Frings et al. in their lucid article (1) provide non-specialists with crucial evidence from impressive findings relating to the anterior segment of the eye. We have some additional points to add to the differential diagnosis of red eye:
In patients with glaucoma, instilling some types of pressure-lowering eye drops will often lead to conjunctival hyperemia, which is not caused by inflammation, dryness of the eye, or allergic reactions, but may upset patients because of the reddening.
Particular attention should be paid to keratoconjunctivitis sicca, which is common in older persons. Even though the authors did mention the publication by Messmer et al. (2) (p. 308), it would be desirable if some publications were to actually point out the symptoms that are reported so often by patients in our labor-intensive modern society. Working on computer screens or in dusty air can easily cause conjunctivitis, with red eyes and a sensation of glare; this will inevitably lead to disrupted working routines.
Episcleral and conjunctival venous stasis with additional reddening of the lids can also occur in spontaneously formed low flow arteriovenous fistula between the dural branches of the external carotid artery and the cavernous sinus. The diagnosis of a low flow fistula is occasionally made late by angiography as the symptoms are less obvious than those of a high flow fistula (3).
References
- 1.Frings A, Geerling G, Schargus M. Red eye—a guide for nonspecialists. Dtsch Arztebl Int. 2017;114:302–312. doi: 10.3238/arztebl.2017.0302. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Messmer EM. The pathophysiology, diagnosis and treatment of dry eye disease. Dtsch Arztebl Int. 2015;112:71–82. doi: 10.3238/arztebl.2015.0071. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Schmidt D, Schumacher M. Zentralvenenverschluß als Folge von spontanen arteriovenösen Fisteln der A. carotis zum Sinus cavernosus. Fortschr Ophthalmol. 1991;88:683–686. [PubMed] [Google Scholar]