Causes of Diplopia

• Third nerve palsy (vertical and horizontal diplopia)
  –Compressive lesions (especially if pupil is involved), including aneurysm, cavernous sinus or orbit tumor, pituitary apoplexy, and uncal herniation
  –Ischemic microvascular disease (e.g., diabetes mellitus, hypertension)
  –Midbrain infarct
  –Giant cell arteritis
  –Herpes zoster
  –Leukemia
  –Meningitis
  –Subarachnoid hemorrhage
  –Ophthalmoplegic migraine
  –Trauma
• Fourth nerve palsy (vertical diplopia): Etiologies include trauma, ischemic microvascular disease, congenital, multiple sclerosis, and other causes as above
• Sixth nerve palsy (horizontal diplopia): Etiologies include ischemic microvascular disease, trauma, increased ICP (bilateral palsy), tumor, multiple sclerosis, post-LP, sarcoidosis/vasculitis, pontine infarct, and other causes as above
• Myasthenia gravis
• Orbital disease (e.g., Graves’ orbitopathy, orbital inflammation, tumor)
• Cavernous sinus or superior orbital fissure syndrome (multiple CN involvement)
• Postocular surgery
• Trauma
• Brown's syndrome (restriction of superior oblique tendon)
• Internuclear ophthalmoplegia (MS, CVA)
• Vertebrobasilar insufficiency (vertigo)
• Botulism
  Monocular diplopia
• Refractive error (high astigmatism)
• Corneal opacity or irregularity
• Cataract
• Dislocated lens or lens implant
• Extrapupillary openings
• Macular disease
• Retinal detachment
• Nonphysiologic

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Source: In a Page: Signs and Symptoms, 2004

Diplopia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Monocular diplopia
  –Rare, usually associated with the cornea, lens, vitreous, or refractive anomalies such as high uncorrected astigmatism
  –May occur in lens implant dislocation
  –Neurologic disorders may present as monocular diplopia with repetitive images

• Binocular, decompensated phoria with
• concomitant strabismus, nonpathologic
  –Recent ocular surgery
  –Ocular myasthenia (may be transient)
• Binocular with proptosis, gaze restriction
  –Thyroid disease, orbital pseudotumor, cavernous sinus thrombosis or fistula
• Binocular with isolated third nerve
  –Atherosclerosis, hypertension, diabetes, tumor, aneurysm
• Binocular with isolated sixth nerve
  –Trauma, atherosclerosis, hypertension, diabetes, tumor, increased intracranial pressure, sinus disease
• Binocular with isolated fourth nerve
  –Trauma, stroke, thyroid eye disease, atherosclerosis, hypertension, diabetes
• Binocular with multiple muscle weakness in one eye
  –Cavernous sinus lesion
• Binocular with multiple muscle weakness in both eyes
  –Progressive supranuclear palsy, CPEO, acute postinfectious disorders
• Adduction weakness or abducting nystagmus
  –Inner nuclear ophthalmolplegia (INO), brainstem disease, stroke, MS, posterior fossa mass
• Vertical diplopia with no fourth or third palsy
  –Stroke, multiple sclerosis, posterior fossa mass

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Papilledema (Optic Disc Swelling): Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Pseudotumor cerebri
  –Other symptoms: Headache, nausea, and vomiting all worse in morning, transient visual obscurations, diplopia
  –Diagnosis includes increased ICP, normal imaging, normal CSF
  –More common in obese females

• Optic neuritis
  –May be associated with postviral syndromes or meningoencephalitis
  –Loss of vision, pain on eye movement
  –Vision usually improves within a few weeks, but not full recovery

