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Home Books Current Medical Diagnosis and Treatment 2020

7-01: Symptoms of Ocular Disease

Jacque L. Duncan; Neeti B. Parikh; Gerami D. Seitzman; Paul Riordan-Eva

1. REDNESS

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).

eFigure 7–1.

Spontaneous subconjunctival hemorrhage while receiving warfarin. (From the University of California, Davis, Cornea and External Diseases. Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw-Hill, 2018.)

A photo of an eye shows bleeding in the conjuctival region.
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A photo of an eye shows bleeding in the conjuctival region.
Table 7–1.The inflamed eye: differential diagnosis of common causes.
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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
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Beal  C  et al. Clinical evaluation of red eyes in pediatric patients. J Pediatr Health Care. 2016 Sep–Oct;30(5):506–14.
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Dunlop  AL  et al. Approach to red eye for primary care practitioners. Prim Care. 2015 Sep;42(3):267–84.
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Frings  A  et al. Red eye: a guide for non-specialists. Dtsch Arztebl Int. 2017 Apr 28;114(17):302–12.
[PubMed: 28530180]  
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Navaratna  AF  et al. More than meets the (painful red) eye. Aust Fam Physician. 2016 Jun;45(6):383–4.
[PubMed: 27622227]  
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Tarff  A  et al. Ocular emergencies: red eye. Med Clin North Am. 2017 May;101(3):615–39.
[PubMed: 28372717]  

2. OCULAR DISCOMFORT

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, atropine-like agents); ocular surface disease; or dry environment.

Watering is usually due to inadequate tear ...

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