Painful Red Eye Flashcards
Sequence of events
Open question
Timeline- when, progression, sudden or gradual deterioration
Symptom analysis
SOCRATES
Site- both eyes or one, whole eye or just part of it
Onset- when did you first notice this
Character- describe the pain
Radiation- do you feel the pain anywhere else, does it give you a headache
Associated symptoms- systems review
Timing- always there or come and go, if intermittent, how long does it last for, how often do you get the pain
Exacerbating or relieving factors- eye movement, bright light, cab you recall any trauma to eye or foreign objects
Severity- how bad from 1-10, does it hamper sleep
Systems review
Ophthalmology- vision affected, if so, in what way eg. Blurry, can you read small print, discharge, itchy, dryness, halos around lights, red tinge to vision, loss of colour vision, previous vision problems, glasses, contacts, flashes and floaters
Constitutional- FWARJNLCT
RS- cough
GIT- bowels (constipation- subconjunctival haemorrhage), abdominal pain, vomiting
GUT- burning when passing urine, discharge, recent STI treatment
MSK- pains in joints, rashes
Patients perspective
Feelings and impact
ICE
Background information
PMH- previous eye trouble, wear glasses, inflammatory arthritis, IBD, hay fever
DH- eye drops, steroids, contact lenses (daily or monthly wear, do they clean them)
FH
SH- risk of foreign body from job eg. Blacksmith, do you drive etc.
Conjunctivitis (viral, bacterial, allergic)
Usually unilateral, but can become bilateral due to autoinnoculation Conjunctival injection (red sclera), watery or purulent discharge Allergic- abrupt onset after exposure, bilateral, chemosis, pruritis, eyelid oedema, watery discharge with foreign body sensation, nasal congestion, hives, tends to have seasonal variation (Think reactive arthritis)
Acute angle closure glaucoma
Ophthalmology emergency- if not treated rapidly, will result in irreversible damage to optic nerve and retina
Unilaterally, common in evenings due to low light levels
Symptoms include red eye, pain (globe, headache, and abdominal), blurred vision, haloes around lights, nausea and vomiting
Infectious keratitis (bacterial, fungal, parasitic, herpes simplex, herpes zoster)
Unilateral painful eye that mimics conjunctivitis
No foreign body sensation, photophobia and reduced vision
Much more likely in contact lens wearers or the immunosuppressed (daily or monthly wear, do they clean them etc.)
Potentially blinding- emergency
Acute anterior uveitis
Acute pain, often a recurring event, in one eye, with photophobia, redness and blurred vision
Pain felt more deeply than conjunctivitis
Photophobia occurs because the iris is inflamed and so miosis is painful
May have background of spondyloarthropathies, IBD, Reuters syndrome, and or psoriasis
Episcleritis
Injection of a localised area or diffuse area overlying the suckers with a non tender globe
Often recurrent and characterised by rapid onset of a dull ache, redness, and tenderness
Vision not affected
Scleritis
Severely painful, sub acute onset, tearing, photophobia
Tender globe to touch, painful eye movements
Often recurrent and bilateral, although not simultaneously
Strongly associated with RA, vasculitides, SLE
Potentially sight threatening, may result in astigmatism
Subconjunctival haemorrhage
Diffuse red eye universally with no pain or visual disturbance
Often after coughing, vomiting or straining (constipation)
May be caused by trauma- exclude globe damage or foreign body
Resolves spontaneously (check BP, reassure, send away)
Investigations
Thorough eye exam including visual fields
Dilated ophthalmoscopy, slit lamp examination (don’t dilated if suspecting angle closure)
Tonometry
Conjunctival or corneal scrape for culture/PCR
Syphyllis serology and antibody testing (if complex uveitis)
Gonioscopy
Endophthalmitis
Ask about recent surgeries and foreign bodies
Optic neuritis
Painful eye and eye movements
Central scotoma
Change in colour vision