• Optic neuropathy
  –Compressive: Associated with NF1 and optic nerve glioma, presents with progressive visual loss, strabismus, nystagmus, proptosis
  –Infiltrative: From cancers (leukemias, lymphomas), infection, or inflammation (sarcoidosis, TB, toxocariasis, toxoplasmosis, CMV); optic disc swelling, vision loss, and hemorrhages
  –Toxic/nutritional optic neuropathy: Symmetric neuropathy from nutritional deficiency (thiamine, B12), drugs (tobacco/alcohol, chloramphenicol, rifampin), toxins (lead, methanol); visual field and vision loss; may recover with treatment
  –Leber optic neuropathy: Mitochondrial DNA transmission, presents late teens to middle 20s; visual field and vision loss, may spontaneously improve

• Increased ICP: Idiopathic intracranial hypertension, intracranial hemorrhage, space-occupying lesion
• Growth hormone supplementation
• Retinal hemorrhage and loss of vision
• Retinal vein occlusion
• Malignant hypertension: Associated with retinal hemorrhage, exudates, and cotton wool spots
• Optic neuropathy, nonarteritic or arteritic
• Demyelinating disease
• Infectious conditions: Toxoplasmosis, Lyme disease, Bartonella; hard exudates may be visible funduscopically

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Scotoma: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Chorioretinitis

Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

Macular degeneration

Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

Optic neuritis

Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain — especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

Retinal pigmentary degeneration

Retinal pigmentary degeneration causes premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom —  impaired night vision —  appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Diplopia: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Alcohol intoxication

Botulism

Brain tumor

Cavernous sinus thrombosis

Diabetes mellitus

Encephalitis

Head injury

Intracranial aneurysm

Multiple sclerosis (MS)

Myasthenia gravis

Ophthalmologic migraine

Orbital blowout fracture

Orbital cellulitis

Orbital tumor

Stroke

Thyrotoxicosis

Transient ischemic attack (TIA)

Other causes

Eye surgery

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Scotoma: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Chorioretinitis

Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

Glaucoma

Prolonged elevation of IOP can cause an arcuate scotoma. Poorly controlled glaucoma can also cause cupping of the optic disk, loss of peripheral vision, and reduced visual acuity. The patient may also see rainbow-colored halos around lights.

Macular degeneration

Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

Migraine headache

Transient scintillating scotomas, usually bilateral and often homonymous, can occur during a classic migraine aura. Besides pain, characteristic associated symptoms include paresthesia of the lips, face, or hands; slight confusion; dizziness; and photophobia.

Optic neuritis

Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe visual loss or blurring, lasting up to 3 weeks, and pain—especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

Retinal pigmentary degenerations

These disorders cause premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom—impaired night vision—appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Diplopia: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Alcohol intoxication

Diplopia, a common symptom of this disorder, may be accompanied by confusion, slurred speech, halitosis, staggering gait, behavior changes, nausea, vomiting and, possibly, conjunctival injection.

Botulism

The hallmark signs of botulism are diplopia, dysarthria, dysphagia, and ptosis. Early findings include dry mouth, sore throat, vomiting, and diarrhea. Later, descending weakness or paralysis of extremity and trunk muscles causes hyporeflexia and dyspnea.

Brain tumor

Diplopia may be an early symptom of a brain tumor. Associated signs and symptoms vary with the tumor’s size and location but may include eye deviation, emotional lability, decreased LOC, headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Cavernous sinus thrombosis

This disorder may produce diplopia and limited eye movement. Associated signs and symptoms include exophthalmos, orbital and eyelid edema, diminished or absent pupillary responses, impaired visual acuity, papilledema, and fever.

Diabetes mellitus

Among the long-term effects of this disorder may be diplopia due to isolated third cranial nerve palsy. Diplopia typically begins suddenly and may be accompanied by pain.

Encephalitis

Initially, this disorder may cause a brief episode of diplopia and eye deviation. However, it usually begins with sudden onset of high fever, severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, decreased LOC, seizures, ataxia, and paralysis.

Head injury

Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, headache, decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm

This life-threatening disorder initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis (MS)

Diplopia, a common early symptom of MS, is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

This disorder initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in blank facial expression; nasal voice; difficulty chewing, swallowing, and making fine hand movements and, possibly, signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine

Most common in young adults, this disorder results in diplopia that persists for days after the headache resolves. Accompanying signs and symptoms include severe unilateral pain, ptosis, and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture

This fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis but doesn’t affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient’s pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis

Inflammation of the orbital tissues and eyelids causes sudden diplopia as well as eye deviation and pain, purulent drainage, eyelid edema, chemosis and redness, exophthalmos, nausea, and fever.

