Month: August 2022

What do you do when you have a Red Eye?

/ Subash Rau / Leave a comment

There are many causes for a red eye and most people get very alarmed on seeing a very red eye. This article hopes to share some information about the common causes for a red eye and what one should do after developing a red eye. Before we go into the causes and the a development of a red eye, lets briefly look at the anatomy of the eye in the picture below.

The eye is like a ball made of the tough sclera (white part of the eye) all around except in the very front of the eye where the transparent cornea is attached. The front part of the sclera is covered by the protective conjunctiva which folds under the eyelids. The conjunctiva has a rich supply of blood vessels and they open up whenever there is an irritation and make the eye red.

The cornea is the transparent window that allows the light inside the eye. The amount of light allowed in is controlled by the iris and its central opening called the pupil. The lens of the eye which is biconvex focuses the light on to the fovea , an area on the retina where light is transduced into electric impulses that are carried by the optic nerves for interpretation in the brain.The retina is the inner most layer (of nerves) inside of the sclera and is separated from the sclera by the vascular choroid layer.

The eye is an extremely sensitive organ and the body does everything to protect it. Therefore any irritation which may be due to injury, abrasions, allergy, infection immediately stimulates an increase in the blood flow into the eye to help contain and repair the damage sustained. So a red eye is an indicator that all is not well with the eye.

So when should you go immediately to an Ophthalmologist or to a Eye hospital?

You need to go immediately to an eye hospital if you have severe pain in the eye or if your vision is impaired or if your pupils are irregular. There are 6 conditions that should make you seek help immediately.

1. Severe conjunctivitis : the eyes would be red, painful and with a lot of pus like discharge from the affected eyes.

2. Corneal ulcer is an extremely painful condition and can happen due to accidentally touching the eye, rubbing the eye or due to some caustic fluid splash on the eye or due to herpetic infection. The eye will be red with excessive tearing and patient would find it difficult to open eye and look at light.

3. Uveitis – is when the iris and the ciliary body are inflamed due to an infection or any other condition. The eye will be red, painful with visual loss and inability to look into the light (Photophobia). On examination the pupils could be small and irregular and pus collection inside the eye may be made out (Hypopyon)

4. Acute angle closure glaucoma – can happen with those with farsightedness.The eye is filled with fluid that must be circulated. For many reasons when the drainage of this fluid is blocked the pressure increase inside the eye leading to the condition. The eye of such a person is red, very painful, vision is blurry, and nausea and vomiting may happen. On examination the cornea may be hazy and the pupil is dilated.

5. Herpes Zoster ophthalmicus- is a condition when the ophthalmic division is affected by the Varicella zoster virus (which causes chicken pox). Much after the initial chicken pox is overcome, the virus comes out of hiding along certain nerves to produce small vesicles on the skin. When this process affects the eye, it is a ophthalmic emergency.

6. Scleritis – also shows up with red painful eye with visual loss.

The way to approach a red eye when there are no worry signs is as follows-

1.Look out for discharge from the eye-if there is no discharge it could be sure to a sub conjunctival bleed which is usually seen in an elderly patients who may be on blood thinners and might have strained hard recently (or even after a bout of violent coughing or sneezing) This can

happen suddenly and may be noticed after a overnights sleep leading to severe anxiety.

2. If the discharge happens only intermittently- it could because of dry eyes, again something that is common in the elderly. Dry eyes can happen after prolonged screen times and in conditions such as Sjögren’s syndrome. Using artificial tears eye drops will make things much better.

3. If the discharge is continuous – to see if the discharge is watery or purulent (pus like).Pus like discharge always indicates infection and will get better with antibiotics (eye drops and tablets). If the watery eye discharge is associate with mild itching, it could be due to viral conjunctivits and if the itching is severe, it could be due to allergic conjunctivitis.

Take home message:

1. If the red eye is very painful, with visual loss and irregular pupil – rush to the Eye doctor/hospital.

2. If the red eye is not or minimally painful, with clear vision, mild irritation and discharge – you can probably wait till the next day before going to see an ophthalmologist.

3. If you are very anxious or in doubt – see the ophthalmologist immediately.

WHAT A HEADACHE!

