye by the absence of pain, photophobia, and corneal staining. Under these conditions the episcleritis is differentiated by its focality and a subconjunctival hemorrhage is differentiated generally by the lack of watering eyes, itching and photosensitivity. Clinical criteria do not differentiate viral conjunctivitis accurately bacterial conjunctivitis. Corneal diseases from other causes of a red eye (and against each other in general) differentiated by a fluorescein staining. These disorders are often characterized by pain and photophobia. When the ocular instillation anesthetic drops (z. B. Proparakain-POS® 0.5%), which is carried out before the tonometry and, ideally, before the fluorescein instillation, the pain completely alleviates, the cause is likely to be limited to the cornea. If pain is present and will not be alleviated by an ocular anesthetic, the cause may be an anterior uveitis, glaucoma or scleritis. Since patients may have an anterior uveitis as a result of a corneal lesion, the persistence of pain after the instillation of the anesthetic does not rule out a corneal lesion. Anterior uveitis, glaucoma, acute angle-closure glaucoma and scleritis can be differentiated in general, by other causes of red eye by the presence of pain and lack of corneal staining. Anterior uveitis is likely in patients with pain, real photophobia, absence of fluorescein staining of the cornea and normal intraocular pressure and finally based on the presence of cells and positive Tyndall (flare) is diagnosed in the anterior chamber. However, such findings for a general practitioner may be difficult to detect. Acute angle-closure glaucoma can be usually detected by the sudden appearance of his severe and characteristic symptoms, but a tonometry provides a reliable diagnosis. An instillation of phenylephrine 2.5% causes a fading of the red eye, unless the cause is a scleritis. Phenylephrine is instilled to dilate the pupil in patients who need a comprehensive retinal examination. It should be not used in patients who meet the following criteria, however: Suspected acute angle-closure glaucoma A anamnestic angle closure glaucoma A restricted anterior chamber tests tests are usually not necessary. A virus culture can help when herpes simplex or herpes zoster is suspected and the diagnosis is not clear clinically. Corneal ulcers are cultivated by an ophthalmologist. Gonioscopy is performed in patients with glaucoma. Tests for autoimmune diseases may be appropriate in patients with uveitis and no obvious cause (eg. As trauma). Patients with scleritis undergo further tests under the supervision of an ophthalmologist. The cause of therapy is treated. A red eye in itself does not need to be treated. Topical vasoconstrictors are not recommended. Summary Most cases are caused by conjunctivitis. Pain and photophobia real point to other, towards more serious diagnoses. In patients with pain is a slit-lamp examination with fluorescein staining and a tonometry of particular importance. The persistence of pain despite an ocular anesthetic in a patient with a normal fluorescein investigation indicates a anterior uveitis, scleritis or acute angle-closure glaucoma. These diagnoses should not be overlooked.