Red eye
red flags
- ↓ visual acuity
- Deep eye pain
- Contact lens use (⇒ corneal ulcer = same day referral)
- Photophobia (suggests iris involvement)
- Chemical injury
- Abnormal pupil reaction, painful constriction
- Recent surgery
- Endophthalmitis = infection in vitreous humour - typically 2-3/52 post-op/vitreous injections
- refer urgently! i.e. within hours
- will require intravitreous abx
| Headline | |
|---|---|
| History | ➥ Discharge ➥ Past ocular hx (esp rheum) ➥ Symptoms: Sudden visual loss, photophobia, systemic s/s, pain/foreign body sensation |
| Examination | external inspection visual acuity fluorescein pupil reflexes, cornea clarity, distribution of redness (bulbar = over white of eye vs circum-corneal/ciliary) |
| Diagnostic investigations | IOP (because that's so easily done in ED), Talbot’s test: ↑ pain on accommodation? |
| Differentials | corneal foreign body keratitis e.g. neglected foreign body Conjunctivitis, NB Neonatal conjunctivitis needs urgent eye clinic |
patterns
- Scleritis: painful, no discharge +/- visual acuity change → eye clinic within 24h
- bluish appearance, sclera oedema
- Anterior uveitis: painful, reduced acuity, photophobia, risk factors, asymmetrical pupil → ⚠️ urgent referral
- Acute closed-angle glaucoma: cloudy asymmetrical pupil, photophobia, N+V → ⚠️ urgent referral
- Episcleritis: mild, sectoral, recurrent, resolves quickly, mild photophobia
| Acute closed-angle glaucoma | Anterior uveitis | |
|---|---|---|
| Pupil | Semi-dilated, irregular | Small, fixed, irregular |
| Distribution of redness | Conjunctival injection | Ciliary flush |
| Pain | ++ | ++ |
| Photophobia | - | ++ |
| Visual acuity | ↓ | ↓ |
| Cornea | N | hazy |