Red eye is a common condition encountered in the emergency department (ED) and can range from benign to sight-threatening conditions. As a junior doctor, understanding the potential causes, assessment, and management strategies for red eye is crucial for effective patient care.
Understanding Red Eye
Red eye is characterized by redness of the sclera (the white part of the eye) due to dilation of blood vessels. It can be caused by a variety of factors, including infections, inflammation, trauma, and systemic conditions.
Common Causes of Red Eye
Infectious Causes
Conjunctivitis: The most common cause of red eye, which can be viral, bacterial, or allergic. Viral conjunctivitis often presents with watery discharge and is highly contagious. Bacterial conjunctivitis usually has purulent discharge.
Keratitis: Inflammation of the cornea, often due to infection (bacterial, viral, fungal) or contact lens use. It can lead to corneal ulcers if not treated promptly[1][2].
Endophthalmitis: A severe infection of the entire eyeball, often following surgery or trauma. It requires urgent ophthalmological intervention[1].
Inflammatory Causes
Uveitis/Iritis: Inflammation of the uvea or iris, presenting with pain, photophobia, and blurred vision. It may be associated with systemic autoimmune conditions[2][4].
Scleritis: Inflammation of the sclera that can cause deep eye pain and redness. It is often associated with systemic inflammatory diseases[2].
Other Causes
Acute Angle-Closure Glaucoma: A sight-threatening condition characterized by sudden onset of severe eye pain, headache, nausea, and vision changes such as halos around lights. It requires immediate treatment to reduce intraocular pressure[1][4].
Subconjunctival Hemorrhage: A benign condition where a small blood vessel breaks under the conjunctiva, causing a bright red patch on the sclera without pain or vision changes[5].
Dry Eye Syndrome: Insufficient tear production leading to irritation and redness[1].
Initial Assessment and Management
History Taking
A thorough history is essential to guide further evaluation:
Onset and duration of symptoms
Presence of pain, discharge, photophobia, or vision changes
Recent eye trauma or surgery
Use of contact lenses
Systemic symptoms or conditions
Physical Examination
The physical examination should focus on identifying signs that may indicate specific causes:
Visual acuity assessment
Inspection for discharge type and pattern of redness
Pupil size and reaction to light
Corneal clarity and presence of any lesions
Palpation for ocular tenderness
Diagnostic Workup
Depending on clinical suspicion from history and examination, the following tests may be considered:
Slit Lamp Examination: To assess anterior eye structures in detail.
Fluorescein Staining: To detect corneal abrasions or ulcers.
Intraocular Pressure Measurement: To rule out glaucoma.
Management Strategies
Management of red eye in the ED focuses on addressing both symptom relief and underlying causes:
Symptomatic Treatment:
Lubricating eye drops for dry eyes.
Cold compresses for allergic conjunctivitis.
Specific Interventions:
Antibiotic drops for bacterial conjunctivitis.
Antiviral medication for herpetic keratitis.
Urgent ophthalmology referral for suspected acute angle-closure glaucoma or endophthalmitis.
Monitoring and Follow-up:
Referral to an ophthalmologist for persistent or unclear cases requiring further evaluation.
Challenges and Considerations
Red eye can be challenging due to its broad differential diagnosis. It is crucial to identify red flags that suggest serious underlying conditions requiring urgent intervention. These include severe pain, vision loss, photophobia, and unilateral presentation with systemic symptoms.
By taking a systematic approach to the assessment and management of red eye, you can effectively address this common complaint in the emergency setting while ensuring appropriate follow-up care.
Citations: [1] https://www.imo.es/en/symptom/red-eye/ [2] https://bpac.org.nz/bpj/2013/august/docs/bpj54-pages8-21.pdf [3] https://pmc.ncbi.nlm.nih.gov/articles/PMC5443986/ [4] https://emergencycarebc.ca/clinical_resource/clinical-summary/red-and-painful-eye-unilateral-and-bilateral-diagnosis-and-treatment/ [5] https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html
Comments