The Acute Red eye
This is a common
exam question. The causes are usually one of the following:
Conjunctivitis
This manifests as a "gritty" red eye. There
may be a sticky discharge (especially after sleep), if the infection is
bacterial. There is normal visual acuity, the pupil is normal. Causes
include S aurues, H influenzae, Pseudomonas, Chlamydia, and viruses
such as herpes simplex.
The treatment is topically 2 hourly
antibiotics. Advice to give to patients is that it is very infectious,
so don't share towels.
Uveitis
This is inflammation of all or part of the uveal tract. It manifests as
a red eye with circumcorneal injection and constant "aching" pain. The
pupil is small and fixed. There may be loss of visual acuity in severe
cases. Uveitis is associated with retinal detachment. The condition is
associated with ankylosing spondylitis, psoriasis, sarcoidosis,
Crohn's, ulcerative colitis, syphilis and TB.
Treatment is
with topical steroids and pupillary dilators, as well as treatment of
the underlying cause.
Episcleritis
This is a common condition which is benign and self-limiting. It may be
associated with collagen diseases, herpes zoster, gout and syphilis. It
manifests as a localised inflamed patch on the sclera.
A
non-steroidal anti-inflammatory should be given.
Scleritis
This is more serious than scleritis and presents
with severe pain. Vision may be affected and there may be focal or
diffuse redness of the sclera. The same associations, such as a strong
connection to rheumatoid arthritis, are also true of scleritis.
The condition is resistant to treatment, but non-steroidal are tried.
Conjunctival haemorrhage
A blood level is seen.
It is usually due to trauma.
Treatment is not required.
Foreign body
A
painful "gritty" eye. The pupil is normal and vision is not impaired.
There may be a history of trauma. Topical anaesthesia to examine the
eye, and eversion of the upper lid is tried. It may be necessary to
remove foreign bodies in the cornea with drill tips.
Acute
Glaucoma
This is discussed in
this section
.
