The acute red eye



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Acute angle closure glaucoma: Characterised by sudden onset painful red eye with vomiting from pain, halos seen around lights, decreased visual acuity due to corneal oedema, semi dilated  non reactive pupil and stony hard eyeball. There may be a history of intermittent subacute attacks. THIS IS AN OCULAR EMERGENCY which requires immediate treatment (iv acetazolamide, topical treatment and laser iridotomy).

Keratitis: This is inflammation of the cornea. Can be viral, fungal, bacterial or due to acanthoemeba (as seen in contact lens wearers). Presentation: unilateral photophobia, blurring, pain, eyelid oedema, discharge, hypopyon, dendritic ulcer (HSV) and stromal precipitates.

Conjunctivitis: This is inflammation of the conjunctiva. It can be bacterial, viral, chlamydial or allergic.

  Simple bacterial conjunctivitis:  subacute onset, bilateral, burning + discharge.  Gonococcal conjunctivitis presents with creamy discharge and oedema.

  Adenovirus: Types 8 and 19 cause contagious viral conjunctivitis. (types 3, 4 and 7 associated with pharyngitis). Acute onset, bilateral, watering, redness, discomfort and photophobia.

  Adult chlamydial conjunctivitis presents with chronic unilateral discharge. Neonatal forms may pass from mother to child. Trochoma occurs in developing world where chlamydia trochomatis is carried by the common fly à associated with scarring.

  Vernal (allergic) conjunctivitis: associated with atopy. Causes burning, photophobia, itching and characteristic cobblestone papillae.

Uveitis: This is inflammation of the uvea (iris, ciliary body and choroid together).  Can manifest as anterior uveitis (predominantly iritis), intermediate uveitis, posterior uveitis or panuveitis.  May be acute or chronic.  Presentation of acute uveitis:  unilateral, pain, photophobia, injections around the limbus, no itching, poorly reactive pupil. Signs: keratic precipitates (KPs), posterior synechiae and hypopyon. This is associated with HLA-B27 and AS.

Other things to look out for in the acute red eye include a hx of trauma, foreign bodies and operations (eg. post op endophthalmitis).