RED EYE
Most textbooks consider the causes of red eye to be conjunctivitis,
iritis, or glaucoma, but it may be the result of taking the night plane from
Los Angeles to New York. If these are all the causes you can remember, you
will be sadly mistaken in some cases. Most of the causes can be quickly
recalled by simply considering the anatomy of the eye, because
trauma or inflammation is the usual cause.
Beginning with the eyelids, one recalls blepharitis and hordeolum.
The conjunctiva suggests conjunctivitis. The cornea may be
involved by a foreign body or keratitis; corneal ulcers should also be
looked for. Proceeding to deeper layers, the physician should consider
iritis, scleritis, or injury to these
structures. Finally, between the cornea and iris is the canal of Schlemm, which recalls glaucoma. The vascular supply suggests a
cavernous sinus thrombosis.
Another method that will bring to mind even more of the possibilities is to
use the mnemonic FOREIGN. The word and the first letter signify
foreign bodies. The O suggests otolaryngologic conditions such as
upper respiratory infections. The R brings to mind refractive
errors and astigmatism. The E suggests the exanthema and the
conjunctivitis of measles. It will also help recall episcleritis and
scleritis. I should signify iritis, conjunctivitis, and other
inflammatory lesions. The G suggests glaucoma. Finally, the
N should indicate neoplasms of the orbit.
Approach to the Diagnosis
Pinning down the diagnosis of a red eye is usually not difficult
because most causes will be evident to the naked eye. However, a careful
search for a foreign body with a magnifying glass and for a corneal abrasion
using fluorescein will be necessary in some cases. The association of other
signs and symptoms will be invaluable. Diffuse erythema of the eye usually
indicates trauma, conjunctivitis, or scleritis, whereas circumcorneal
injection suggests iritis or glaucoma. A dilated pupil suggests glaucoma,
whereas a constricted or distorted pupil suggests iritis. A slit lamp will
differentiate keratitis and obscure foreign bodies. Tonometry is useful in
differentiating glaucoma from other conditions. A smear and culture will
help differentiate infectious conjunctivitis from allergic conjunctivitis,
but the latter is usually bilateral whereas the former is usually
unilateral. An ophthalmologist should be consulted immediately if there is
any doubt about the diagnosis.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Eye pain
» Next page: EYE PAIN (Differential Diagnosis in Primary Care)
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