Red eye

Last Updated on by FRCEM Intermediate

History and Physical Examination

Obtain the following information:

  • Onset

  • Visual changes

  • Foreign body sensation

  • Trauma

  • Photophobia

  • Pain

  • Discharge, clear or colored

  • Prior episodes

  • Ophthalmologic history, including eye surgery

  • Bilateral or unilateral

  • Contact lens use

  • Comorbid conditions, such as collagen-vascular disease

Perform a complete ophthalmologic examination on all patients, to include the following:

  • Visual acuity (each eye should be tested separately)

  • Extraocular movements

  • Pen light examination (should test for pupil reactivity, pupil shape, discharge, pattern of injection, and corneal opacity)

  • Tests for direct and consensual photophobia

  • Slit-lamp examination (examine the cornea for edema, defects, or opacification with and without fluorescein) – Mastery of slit-lamp technique is a prerequisite for making the correct diagnosis

  • Anterior chamber evaluation should be performed for depth, cells, and flare

  • Intraocular pressure (IOP) measurements

  • Eyelid inspection with eversion

Certain signs help distinguish among the various causes of a red eye

 

Acute angle glaucoma

Cause

  • Hyperopia.
  • Advancing age.
  • Shallow anterior chamber.
  • Dim light.
  • Anticholinergic drugs.

Symptoms

  • Preceding episodes Of blurred vision or Haloes around vision,
  • Sudden onset unilateral red painful with nausea and vomiting.
  • headache and
  • impaired vision

Signs

  • Reduced Visual acuity,
  • hazy circumcorneal erythema.
  • Fixed semi-dilated ovoid pupil,
  • tender hard eyeball on palpation.
  • reduced intraocular Movements

Management

  • Refer ophthalmology
  • Analgesia,
  • 2% or 4% pilocarpine eye drops
  • acetazolamide 500 mg IV stat,
  • timolol eye drops,
  • Peripheral iridectomy

Iritis (anterior uveitis)

Causes

  • B27-serotype Ankylosing spondylitis.
  • Ulcerative coitis.
  • Psoriatic arthropathy,
  • Reiter’s syndrome,
  • Sarcoidosis.

Symptoms

  • Acute pain,
  • photophobia,
  • blurred Vision,
  • lacrimation.

Sign

  • Tender eyeball,
  • circumcorneal erythema,
  • small irregular pupil.
  • Talbot’s test
  • Slit lamp shows white precipitates on the back of the cornea and blood cells in a hazy anterior chamber

Management

  • Refer ophthalmology
  • Steroid eye drops,
  • pupil dilatation with cyclopentolate.
  • analgesia

Scleritis

Causes

  • Connective tissue disorders eg rheumatoid arthritis (most common).
  • Wegener’s granulomatosis.
  • SLE.
  • polyarteritis nodosa,
  • ankylosing spondylitis

symptoms

  • Severe pain.
  • watering.
  • photophobia,
  • visual blurring

Sign

  • Conjunctival edema and thinning of the sclera (if severe globe perforation is a risk).
  • Scleral, episcleral conjunctival vessels all involved

Management

  • Refer ophthalmology
  • Most will need oral Steroids or immunosuppressant to control the pain

 

Episcleritis

cause

  • no cause found.

symptoms

  • Aching red eye,

Sign

  • Tender over the inflamed area
  • Episcleral vessels blanch if phenylephrine 10 % is applied.

Management

  • usual benign and limiting condition.
  • Treatment is topical or systemic NSAIDs

Conjunctivitis

cause

  • common in Children
  • Contact lens wearers (risk of Pseudomonas),
  • high risk of STI’s (risk of or gonorrhoeal infection)

Symptoms

  • Itching.
  • burning.
    grittiness or foreign body sensation,

Signs

  • Red inflamed oedematous conjunctiva.
  • lacrimation, and purulent discharge.

Treatment

  • Chloramphenicol or fusidic acid eye drops if bacterial is suspected
  • In allergic conjunctivitis — antihistamine or sodium cromoglycate eye drops,

Corneal abrasion

cause

  • Contact lens wearers.
  • Often follows scratch or grit eye,

symptoms

  • Unilateral, painful, red, Watery eye
  • If large, be blurred vision

sign

  • Instill fluorescein, corneal abrasion Should Stain green under blue light

Treatment

  • Chloramphenicol eye drops/ointment (fusidic acid is alternative)
  • Analgesia
  • Cyclopentolate

Corneal ulceration

cause

  • Ulcers may be bacterial.
  • herpetic (zoster or simplex).
  • fungal (candida,Aspergillus).
  • protozoal (acanthamoeba)
  • vasculitis eg rheumatoid arthritis.

symptoms

  • redness, pain, photophobia.
  • foreign body sensation
  • reduced visual acuity

signs

  • Ulceration may be visible to the naked eye.
  • Instill corneal ulceration should stain green under blue light

Management

  • Refer ophthalmology.
  • Treatment depends on the cause,
  • Analgesia
  • Cyclopentolate

Subconjunctival hemorrhage

Cause

  • usually unknown.
  • hemorrhage May following sneezing, vomiting
  • In trauma,-intraocular, orbital or basal skull fracture should be considered

signs

  • painless red eye
  • Usually asymptomatic.
  • A well-defined area of hemorrhage over the sclera.

management

  • Benign, self-limiting No treatment required.

Was this article helpful?

Related Articles

Leave A Comment?

This site uses Akismet to reduce spam. Learn how your comment data is processed.