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redeye

acute atraumatic painful red eye(s)

Introduction

  • there are a range of non-traumatic possibilities, some of which are potentially vision threatening such as glaucoma or uveitis
  • note that the patient may not be aware of a trauma, hence examination should include looking for foreign body, eye trauma
  • bilateral red eyes tend to be more likely due to either conjunctivitis, welder flash burns - UV keratopathy (photo keratitis), or chemical burns
  • the patient with an acute red eye (especially if unilateral) requires a complete eye exam as there are important conditions that need urgengt Rx
  • BEWARE the unilateral red eye - acute glaucoma requires immediate Rx to avoid permanent vision loss!
  • BEWARE bilateral red eyes - conjunctivitis may be caused by highly contagious organisms such as adenovirus - wear gloves and wash hands!

Clinical examination approach

  • visual acuity measurement
    • with glasses on if usually wears them
    • both eyes
    • if severely abnormal, check acuity with pinpoint aperture to exclude a refractive error
  • check for herpes zoster (shingles) - a lesion on tip of nose is suggestive of zoster ophthalmicum
  • general appearance of the eye looking for:
    • is there an obvious eyelid infection such as a stye
    • pupil size, shape and reaction
      • irregular pupil may suggest a penetrating injury (eg. from a small metal chip from hitting a metal object against a metal object) - or an old injury
      • unilateral fixed dilated pupil raises possibility of acute glaucoma or use of cycloplegic drops (which may also cause acute glaucoma)
    • presence of a hyphaema suggests traumatic injury
    • red injected sclera could suggest:
      • episcleritis - especially if sectoral, not severely painful, no photophobia
      • uveitis - especially if mainly surrounds the iris
      • conjunctivitis - especially if bilateral
      • excessive rubbing of eye due to corneal FB, keratitis, etc
  • slit lamp examination
    • presence of a corneal FB (may require slit lamp exam)
    • presence of corneal pathology (usually requires slit lamp exam +/- flourescein staining):
      • vertical linear lines suggest a subtarsal FB - evert the upper eyelid to look for one
      • an oblique linear ulcer suggests a corneal abrasion eg. from a leaf on a tree or a baby's fingernail, but could be Herpes simplex virus (HSV)
      • diffuse keratitis sparing upper and lower parts of corneal suggests welding burns from UV exposure - but this is usually bilateral
      • generalised keratitis suggests chemical burn or toxin (eg. “Christmas eye” in NE Victoria), or inadequate lubrication (eg. in Facial palsy)
      • geographic ulcers suggest Herpes simplex virus (HSV) or possibly bacterial or rarely fungal infection
      • a small discrete ulcer suggests possible corneal FB which has now fallen off
    • assess anterior chamber:
      • inflammatory cells in the anterior chamber suggests uveitis
  • ocular pressures
    • particularly if any features to suggest glaucoma, uveitis or eye trauma, then check ocular pressures in each eye
      • a low pressure in one eye suggests penetrating injury
      • a high pressure suggests acute glaucoma
redeye.txt · Last modified: 2025/06/10 06:25 by gary1

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