2408 Apple APR MAY 2016 A4 Bleed 5

SEEING
RED
By Mr. Daniel Ezra
MA(Cantab) MBBS MMedEd MD(Cantab.) FRCS FRCOphth FHEA
Mr. Ezra is consultant ophthalmic surgeon to
Moorfields Eye Hospital, and practices privately.
Without doubt, almost all of you will have
experienced an episode of red eyes at some
point. There are many conditions that cause
this, and some can be quite alarming.
Eye problems contribute up to
7% of GP visits, and the majority
of these relate to red eyes
No discussion of red eyes in primary care can be made
without mention of blepharitis - an inflammatory
disorder of the eyelid margins. It is extremely common,
affecting up to 20% of people, and tends to present
with non-specific symptoms of redness, grittiness and
dryness. There are approximately 30 oil producing
glands in each eyelid that supply oil for the tear film.
This oily layer covers the watery layer of the tear film
preventing evaporation and providing stability. Changes
in the constitution of the oil secretions make them
solid rather than liquid at body temperature, clogging
the glands and allowing bacteria to colonise the eyelid
margins. These bacteria in turn produce toxins that
cause irritation (see figure 1). The best treatment is hot
compresses and massage which act to heat the eyelid
margin and liquefy the secretions. For more persistent
or serious complaints, steroids and antibiotics may be
required but this is unusual. Another option may be
deep cleaning using specialised equipment which usually
gives relief for 6-9 months.
Another very common condition is infective
conjunctivitis. This usually arises after an upper
respiratory tract infection such as a cold or the flu.
There are two types of infective conjunctivitis: bacterial
and viral. Bacterial conjunctivitis is easy to recognise; it
is characterised by significant mucous discharge which
typically causes the eyelids to stick together in the
morning, requiring considerable effort to reopen them
(see figure 2). Bacterial conjunctivitis is treated with
antibiotic eye drops. The viral form of conjunctivitis
feels very different. It causes a more watery discharge
with less stickiness, but paradoxically causes more
irritation and grittiness. Viral conjunctivitis is not cured
by antibiotic drops, but is treated with supportive
measures such as lubricants until the infection resolves,
usually after just a few days. Infective conjunctivitis,
especially the viral type is highly contagious. It is
important to prevent the spread of infection by
ensuring that hands are always washed and not to
share towels or bedsheets.
The red eye condition with probably the most alarming
appearance is also probably the most benign;
subconjunctival haemorrhage. This is a condition where
blood collects under the conjunctiva after a small
capillary ruptures. This is usually entirely benign and
tends to resolve after a few days (see figure 3).
Figure 1 Figure 2 Figure 3
Whilst these conditions are not sight threatening,
please remember that if you have a red eye with
symptoms of significant pain, aversion to light or
decrease in vision, this may indicate a more serious
problem and you should see an Ophthalmologist (eye
specialist) or a GP at the earliest opportunity.
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