Orbital tumor

An enlarging tumor can cause diplopia, exophthalmos and, possibly, blurred vision.

Stroke

Diplopia characterizes this life-threatening disorder when it affects the vertebrobasilar artery. Other signs and symptoms include unilateral motor weakness or paralysis, ataxia, decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis

Diplopia occurs when exophthalmos characterizes the disorder. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It’s accompanied by impaired eye movement, excessive tearing, eyelid edema and, possibly, inability to close the eyelids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack (TIA)

A TIA, which may be a warning sign of a future stroke, is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours.

Other causes

Eye surgery

Fibrosis associated with eye surgery may restrict eye movement, resulting in diplopia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Eye pain [Ophthalmalgia]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acute angle-closure glaucoma

Blurred vision and sudden excruciating pain in and around the eye characterize this disorder; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

Astigmatism

Uncorrected astigmatism commonly causes headaches and eye fatigue, aching, and redness. This disorder occurs in both older and younger people.

Blepharitis

Burning pain in both eyelids is accompanied by conjunctival injection and an itching, sticky discharge. Related findings include a foreign-body sensation, eyelid ulcerations, and loss of eyelashes.

Burns

In chemical burns, sudden severe eye pain may occur with erythema and blistering of the face and eyelids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. In ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

Chalazion

A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

Conjunctivitis

Some degree of eye pain and excessive tearing occur in four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.

Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it typically produces burning, a foreign-body sensation, a purulent discharge, and conjunctival injection.

If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

Viral conjunctivitis produces itching, red eyes; a foreign-body sensation; visible conjunctival follicles; and eyelid edema.

Corneal abrasions

This type of injury typically produces a foreign-body sensation, excessive tearing, photophobia, and conjunctival injection.

Corneal erosion (recurrent)

In this disorder, severe pain occurs on waking and continues throughout the day. Accompanying the pain are conjunctival injection and photophobia.

Corneal ulcers

Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

Dacryoadenitis

Temporal pain may affect both eyes in this disorder. Associated findings include exophthalmos, conjunctival injection, severe eyelid erythema and edema, and a purulent eye discharge.

Dacryocystitis

Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling around the lacrimal punctum.

Episcleritis

Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

Erythema multiforme major

This disorder commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

Foreign bodies in the cornea and conjunctiva

Sudden severe pain is common in this condition, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

Glaucoma

Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Acute angle-closure glaucoma may cause severe pain and pressure over the eye, blurred vision, halo vision, decreased visual acuity, and nausea and vomiting.

Herpes zoster ophthalmicus

Eye pain occurs with severe unilateral facial pain, usually several days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.

Hordeolum (stye)

This lesion usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

Hyphema

Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and eyelid edema, conjunctival injection, and visual impairment may also occur.

Interstitial keratitis

Associated with congenital syphilis, this corneal inflammation produces eye pain with photophobia, blurred vision, prominent conjunctival injection, and grayish pink corneas.

Iritis (acute)

Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

Keratoconjunctivitis sicca

This condition—known as dry eye syndrome—causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. A copious mucoid discharge and inadequate tearing are typical.

Lacrimal gland tumor

This neoplastic lesion usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

Migraine headache

Migraines can produce head pain so severe that the eyes also ache. Nausea, vomiting, blurred vision, and light and noise sensitivity may also occur.

Ocular laceration and intraocular foreign bodies

Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

Optic cellulitis

This disorder causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, a purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.

Optic neuritis

In this disorder, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

Orbital floor fracture

Sometimes called a blowout fracture, this injury causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia.

Orbital pseudotumor

This disorder causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and limited extraocular movement may also occur.