/ Subash Rau / Leave a comment

We all get headaches sometime or the other in our lives! I remember my first episode of migraine which I got when I was in 7th grade. My mother rightly diagnosed me to have migraine (being from a family of doctors), gave me some paracetamol and had asked me to go to sleep. I got my eyes checked a few days later, started wearing prescription glasses and never had migraine again for several years. My father told me that only intelligent people got a migraine and that made me very proud of my headache as none of my other siblings had a migraine till then. Apart from Migraine, one can have a headache from many causes such as head injuries, cervical spondylosis, dental caries, sinusitis, high BP,depression, malocclusion and Temperomandibular joint dysfunction etc.

So when should you go to the doctor and hospital immediately?

What are the danger signs in headache?

1. The worst headache in your life or a “bolt out of the blue” type of a headache.

2. Headache associated with slurred speech, visual disturbance, weakness of limbs, inability to walk due to loss of balance, confusion or memory loss.

3. Headache that happens after weight lifting or sex.

4. Headache after a head injury (however mild especially in the elderly)

5. Headache with recurrent vomiting.

6. Headache that wakes you up from sleep or is the worst after waking up in the morning.

7. If you have a chronic headache but its character and severity has changed recently.

Headaches may be classified as primary or secondary to other illnesses. The primary headaches are Migraine, Tension type and Cluster headaches. So lets look at the classic presentation of the common headache syndromes.

Migraine – this headache is usually episodic (can last for a few hours to 3 days) , usually unilateral, throbbing or pulsation and often associated with nausea, vomiting, visual disturbances (aura) and inability to look at the bright lights and handle loud sounds. Sufferers would usually prefer to lie still with their eye closed as the headache could be made worse by movement. Migraines are often precipitated by certain foods (cheese, chocolate, Agina Moto – MSG) sleep deprivation, hunger and stress. Migraine could get much better after sleep and after vomiting. A variety of medicines are available for the treatment of Acute Migraine and prophylaxis (preventive) therapies are available if the patient has more than 2 attacks of migraine a month.

Tension type Headache– this headache usually affects the back of the head and usually in the evenings. It may be associated with scalp tenderness and may be provoked by emotional stress, fatigue,notice and glare. Treatment of anxiety and depression may be needed.

Headache due to Sinusitis – headache due to sinusitis may feel more like head heaviness. The sinus are air pockets in the skull bones that are lined by mucous producing membranes and they drain the mucous produced into the back of the nose. They exist to make the head feel lighter and to provide resonance to the voice. When the drainage passages of the sinuses are blocked, they fill up with mucous, bacteria migrate into the sinuses and the mucous changes colour to yellow. Typically patients have a constant dripping from the sinuses into the back of the throat and there may be tenderness over the affected sinus. Sometimes the headache gets worse on ending downwards.

Cluster headaches are not so common. The headache is severe, unilateral, behind the eye and associated with a blocked or a runny nose on the same side and a red tearing eye. The headache can occur in clusters, lasting 15min to 3 hrs, daily for several days together. They can happen at night and wake the person up from sleep and can have specific triggers like migraine. But in contrast to migraine, the headache is non-throbbing/pulsatile.

Headache due to cervical spondylosis – severe spondylosis affecting the upper cervical vertebrae can give a severe headache which affects the back of the head right upto the vertex ( the top of the head on looking down). Movements of the neck are painful and could be restricted with neck stiffness.

Headaches due to a brain tumour– brain tumours increase the pressure in the brain and cause pain by displacing the pain sensitive structures. The headache is worse on lying down, can wake the person up from sleep or worsen and peak on waking after a nights sleep. Sometimes the headache can worsen after coughing or sneezing. The headache may be associated by visual disturbances or loss of balance, loss of power in limbs, confusion and memory disturbances.

Other headaches occur acutely due to a cerebrovascular catastrophe like a subarachnoid bleeding where it is severe, associated with vomiting, visual disturbance and abnormalities of consciousness. Meningitis can also cause a headache with fever and neck stiffness (inability to bend neck forwards)

Headaches can also occur with high BP usually above a systolic value of 180mmHg. The headache could be quite variable in character as well as in severity.

So what must you do if you have a headache?

The first thing is to see if it has any danger signs. If yes, please go to the emergency department of a good hospital. If not, you could take a paracetamol tablet, go to sleep and fix an appointment to see you doctor the next day. Most headaches are curable and they just require the doctor to find the best medicine for its control or cure.