Red Eye

History

Red flags on history include:

• decreased vision
• severe pain
• pain/decreased vision with use of contact lenses
• mechanical or chemical trauma
• recent eye surgery

Inquire into use of contact lenses, chemical or mechaical truama, and past history.

Symptoms can be useful in leading towards diagnosis:

sharp or superficial pain: problem with surface

deep or dull pain, espeically with decreased vision and haloes: suggestive of glaucoma

discharge and lacrimation: conjunctivitis

photosensitivity: superficial inflammation, iritis

recurrence of redness: iritis, allergic conjunctivitis

review of systems:

dermatologic and rheumatologic: systemic inflammatory condition

respiratory: allergic conjunctivitis

Physical Exam

There are three main components to evaluating a red eye.

Visual acuity.

Pupillary light reflexes. If pupils are equal, round, and reactive, acute-angle glaucoma is very unlikely (Mahmood and Narang, 2008). Tonometry, if avaliable, may also be used to evaluate for glaucoma.

Examination with penlight or slit lamp. Fluorescein dye, used with a cobalt blue light, can be used to detect corneal defect, such as abrasion, ulceration, or foreign body. A dendritic pattern suggests herpetiform keratitis.

Red flags include:

• decreased visual acuity
• pupil irregularity
• sluggish pupillary reflex
• corneal opacification
• hyphema or hypopyon
• increased ocular pressure

Scleritis: violet-coloured

ciliary flush/limbic

eye full of blood: subconjunctival hemorrhage

Lab Investigations

If inflammation is suspected, an ESR may be helpful.

Diagnostic Imaging