Diagnosis and Management of the Acute Red Eye
Section snippets
Conjunctivitis
The most common cause of red eye is conjunctivitis. The term conjunctivitis refers to inflammation of the conjunctiva, a membrane that lines the outer aspect of the globe (bulbar conjunctiva) and reflects back on itself to line the inner lids (the palpebral conjunctiva) [2]. Conjunctivitis is usually separated into broad categories based on the etiologic agent and time course of illness. The most common causes of acute conjunctivitis (less than 4 weeks) are allergic, viral, and bacterial.
Subconjunctival hemorrhage
Subconjunctival hemorrhage is caused by bleeding of the conjunctival or episcleral vessels deep to the conjunctiva into the subconjunctival space [10]. Subconjunctival hemorrhage can be spontaneous or related to trauma or systemic illness. When it is spontaneous, it is usually secondary to decreased lubrication of the eye [11].
The patient will usually present with a painless red eye that has no effect on his or her vision. It often causes alarm when the patient first notices it. There is no
Episcleritis
The episclera is a thin membrane that covers the sclera and lies beneath the conjunctiva. Episcleritis is generally a benign inflammatory condition that involves only the superficial episcleral tissue and not the deep episcleral tissue that overlies the sclera. Most cases are idiopathic in nature and are commonly seen in young adults [12], [13]. Episcleritis can be associated with systemic diseases such as rheumatoid arthritis, polyarteritis nodosa, systemic lupus erythematosus (SLE),
Scleritis
Scleritis is defined as an inflammation of the sclera that may involve the cornea, adjacent episclera, and underlying uvea. The maximal involvement in scleritis is the deep episcleral plexus, which is displaced outward by the edematous swollen sclera. The classification of scleritis can be divided into anterior and posterior. Anterior scleritis is further subdivided into diffuse, nodular, or necrotizing. Diffuse anterior scleritis is characterized by extensive scleral edema and congestion of
Uveitis
Uveitis can be defined as an inflammation of the iris (iritis), ciliary body (cyclitis), and choroid (choroiditis). Anterior uveitis, often called iridocyclitis, involves inflammation of the anterior portion of the uveal tract and usually affects young or middle-aged persons. Posterior uveitis includes vitritis, choroiditis, retinitis, chorioretinitis, or retinochoroiditis. Panuveitis or diffuse uveitis are the terms used to characterize both anterior and posterior involvement. There are
Acute angle-closure glaucoma
AACG is a condition that develops when the peripheral tissue of the iris blocks the outflow of fluid from the anterior chamber, resulting in elevated intraocular pressure [1]. Mydriasis, such as in the low-light evening hours, can often worsen the condition as the accordion-like folds of the iris gather together into folds that cause obstruction. Mydriatic medications, systemic anticholinergics (eg, antihistamines or antipsychotics), and accommodation (ie, reading) can also cause pupillary
Summary
The acutely red eye is a common complaint in the emergency department. Although most causes are benign and self-limiting, appropriate work-up and treatment can identify serious conditions and prevent significant morbidity such as blindness. As outlined herein, the emergency physician should obtain a relevant history and perform a thorough examination using the slit lamp and measurement of intraocular pressures when appropriate.
In general, patients who present with severe ocular pain, acute
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