redeye
acute atraumatic painful red eye(s)
see also:
Introduction
- 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