This article covers the potential causes of an acutely painful red eye, including scleritis, uveitis, corneal abrasion, corneal ulcer, viral keratitis, acute angle closure glaucoma and endophthalmitis.
These serious ophthalmological conditions typically require urgent specialist evaluation and management, so early recognition and referral are essential.
This article discusses possible underlying causes of a painless red eye, including subconjunctival haemorrhage, episcleritis, conjunctivitis and blepharitis.
A man presents with a diffusely red eye and a problem with his eyelids. You resist the urge to send out a ‘Trauma Call‘ and start wracking your brains for everything you know about eyelid disorders.
“Patients with benign eye conditions shouldn’t have more than a mild irritation,” she said. “I had a patient one time who appeared to have conjunctivitis, but he endorsed a moderate level of pain. So, sure enough on fluorescein exam, he had a viral keratitis from a herpes virus. That is something we would not have wanted to miss in the emergency department.”
“When you are evaluating a patient with an acute red eye,” Dr. Osborn said, “the presence or absence of pain is a very important feature.”
In order to appropriately diagnose the red eye, a methodical, structured history and physical needs to be performed to narrow the differential diagnosis. In this article, we will only discuss the isolated red sclera. It does not include pathologies that involve the surrounding soft tissue (orbital cellulitis, blepharitis, etc.)
Red eye, or hyperaemia, is one of the most common presentations to primary care and the emergency department. However, despite this the underlying cause is often misdiagnosed which can lead to severe, sight-threatening conditions being missed.
• Needs treatment
within a few days
• Does not require
For the purposes of this review, the acute red eye refers to a patient with conjunctival and/or scleral redness. The differential diagnosis ranges from routine (subconjunctival hemorrhage) to immediately sight-threatening diagnoses (acute angle closure glaucoma [AACG] or endophthalmitis).
Unfortunately, 64%-84% of cases are misdiagnosed as conjunctivitis, leading to adverse outcomes...
Managing the Red Eye introduces the primary care physician to skills useful in evaluating
the red eye and provides a practical clinical approach to diagnosis and treatment of many
common red eye disorders.
Review by Abdulrahman Al-Shammari.
The duration and laterality of symptoms (unilateral- vs. bilateral) and the intensity of pain are the main criteria allowing the differentiation of non-critical changes...
There are many causes of ‘red eye’ — how can they broken down as an approach to diagnosis and management?
Are you in pain?
That’s because pain, particularly complaints of more than mild pain, is a major marker that the cause of the acute red eye is serious enough to warrant more detailed or immediate treatment, said Megan Boysen Osborn, MD,
One of the most helpful differentiating symptoms of a red eye, also called injection, is pain. In general, the non-painful red eye denotes a less serious, non-vision threatening cause. A painful red eye is often a more serious problem. Furthermore, patients who wear contact lenses and have a red eye with or without pain should also be considered high risk patients and warrant urgent evaluation.
Intraocular pressure measurements.
Apply your topical anesthetic prior to performing a pressure assessment.
Measure the unaffected eye as well for control.
Normal IOP = 12 to 22 mmHg.
Used primarily to identify or rule out AACG and other etiologies that may increase pressures behind the eye (e.g., orbital cellulitis, cavernous sinus thrombosis, retrobulbar hematoma).
The application of topical anesthetics to the eye helps to differentiate between superficial and deeper causes of pain. Pain that is not completely relieved by topical anesthetics is more likely to be from the sclera or anterior chamber.
The four main causes of acute red eye presenting to the ED are
Inflammation outer eye,
Inflammation inner eye,
Aqueous outflow blockage,
Corneal ulcer = combination of conjunctivitis and Iritis.