Pemphigus

In this disorder, bilateral eye pain and irritation may be accompanied by blurred vision and a thick discharge. Blisters may develop on the conjunctiva alone or may extend to the nasal, oral, and vulvar mucous membranes as well as the skin.

Scleritis

This inflammation produces severe eye pain and tenderness, conjunctival injection, bluish purple sclera and, possibly, photophobia and excessive tearing.

Sclerokeratitis

Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

Subdural hematoma

Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma’s location and size.

Trachoma

Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, an eye discharge, eyelid edema and erythema, and visible conjunctival follicles.

Uveitis

Anterior uveitis causes sudden severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.

Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

Other causes

Treatments

Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Eye Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Conjunctivitis

❑ Corneal abrasion

❑ Foreign body

❑ Sinusitis

❑ Migraine

❑ Acute glaucoma

❑ Orbital cellulitis

❑ Zoster prodrome

❑ Orbital fracture

❑ Keratitis

❑ Scleritis

❑ Iritis

❑ Optic neuritis

❑ Temporal arteritis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Diplopia/Nystagmus: Differential Overview
(Field Guide to Bedside Diagnosis)

Diplopia

❑ Alcohol

❑ Diabetes

❑ Brainstem ischemia/lesion

❑ Grave disease

❑ Multiple sclerosis

❑ Ophthalmoplegic migraine

❑ Myasthenia gravis

❑ Wernicke encephalopathy

❑ Zygoma fracture

❑ Basilar meningitis

❑ Posterior communicating artery aneurysm

❑ Cavernous sinus thrombosis

❑ Syphilis

❑ Guillain-Barré variant

❑ Botulism

Nystagmus

❑ Labyrinthitis

❑ Multiple sclerosis

❑ Oculogyric crisis

❑ Cerebellar lesion

❑ Brainstem lesion

❑ Frontal lesion

❑ Occipital lesion

❑ Dorsal midbrain lesion

❑ Heavy metal intoxication

❑ Congenital

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Eye pain: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

See Eye pain: causes and associated findings, page 142.

Acute angle-closure glaucoma

Astigmatism

Blepharitis

Burns

Chalazion

Conjunctivitis

Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.

Corneal abrasions

Corneal erosion (recurrent)

Corneal ulcers

Dacryoadenitis

Dacryocystitis

Episcleritis

Erythema multiforme major

Foreign bodies in the cornea and conjunctiva

Glaucoma

Herpes zoster ophthalmicus

Hordeolum (stye)

Hyphema

Interstitial keratitis

Iritis (acute)

Keratoconjunctivitis sicca

Lacrimal gland tumor

Migraine headache

Ocular laceration and intraocular foreign bodies

Optic cellulitis

Optic neuritis

Orbital floor fracture

Orbital pseudotumor

Pemphigus

Scleritis

Sclerokeratitis

Subdural hematoma

Trachoma

Uveitis

Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape.

Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

Other causes

Medical treatments

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Eye pain: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Blepharitis

With blepharitis, burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include foreign-body sensation, lid ulcerations, and loss of eyelashes.

Burns

With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

Chalazion

A chalazion causes localized pain, tenderness, redness, and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

Conjunctivitis

Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge.

Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

Viral conjunctivitis produces itching, red eyes, foreign-body sensation, visible conjunctival follicles, and eyelid edema.

Corneal abrasions

With corneal abrasions, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common. The patient commonly reports feeling that “something is in” the eye.

Corneal erosion (recurrent)

With recurrent corneal erosion, severe pain occurs on waking and continues throughout the day. Conjunctival injection and photophobia also occur.

Corneal ulcers

Both bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea, unilateral pupil constriction, and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

Dacryocystitis

Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

Foreign body in the cornea or conjunctiva

Sudden severe pain is common but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

Glaucoma

Open-angle glaucoma may cause mild aching in the eyes as well as loss of peripheral vision, halo vision, and reduced visual acuity that isn’t corrected by glasses. Angle-closure glaucoma is characterized by blurred vision and sudden, excruciating pain in and around the eye. The pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

Herpes zoster ophthalmicus

With herpes zoster ophthalmicus, eye pain occurs with severe unilateral facial pain, usually days before vesicles erupt. Other signs include red, swollen eyelids; excessive tearing; a serous eye discharge; conjunctival injection; and a white, cloudy cornea.

