THE RED EYE

see also Eye trauma and Eye burns

CAUSES

HISTORY

EXAMINATION

COMPLICATIONS

TREATMENT

Acute glaucoma

Severe pain
headache
Photophobia
Visual haloes

Mid-size un-reactive pupil
Decrease visual acuity
Corneal haze
Increased eyeball turgor

 

Urgent eye consult
Acetazolamide 500mg IV
100 ml glycerine (mixed in orange juice)
OR
120 ml 20% Mannitol IV
Pilocarpine 6% ii gtt @ 5min

Bacterial conjunctivitis

Watery eye
Purulent discharge
Irritation

Conjunctival inflammation

Corneal infiltrates
Corneal ulceration

Chloramphenical ii gtt qid
Chloramphenical ointment nocte

Viral conjunctivitis

Watery eye
Discharge
Foreign body sensation

Conjunctival inflammation
Follicles on inner lid

Corneal ulceration

Acyclovir ointment (if dendritic ulcer noted)
else supportive
Isolate from others
Eye F/U if dendritic ulcer

Allergic conjunctivitis

Itching
Watery
Discharge
Atopic history

Conjunctival inflammation
Papillae on inner lid

Corneal erosions
Keratitis

Otrivine-Antistin drops

Iritis

Deep, throbbing pain
Photophobia
Blurred vision
Associated with seronegative arthropathy, inflammatory bowel disease, sarcoidosis

Limbal injection
Anterior chamber flare/cells
Corneal (inner layer) keratitic precipitates
Small/Irregular pupil (due to posterior synechiae)
Cataract (late)

Raised intraocular pressure

Steroid eye drops
(after discussion with ophthalmologist)
Cycloplegics
Eye clinic review in 24/24

Scleritis

Severe pain
Photophobia
Lacrimation
Associated with rheumatoid arthritis, connective tissue disorders

Scleral vessel inflammation
Blue tinge

Scleral ulceration
Glaucoma
Keratitis

Steroid drops
(after discussion with ophthalmologist)

Episcleritis

Painless
Associated with collagen disorders, herpes zoster, gout, erythema nodosum, erythema multiforme

Localised red patch on sclera

 

Steroid drops
(after discussion with ophthalmologist)