RED EYE

Question 1

Approach to the Critically Ill Red Eye

Answer 1

DISABILITY

Diagnosis and treatment may be time sensitive to prevent permanent loss of vision

Obtain Visual Acuity

Obtain Intraocular Pressure (IOP). Value > 21 mm Hg is abnormal

Caustic Contamination: Irrigation with Morgan Lens until tear-film pH = 7.4,
outpatient Ophtho

Acute Angle-Closure Glaucoma:

Goal: IOP <35 or 25% reduction

Timolol 0.5% 1gtt
Apraclonidine 1% 1gtt Pilocarpine 1% 1gtt q15 mins
Prednisolone
1% 1gtt
Acetazolamide 500mg IV Mannitol 1g/kg IV, Emergent Ophtho Consult

Question 2

DDx Critical Diagnosis requiring urgent opthalmology consult

Answer 2

Acute angle closure glaucoma

Hyphema

Hypopyon (Endophthalmitis)

Bacterial Keratitis

Corneal Ulcer

Anterior Uveitis

Caustic Contamination

Question 3

DDx

Answer 3

Chalazion
Hordeoleum
Blepharitis
Dacrocystitis
Corneal Abrasion
Cornal Ulcer
Corneal Foreign Body
Chemical Burn
Ultraviolet Keratitis
Superficial Keratitis
Bacterial Conjunctivitis
Viral Conjunctivitis
Allergic Conjunctivitis
Iritis / Uveitis
Episcleritis
Scleritis
Endophalmitis
Acute Closure Glaucoma

Question 4

DDx for decreased visual acuity with Red Eye

Answer 4

Iritis (will get photophobia and blurred vision)

Angle closure glaucoma (glurred vision with headache and nuasea)-will also see hazy cornea
Scleritis )will get blurred vision with globe pain to palpation

Question 5

History

Answer 5

Ask these questions:

Onset: acute < 7 days
Laterality

Vision Loss: suggest pathology of the cornea, anterior chamber, iris and lens

Eye pain / discomfort (ache, burn, throb, pruritis)

Foreign Body Sensation

Photophobia

Change in appearance

Trauma: Projectiles / Foreign body

Exposure to chemicals

Discharge

Flashers
Floaters

Optho History:
Refractory Status
Use of corrective lenses / Contact lenses
Previous Ocular disease
Previous Ocular surgery

Medications: Anticholinergics, Bisphosphonates, Rifabutin, Topiramate

Question 6

Physical Exam

Answer 6

Visual Acuity (VA)
Confrontational Visual Fields (CVF)
Extra Ocular Movement (EOM)

Pupillary Reactions:
Direct pupillary response (PERRLA)
Afferent pupillary response
Swinging flashlight
Accommodation / Convergence

Lids and Adenexa
Conjunctiva and Sclera

Slit Lamp:
Cornea
Anterior Chamber
Iris
Lens

Intra Ocular Pressure (IOP)
Fundoscopy

Question 7

Red Flags

Answer 7

Trauma
Exposure
Pain (including photophobia)
Decreased Visual Acuity
Anisocoria (AKA not PEARL)

Question 8

Investigations

Answer 8

CBC, ESR/CRP in monocular vision loss (r/o temporal arteritis)

Imaging: CT and US as needed to rule out foreign bodies, orbital cellulitis,
fracture, globe pathology.