Hordeolum

A hordeolum (stye) usually produces localized eye pain, burning, and discomfort that increases as the stye grows. Eyelid erythema and edema are also common.

Hyphema

Occurring after eye injury or surgery, hyphema accompanies sudden pain in and around the eye. Orbital and lid edema, conjunctival injection, and visual impairment may occur. The patient may report nausea.

Keratoconjunctivitis sicca

Keratoconjunctivitis sicca, also known as dry eye syndrome, causes chronic burning pain in both eyes, itching, a foreign-body sensation, photophobia, dramatic conjunctival injection, and difficulty moving the eyelids. Excessive mucoid discharge and inadequate tearing are typical.

Lacrimal gland tumor

Lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos. The patient may also have ptosis and eye deviation.

Ocular laceration and intraocular foreign bodies

Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

Optic cellulitis

Optic cellulitis causes dull, aching pain in the affected eye, some degree of exophthalmos, eyelid edema and erythema, purulent discharge, impaired extraocular movement and, occasionally, decreased visual acuity and fever.

Optic neuritis

With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

Orbital floor fracture

Sometimes called a blowout fracture, orbital floor fracture causes eye pain, dramatic eyelid edema and, possibly, enophthalmos and diplopia. The patient may report recent eye trauma and reduced vision. Ecchymosis and ptosis may be visible.

Orbital pseudotumor

An orbital pseudotumor causes deep, boring eye pain and diplopia in about 50% of patients. However, prominent exophthalmos and lateral ocular deviation are more characteristic. Eyelid edema and restricted extraocular movement may also occur.

Uveitis

Anterior uveitis causes sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil. Posterior uveitis causes insidious onset of similar features, plus gradual blurring of vision and distorted pupil shape. Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity (the patient usually can perceive only light).

Other causes

Treatments

Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Scotoma: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Chorioretinitis

Chorioretinitis, inflammation of the choroid and retina, produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

Glaucoma

With glaucoma, prolonged elevation of IOP can cause an arcuate scotoma. Poorly controlled glaucoma can also cause cupping of the optic disk, loss of peripheral vision, and reduced visual acuity. The patient may also see rainbow-colored halos around lights.

Macular degeneration

Macular degeneration results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

Migraine headache

Transient scintillating scotomas, usually bilateral and typically homonymous, can occur during a classic migraine aura. Besides pain, characteristic associated symptoms include paresthesia of the lips, face, or hands; slight confusion; dizziness; and photophobia.

Optic neuritis

Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain — especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

Retinitis pigmentosa

Retinitis pigmentosa initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom — impaired night vision — appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Diplopia: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Brain tumor

Diplopia may be an early symptom of a brain tumor. Accompanying signs and symptoms vary with the tumor’s size and location but may include eye deviation, emotional lability, decreased LOC, headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Diabetes mellitus

Diplopia due to isolated third cranial nerve palsy may be among the long-term effects of diabetes mellitus. It typically begins suddenly and may be accompanied by intense periorbital or head pain. The patient may display the typical signs and symptoms of diabetes to varying degrees.

Encephalitis

Initially, encephalitis may cause a brief episode of diplopia and eye deviation. However, it usually begins with sudden onset of high fever, severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, decreased LOC, seizures, ataxia, and paralysis.

Head injury

Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, headache, decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm

Intracranial aneurysm is a life-threatening disorder that initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis

Diplopia, a common early symptom in multiple sclerosis (MS), is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in blank facial expression; nasal voice; difficulty chewing, swallowing, and making fine hand movements; and possibly signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine

Most common in young adults, ophthalmologic migraine results in diplopia that persists for days after the headache. Accompanying signs and symptoms include severe, unilateral pain; ptosis; and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture

An orbital blowout fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis but doesn’t affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient’s pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis

Orbital cellulitis (inflammation of the orbital tissues and eyelids) causes sudden diplopia. Other findings are eye deviation and pain, purulent drainage, lid edema, chemosis and redness, proptosis, nausea, and fever.

