SYMPTOMS OF OCULAR DISEASE
Redness may be due to hyperemia of the conjunctival, ciliary, or episcleral vessels; erythema of the eyelids; or subconjunctival hemorrhage (eFigure 7–1). The major differential diagnoses are conjunctivitis, corneal disorders, acute glaucoma, and acute uveitis (see Table 7–1).
Table 7–1.The inflamed eye: differential diagnosis of common causes. |Favorite Table|Download (.pdf) Table 7–1. The inflamed eye: differential diagnosis of common causes.
| ||Acute Conjunctivitis ||Acute Anterior Uveitis (Iritis) ||Acute Angle-Closure Glaucoma ||Corneal Trauma or Infection |
|Incidence ||Extremely common ||Common ||Uncommon ||Common |
|Discharge ||Moderate to copious ||None ||None ||Watery or purulent |
|Vision ||No effect on vision ||Often blurred ||Markedly blurred ||Usually blurred |
|Pain ||Mild ||Moderate ||Severe ||Moderate to severe |
|Conjunctival injection ||Diffuse; more toward fornices ||Mainly circumcorneal ||Mainly circumcorneal ||Mainly circumcorneal |
|Cornea ||Clear ||Usually clear ||Cloudy ||Clarity change related to cause |
|Pupil size ||Normal ||Small ||Moderately dilated ||Normal or small |
|Pupillary light response ||Normal ||Poor ||None ||Normal |
|Intraocular pressure ||Normal ||Usually normal but may be elevated ||Markedly elevated ||Normal |
|Smear ||Causative organisms ||No organisms ||No organisms ||Organisms found only in corneal infection |
Spontaneous subconjunctival hemorrhage while receiving warfarin. (From the University of California, Davis, Cornea and External Diseases. Reproduced, with permission, from Riordan-Eva P, Cunningham ET Jr. Vaughan & Asbury's General Ophthalmology, 18th ed. McGraw-Hill, 2011.)
et al. Reasons for visits to an emergency center and hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage. Eur J Ophthalmol. 2016 Mar–Apr;26(2):188–92.
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et al. Approach to red eye for primary care practitioners. Prim Care. 2015 Sep;42(3):267–84.
et al. Diagnosis of the 'red eye': a systematic review. Am J Med. 2015 Nov;128(11):1220–4.e1.
Ocular pain may be caused by trauma, infection, inflammation, or rapid or marked increase in intraocular pressure.
Foreign body sensation may be due to corneal or conjunctival foreign bodies, disturbance of the corneal epithelium, or rubbing of eyelashes against the cornea (trichiasis).
Photophobia is usually due to corneal inflammation (keratitis) or anterior uveitis (iritis). Other causes are albinism, aniridia, cone dystrophy, or fever associated with various systemic infections.
Itching is characteristically associated with allergic eye disease.
Scratching and burning from dryness of the eyes may be due to lacrimal gland hypofunction, secondary to systemic disorders (eg, Sjögren disease) or drugs (eg, ...