Acute red eye
Ophthalmology
Introduction
Author: Naqiya Hassanali
Red eye is a common complaint that can range from benign to sight-threatening conditions. Early identification of serious causes is essential to prevent permanent vision loss.
WIPER
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Presenting Complaint
Pain Description: Can you describe the discomfort in your eye
Eye Involvement: Unilateral or bilateral? Is the entire eye involved or just a part?
Onset and Timing: When did you first notice the redness and pain? Did it start suddenly or gradually? Is the pain constant or does it come and go?
Character: How would you describe the pain—dull, sharp, or irritating?
Associated Symptoms:
Vision Changes: Any blurriness or vision changes?
Discharge: Any discharge from the eye?
Itching: Any itching sensation?
Dryness: Any issues with eye dryness?
Haloes: Do you see haloes around lights?
Exacerbating/Relieving Factors: Does anything make it better or worse, such as eye movements or exposure to bright light? Any history of trauma or foreign body in the eye?
Severity: How would you rate the pain on a scale from 1 to 10?
Systemic Enquiry:
Fever: Any recent fever or feeling unwell?
GI/Respiratory/GUM/Arthralgia/Rashes: Any symptoms related to gastrointestinal, respiratory, genitourinary systems, joint pains, or skin rashes?
Elicit the patient's ideas, concerns and expectations
Past Medical History
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Medications
Enquire about systemic/topical steroids or eye drops.
Any known allergies?Ask about allergies and OTC, herbal or prescribed medications
Family History
Any family history of eye conditions?
Social History
Occupation (risk of foreign body exposure), contact lens use, smoking, and alcohol use.
Differential Diagnosis
Conjunctivitis (viral, bacterial, allergic)
Acute angle-closure glaucoma
Infectious keratitis (bacterial, fungal, parasitic, herpes)
Acute anterior uveitis
Episcleritis/Scleritis
Subconjunctival haemorrhage
Management
Investigations:
Detailed eye examination including visual fields, ophthalmoscopy, and slit-lamp examination.
Other Tests:
Tonometry
Conjunctival and corneal swabs
Syphilis serology, chest X-ray, and HLA-B27 testing
Gonioscopy
Treatment
Acute Angle Closure: Immediate treatment with IV acetazolamide, dexamethasone, pilocarpine, timolol, and iopidine.
Infectious Causes:
Viral conjunctivitis: Cool compress
Bacterial conjunctivitis: Topical antibiotics (e.g., chloramphenicol)
Herpes keratitis: Topical acyclovir
Allergic Conjunctivitis: Topical antihistamines and mast cell stabilizers.
Anterior Uveitis: Cycloplegia and topical steroids.