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Figure 31–1.

Assessment of the red or painful eye.

Table 31–1.Differential diagnosis of nontraumatic unilateral redness and/or eye pain.

History and Examination

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 the onset of pain, previous episodes, associated symptoms, the use of eye drops, other exposures, contact lens use, and systemic illnesses and findings. In addition to a focused history, key examination points should include the following:

A. Visual Acuity

Visual acuity testing should be performed using a standard acuity chart (Snellen). An acute change in vision usually indicates disease of the globe or visual pathway. Pain and decreased acuity may indicate corneal disease, acute angle-closure glaucoma, or iritis.

B. Inspection

Inspection of the eye should include the conjunctiva, cornea, sclera, lens, and pupil, as well as the external lids, lashes, lacrimal ducts, bony orbits, and periorbital areas. One should look for signs of trauma, infection, exudate, or irritation.

C. Pupillary Function

Check pupillary function for shape, symmetry, and reactivity to light and accommodation.

D. Extraocular Muscle Function

Check extraocular muscle function for any signs of entrapment or palsy.

E. Visual Fields

Check for abnormalities in the visual fields. This is generally done in the emergency department by confrontation.

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