acute red eye

Question 1

outline a systematic approach to thinking about the causes of red eye.

Answer 1

Think about the anatomy of the eye and the causes in each part of the eye

• cornea (keratitis). This could be bacterial, marginal or viral.
• eyelids/ eyelashes - blepharitis (inflammation of eyelids)
• conjunctiva - conjunctivitis. This could be bacterial, viral, chlamydial or allergic
• acute angle closure glaucoma
• iris - acute anterior uveitis
• sclera - episcleritis, anterior scleritis
• orbit
• trauma

Question 2

what questions are essential to ask to determine the cause of red eye?

Answer 2

• are 1 or 2 eyes affected?
• is vison affected?
• is there any pain and how severe is it? often helpful to ask if it wakes them up at night or if it causes nausea
• is it sticky, itchy, gritty or burning? (sticky = infectious, gritty = something in eye, itchy = allergic)
• is the patient complaining of photobhobia? - this suggests constriction of the pupil so there may be a problem with the iris
• how long have the eyes been red?

Question 3

what do you need to look at on examination to determine the cause of red eye?

Answer 3

• is the cornea clear and bright? - yellow or white mark? hazy?
• can you see the pupil through the cornea? - is it round, constricted/ dilated, funny shape?
• does the pupil respond to light?
• what type of discharge is present? - sticky/ watery
• is the redness localised, generalised or around the cornea?
• what type of redness is it? - mild red, deeper red, beefy red, salmon pink

Question 4

outline the signs and symptoms of conjunctivitis

Answer 4

sticky, gritty, stringy discharge 
vision not affected 
mild redness over entire surface of eye 
normal pupil 
clear cornea

Question 5

outline the signs and symptoms of episcleritis

Answer 5

irritation
vision not affected
sectoral redness

Question 6

outline the signs and symptoms of anterior uveitis

Answer 6

moderate pain 
photophobia 
watery discharge 
vision may be reduced 
redness around the cornea 
constricted pupil

Question 7

outline the signs and symptoms of a corneal abcess

Answer 7

moderate/ severe pain 
photophobia 
reduced vision 
discharge 
generalised deep redness 
yellow patch on cornea 
iris features indistinct

Question 8

outline the signs and symptoms of scleritis

Answer 8

severe pain - wake up at night, worse on movement
vision may be reduced
intensely red - sectoral or generalised

Question 9

outline the signs and symptoms of acute angle glaucoma

Answer 9

sudden painful loss of vision
vomiting
generalised redness
oval mild-dilated pupil