Chapter 92 My baby’s got a red eye, doctor!
The eye appears red when blood is visible. This is usually the result of vessel dilatation or hemorrhage as a consequence of infection, inflammation, trauma, or abnormality of blood vessels. Frequently, this is associated with other symptoms or signs such as pain, blurring of vision, photophobia, purulent discharge, tearing or blepharospasm. With babies, symptoms can only be inferred.
Assessment with simple magnification or a portable slit-lamp augmented with fluorescein dye staining affords a clinical diagnosis in most babies. Measurement of intraocular pressure and fundal examination will be required in some instances to make a diagnosis. Infectious causes are common and microbiology is the most frequent additional investigation.
Neonatal conjunctivitis presents with a red and discharging eye and is the most common cause of a red eye in a baby (see Chapters 12 and 93). Frequently, discharge is more prominent than red eye.
Ligneous conjunctivitis will rarely present in a baby as a recurrently red eye that discharges. Eversion of the lid will reveal granulomatous lesions with a fibrinous mass forming an approximate cast of the conjunctival fornix. The parents may describe pieces of this fibrinous mass breaking free. Serum plasminogen will be near zero in such infants.1
Birth trauma may result in conjunctival hemorrhage and, rarely, hyphema. There may be direct injury following forceps delivery. Corneal edema secondary to Descemet’s membrane splits may be present. Conjunctival hemorrhage may be the result of non-accidental injury.