Evaluation of the Red or Painful Eye
Assessment of the red or painful eye.
Table 31–1. Differential Diagnosis of Nontraumatic Unilateral Redness and/or Eye Pain. The Most Helpful Findings Are Shaded. |Favorite Table|Download (.pdf)
Table 31–1. Differential Diagnosis of Nontraumatic Unilateral Redness and/or Eye Pain. The Most Helpful Findings Are Shaded.
|History and Clinical Findings||Conjunctivitis||Iritis||Acute Glaucoma||Corneal Infection (Bacterial Ulcer)||Corneal Erosion|
|Vision||Normal to slightly blurred||Slightly blurred||Markedly blurred||Usually blurred||Blurred|
|Pain||None to moderate||Moderate||Severe||Moderate to severe||Severe|
|Photophobia||None to mild||Severe||Minimal||Variable||Moderate|
|Nausea and vomiting||None||None||Occasional||None||None|
|Discharge||Moderate to copious||None||None||Watery||Watery|
|Ciliary injection||Absent||Present - perilimbal||Present||Present||Present|
|Conjunctival injection||Severe diffuse in fornices||Minimal||Minimal, diffuse||Moderate, diffuse||Mild to moderate|
|Cornea||Clear||Usually clear||Steamy||Locally hazy||Hazy|
|Stain with fluorescein||Absent||Absent||Absent||Present||Present|
|Pupil size||Normal||Constricted||Middilated, fixed, and Irregular||Normal||Normal or constricted|
|Gram-stained smear||Variable; depending on cause||No organisms||No organisms||Organisms in scrapings from ulcers||No organisms|
|Pupilary light response||Normal||Poor||None||Normal||Poor to normal|
Historical factors are important in determining the cause of ocular complaints. History, when correlated with characteristic ocular findings on focused physical examination, usually makes the diagnosis. History should include use of eye drops, previous episodes, onset of pain, contact lens use, systemic illnesses and findings, and associated symptoms.
The components of a complete eye examination include the following.
Visual acuity testing using a standard acuity chart (Snellen). An acute change in vision usually indicates disease of the eyeball globe or visual pathway. Pain and decreased acuity indicate corneal disease, acute angle-closure glaucoma, or iritis.
Inspection of the eye to include conjunctiva, cornea, sclera, lens, and pupil, external lids, lashes, lacrimal ducts, orbits, and periorbital areas for sign of trauma, infection, exudate, or irritation.
Check pupillary function for shape, symmetry, and reactivity to light and accommodation.
Extraocular Muscle Function
Extraocular muscle function for any signs of entrapment or palsy.
Check for abnormalities in the visual fields; this is generally done in the emergency department by confrontation.
Direct fundoscopy is generally used to check the retina, optic disc, and retinal vessels.