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Painful red eye
Acute angle‐closure glaucoma
Anterior uveitis or iritis
- Deep, aching pain radiating to periorbital or temporal area
worse with eye movements and accommodation, and with PHOTOPHOBIA
- Ciliary flush, pain relief with cyclolegics but not with topical anesthetics
- Consensual photophobia (Light in the unaffected eye, because it causes bilateral myosis, causes pain)
- Abnormal slit lamp exam : keratitic precipitates or hypopyon, cells and flare in the anterior chamber
- Prevent long‐term vision loss due to scarring, malfunction in the shape of the iris,
and the increased likelihood of retinal detachment
- 50% of cases have underlying infectious or autoimmune diseases
- Management : Cycloplegic drops, Cyclopentolate,
Steroids should only be used with OPH consultation due to concern for
worsening of underlying infection or development of corneal ulcer
Painless red eye
Kawasaki disease
Painless loss of vision
Vascular occlusion, Retinal detachment, Vitreous hemorrhage, Macular disorders,
Neuro‐ophthalmologic disease, Hysteria, Secondary to methanol or viagra
Temporal arteritis
- Jaw claudication and diplopiaare most predictive, temporal area pain and subacute peripheral vision loss,
low grade fever, constitutional symptoms lasting weeks to months
(anorexia, fatigue, myalgias, night sweats, weight loss), ataxia, decreased hearing
- Beading, prominence or tenderness of the temporal artery is the most predictive,
but also temporal scalp area tenderness, hyperesthesia and hypersensitivity,
and vestibular or hearing impairment at time of presentation
- Do not rely on on a normal ESR alone to rule out temporal arteritis
Central Retinal Artery Occlusion (CRAO)
- Sudden abrupt painless vision loss, complete or with central vision retained
- Positive RAPD (rapid afferent pupillary defect) with a blanched,
non‐perfused retina with the pathognomonic cherry‐red spot
Central Retinal Venous Occlusion (CRVO)
- DVT of the eye, vascular engorgement (gradual changes);
tell‐tale – big angry stormy eye on fundcoscopic exam; hyperaemic, ‘blood and thunder’ exam
Painful loss of vision
Optic neuritis
- Triad of unilateral loss of vision, eye pain (especially with eye movement)
and dyschromatopsia (washed out colors, especially red, as if looking through frosted glass)
- Markedly decreased visual acuity, may sometimes see blurred disk margins and swollen veins
- Treatment : IV methylprednisolone
https://emergencymedicinecases.com/episode-9-nontraumatic-eye-emergencies/
Infectious conjunctivitis
- Irrigation and washing
- Contact lens wearers : anti‐pseudomonals (Ciprofloxacin)
- Suspect gonococcal infection with recent unprotected sexual intercourse : admission and IV antibiotics
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