Orbital tumors

Orbital tumors can cause diplopia. Proptosis and possibly blurred vision may also occur. One or both eyes may appear prominent. The patient may also report pain and redness and swelling of the lid of the affected eye.

Stroke

Diplopia characterizes stroke when it affects the vertebrobasilar artery. Other signs and symptoms of this life-threatening disorder include unilateral motor weakness or paralysis, ataxia, decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis

Diplopia accompanies exophthalmos in patients with thyrotoxicosis. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It’s accompanied by impaired eye movement, excessive tearing, lid edema and, possibly, inability to close the lids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack

Transient ischemic attack is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours and may be a warning sign for a future stroke.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Scotoma: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Chorioretinitis.Inflammation of the choroid and retina produces a paracentral scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, subretinal hemorrhage, and neovascularization. The patient may have photophobia along with blurred vision.

Macular degeneration.Any degenerative process or disorder affecting the fovea centralis results in a central scotoma. Ophthalmoscopic examination reveals changes in the macular area. The patient may notice subtle changes in visual acuity, in color perception, and in the size and shape of objects.

Optic neuritis.Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe vision loss or blurring, lasting up to 3 weeks, and pain—especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.

Retinal pigmentary degeneration.Retinal pigmentary degeneration causes premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom—impaired night vision—appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Diplopia: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Alcohol intoxication.Diplopia is a common symptom of alcohol intoxication. It's accompanied by confusion, slurred speech, halitosis, a staggering gait, behavior changes, nausea, vomiting and, possibly, conjunctival injection.

Botulism.Hallmark signs of botulism include diplopia, dysarthria, dysphagia, and ptosis. Early findings include a dry mouth, a sore throat, vomiting, and diarrhea. Later, descending weakness or paralysis of extremity and trunk muscles causes hyporeflexia and dyspnea.

Brain tumor.Diplopia may be an early symptom of a brain tumor. Accompanying signs and symptoms vary with the tumor's size and location, but may include eye deviation, emotional lability, a decreased LOC, a headache, vomiting, absence or generalized tonic-clonic seizures, hearing loss, visual field deficits, abnormal pupillary responses, nystagmus, motor weakness, and paralysis.

Cavernous sinus thrombosis.Cavernous sinus thrombosis may produce diplopia and limited eye movement. Associated signs and symptoms include proptosis, orbital and lid edema, diminished or absent pupillary responses, impaired visual acuity, papilledema, and a fever.

Diabetes mellitus.Among the long-term effects of diabetes mellitus may be diplopia due to isolated CN III palsy. Diplopia typically begins suddenly and may be accompanied by pain.

Encephalitis.Initially, encephalitis may cause a brief episode of diplopia and eye deviation. However, it usually begins with the sudden onset of a high fever, a severe headache, and vomiting. As the inflammation progresses, the patient may display signs of meningeal irritation, a decreased LOC, seizures, ataxia, and paralysis.

Head injury.Potentially life-threatening head injuries may cause diplopia, depending on the site and extent of the injury. Associated signs and symptoms include eye deviation, pupillary changes, a headache, a decreased LOC, altered vital signs, nausea, vomiting, and motor weakness or paralysis.

Intracranial aneurysm.Intracranial aneurysm is a life-threatening disorder that initially produces diplopia and eye deviation, perhaps accompanied by ptosis and a dilated pupil on the affected side. The patient complains of a recurrent, severe, unilateral, frontal headache. After the aneurysm ruptures, the headache becomes violent. Associated signs and symptoms include neck and spinal pain and rigidity, a decreased LOC, tinnitus, dizziness, nausea, vomiting, and unilateral muscle weakness or paralysis.

