acute red eye

The Acute Red Eye

• Most common ocular complaint
• Common- children and adults
• Initial consultation: GP, A&E or optometrist
• Aetiology difficult to determine
• Apprehension
• Careful history vital
• Thorough clinical examination- including visual acuity
• Pentorch, fluorescein, cobalt blue light
• First 24-36 hours, bacterial infection is often practically indistinguishable from other causes of conjunctivitis and also from episcleritis or scleritis

History

• Onset
• Location (unilateral /bilateral /sectoral)
• Pain/ discomfort (gritty, FB sensation, itch, deep ache)
• Photosensitivity
• Watering +/or discharge
• Change in vision (blurring, halos etc)
• Exposure to person with red eye
• Trauma
• Travel
• Contact lens wear
• Previous ocular history (eg hypermetropia)
• URTI
• PMHx eg autoimmune disease

Examination

• Inspect whole patient
• Visual acuity- each eye + PH
• Pupil reactions
• Lymphadenopathy- preauricular nodes
• Eyelids
• Conjunctiva (bulbar and palpebral)
• Cornea (clarity, staining with fluorescein, sensation)
• Anterior chamber (depth)
• Pupils shape/ reaction to light / accomodation
• Fundoscopy
• Eye movements   

Causes

Lids

• Blepharitis
• Trichiasis
• Chalazion/ Stye
• Sub-tarsal foreign body
• Canaliculitis
• Dacrocystitis

Conjunctiva

1. Bacterial conjunctivitis
2. Gonococcal conjunctivitis
3. Chlamydial conjunctivitis
4. Viral conjunctivitis
5. Allergic conjunctivitis
6. Subconjunctival haemorrhage
7. Episcleritis vs Scleritis
8. Pterygium

Cornea

1. Bacterial keratitis
2. Herpetic keratitis
3. Foreign body
4. Corneal ulcer

Anterior chamber

·        Anterior uveitis 

·        Acute angle closure glaucoma

·        Herpes Zoster ophthalmicus

·        Trauma

·        Orbital cellulitis