Red painful eye

Question 1

Differentials for red eye

Answer 1

Conjunctivitis
Anterior uveitis
Acute angle closure glaucoma
Episcleritis
Scleritis

Question 2

HPC questions to ask?

Answer 2

Normal SOCRATES
Itch?
Discharge?

Had this before?

Pain on eye movement - could be scleritis,

Recent loss of vision or worsening vision? - glaucoma (closed), infectious keratitis, anterior uveitis

Photophobia - Anterior uveitis, scleritis, infectious keratitis

Any headache? N+V? (may suggest angle closure glaucoma,

Any recent trauma to the eye? Possible foreign body?

Do you wear contact lenses?
Do you usually have any problems with your eyesight?

Any recent illnesses? (preceding URTI in viral conjuctivitis)

Does the skin around the eye look inflamed or red at all? (Pre-orbital or orbital cellulitis)

Noticed any pupil changes? - fixed dilated pupil can be acute angle closure glaucoma

Question 3

PMH to ask

Answer 3

Do you wear contact lenses?
Usually have eyesight problems?

History of eczema, asthma or hayfever?

Any history of joint problems or autoimmune conditions? (HLA-B27 e.g. Ank Spond ass. with AU, Scleritis ass. with RA)?

Question 4

FH and SH

Answer 4

Anyone at home have similar symptoms?
Any FH of atopy?

SH:

• Smoking
• Alcohol
• Who is at home
• Job
• Any pets at home (allergic conjuncitivits)

ICE

Question 5

Questions to rule out more serious pathology

Answer 5

Pain on eye movement - could be scleritis,

Recent loss of vision or worsening vision? - glaucoma (closed), infectious keratitis, anterior uveitis

Photophobia - Anterior uveitis, scleritis, infectious keratitis

Any headache? N+V? (may suggest angle closure glaucoma,

Any recent trauma to the eye? Possible foreign body?

Do you wear contact lenses?
Do you usually have any problems with your eyesight?

Any recent illnesses? (preceding URTI in viral conjuctivitis, gonorrhoea/chlamydia in conjunctivitis)

Does the skin around the eye look inflamed or red at all? (Pre-orbital or orbital cellulitis)

Noticed any pupil changes? - fixed dilated pupil can be acute angle closure glaucoma

Question 6

Examination

Answer 6

Examine the eye - test acuity, visual fields, reflexes, opthalmoscope

Question 7

Explaining conjunctivitis diagnosis and management

Answer 7

Infection/inflammation of the eye, usually settles within 2-5 days without treatment

Management:

• It is contagious - so wash hands after touching eye, dont share towels
• Avoid using contact lenses until symptoms have cleared
• Can use artificial tears to help - pharmacy
• Bathe the affected eye with boiled cooled water morning and night
• Leaflet
• Bacterial cause and not improving within 3 days - consider topical chloramphenicol QDS for 5days (available OTC)
• Allergic - cold compress (cool damp towel), cold water wash out, a topical antihistamine from the pharmacy may also help if these measures above dont work

Question 8

FU and SN

Answer 8

Follow up in 1 week

SN - if any vision loss or pain on eye movements, or sensitivity to light, ring the GP as may need to go for urgent eye assessment

Question 9

What to do if any pain on eye movement, sensitivity to light or reduced visual acuity?

Answer 9

Refer for same day ophthalmology assessment