Multiple sclerosis (MS).Diplopia, a common early symptom in MS, is usually accompanied by blurred vision and paresthesia. As MS progresses, signs and symptoms may include nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, impotence, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis.Myasthenia gravis initially produces diplopia and ptosis, which worsen throughout the day. It then progressively involves other muscles, resulting in a blank facial expression; a nasal voice; difficulty chewing, swallowing, and making fine hand movements; and, possibly, signs of life-threatening respiratory muscle weakness.

Ophthalmologic migraine.Ophthalmologic migraine results in diplopia that persists for days after the headache. Accompanying signs and symptoms include severe, unilateral pain; ptosis; and extraocular muscle palsies. Irritability, depression, or slight confusion may also occur.

Orbital blowout fracture.An orbital blowout fracture usually causes monocular diplopia affecting the upward gaze. However, with marked periorbital edema, diplopia may affect other directions of gaze. This fracture commonly causes periorbital ecchymosis, but doesn't affect visual acuity, although eyelid edema may prevent accurate testing. Subcutaneous crepitation of the eyelid and orbit is typical. Occasionally, the patient's pupil is dilated and unreactive, and he may have a hyphema.

Orbital cellulitis.Inflammation of the orbital tissues and eyelids causes sudden diplopia. Other findings are eye deviation and pain, purulent drainage, lid edema, chemosis and redness, proptosis, nausea, and a fever.

Orbital tumor.An enlarging orbital tumor can cause diplopia. Proptosis and possibly blurred vision may also occur.

Stroke.Diplopia characterizes stroke when it affects the vertebrobasilar artery. Other signs and symptoms include unilateral motor weakness or paralysis, ataxia, a decreased LOC, dizziness, aphasia, visual field deficits, circumoral numbness, slurred speech, dysphagia, and amnesia.

Thyrotoxicosis.Diplopia occurs when exophthalmos characterizes the disorder. It usually begins in the upper field of gaze because of infiltrative myopathy involving the inferior rectus muscle. It's accompanied by impaired eye movement, excessive tearing, lid edema and, possibly, an inability to close the lids. Other cardinal findings include tachycardia, palpitations, weight loss, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance.

Transient ischemic attack (TIA).TIA is generally accompanied by diplopia, dizziness, tinnitus, hearing loss, and numbness. It can last for a few seconds or up to 24 hours and may be a warning sign of a future stroke.

Other causes

Eye surgery.Fibrosis associated with eye surgery may restrict eye movement, resulting in diplopia.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Eye pain [Ophthalmalgia]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acute angle-closure glaucoma.Blurred vision and sudden, excruciating pain in and around the eye characterize acute angle-closure glaucoma; the pain may be so severe that it causes nausea, vomiting, and abdominal pain. Other findings are halo vision, rapidly decreasing visual acuity, and a fixed, nonreactive, moderately dilated pupil.

Blepharitis.Burning pain in both eyelids is accompanied by itching, sticky discharge, and conjunctival injection. Related findings include a foreign-body sensation, lid ulcerations, and loss of eyelashes.

Burns.With chemical burns, sudden and severe eye pain may occur with erythema and blistering of the face and lids, photophobia, miosis, conjunctival injection, blurring, and an inability to keep the eyelids open. With ultraviolet radiation burns, moderate to severe pain occurs about 12 hours after exposure along with photophobia and vision changes.

Chalazion.A chalazion causes localized tenderness and swelling on the upper or lower eyelid. Eversion of the lid reveals conjunctival injection and a small red lump.

Conjunctivitis.Some degree of eye pain and excessive tearing occurs with four types of conjunctivitis. Allergic conjunctivitis causes mild, burning, bilateral pain accompanied by itching, conjunctival injection, and a characteristic ropey discharge. Bacterial conjunctivitis causes pain only when it affects the cornea. Otherwise, it produces burning and a foreign-body sensation. A purulent discharge and conjunctival injection are also typical.

