EMERGENCY EVALUATION OF IMPORTANT OCULAR SYMPTOMS
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. |Favorite Table|Download (.pdf) Table 31–1. Differential diagnosis of nontraumatic unilateral redness and/or eye pain.
|History and Clinical Findings ||Conjunctivitis ||Iritis ||Acute Glaucoma ||Corneal Infection (Bacterial Ulcer) ||Corneal Erosion |
|Incidence ||Extremely common ||Common ||Uncommon ||Uncommon ||Rare |
|Onset ||Insidious ||Insidious ||Sudden ||Slow ||Sudden |
|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 |
|Hypopyon ||Absent ||Occasional ||Absent ||Occasional ||Absent |
|Pupil size ||Normal ||Constricted ||Middilated, fixed, and irregular ||Normal ||Normal or constricted |
|Intraocular pressure ||Normal ||Normal ||Elevated ||Normal ||Normal |
|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 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:
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.
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.
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.
Check for abnormalities in the visual fields. This is generally done in the emergency department by confrontation.