If the cornea is affected, fungal conjunctivitis may cause pain and photophobia. Even without corneal involvement, it produces itching, burning eyes; a thick, purulent discharge; and conjunctival injection.

Viral conjunctivitis produces itching, red eyes, a foreign-body sensation, visible conjunctival follicles, and eyelid edema.

Corneal abrasions.With this type of injury, eye pain is characterized by a foreign-body sensation. Excessive tearing, photophobia, and conjunctival injection are also common.

Corneal ulcers.Bacterial and fungal corneal ulcers cause severe eye pain. They may also cause a purulent eye discharge, sticky eyelids, photophobia, and impaired visual acuity. In addition, bacterial corneal ulcers produce a grayish white, irregularly shaped ulcer on the cornea; unilateral pupil constriction; and conjunctival injection. Fungal corneal ulcers produce conjunctival injection, eyelid edema and erythema, and a dense, cloudy, central ulcer surrounded by progressively clearer rings.

Dacryocystitis.Pain and tenderness near the tear sac characterize acute dacryocystitis. Additional signs include excessive tearing, a purulent discharge, eyelid erythema, and swelling in the lacrimal punctum area.

Episcleritis.Deep eye pain occurs as tissues over the sclera become inflamed. Related effects include photophobia, excessive tearing, conjunctival edema, and a red or purplish sclera.

Erythema multiforme major.Erythema multiforme major commonly produces severe eye pain, entropion, trichiasis, purulent conjunctivitis, photophobia, and decreased tear formation.

Foreign bodies in the cornea and conjunctiva.Sudden severe pain is common, but vision usually remains intact. Other findings include excessive tearing, photophobia, miosis, a foreign-body sensation, a dark speck on the cornea, and dramatic conjunctival injection.

Hordeolum (stye).Hordeolum usually produces localized eye pain that increases as the stye grows. Eyelid erythema and edema are also common.

Iritis (acute).Moderate to severe eye pain occurs with severe photophobia, dramatic conjunctival injection, and blurred vision. The constricted pupil may respond poorly to light.

Lacrimal gland tumor.A lacrimal gland tumor is a neoplastic lesion that usually produces unilateral eye pain, impaired visual acuity, and some degree of exophthalmos.

Migraine headache.Migraines can produce pain so severe that the eyes also ache. Additionally, nausea, vomiting, blurred vision, and light and noise sensitivity may occur.

Ocular laceration and intraocular foreign bodies.Penetrating eye injuries usually cause mild to severe unilateral eye pain and impaired visual acuity. Eyelid edema, conjunctival injection, and an abnormal pupillary response may also occur.

Optic neuritis.With optic neuritis, pain in and around the eye occurs with eye movement. Severe vision loss and tunnel vision develop but improve in 2 to 3 weeks. Pupils respond sluggishly to direct light but normally to consensual light.

Scleritis.Scleritis produces severe eye pain and tenderness, along with conjunctival injection, a bluish purple sclera and, possibly, photophobia and excessive tearing.

Sclerokeratitis.Inflammation of the sclera and cornea causes pain, burning, irritation, and photophobia.

Subdural hematoma.Following head trauma, a subdural hematoma commonly causes severe eye ache and headache. Related neurologic signs depend on the hematoma's location and size.

Trachoma.Along with pain in the affected eye, trachoma causes excessive tearing, photophobia, eye discharge, eyelid edema and redness, and visible conjunctival follicles.

Uveitis.Anterior uveitis causes the sudden onset of severe pain, dramatic conjunctival injection, photophobia, and a small, nonreactive pupil.

Posterior uveitis causes an insidious onset of similar features as well as gradual blurring of vision and distorted pupil shape.

Lens-induced uveitis causes moderate eye pain, conjunctival injection, pupil constriction, and severely impaired visual acuity. In fact, the patient usually can perceive only light.

Other causes

Treatments and surgery.Contact lenses may cause eye pain and a foreign-body sensation. Ocular surgery may also produce eye pain, ranging from a mild ache to a severe pounding or stabbing sensation.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

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