Friday, November 1, 2013

Ojo rojo - August 2, 2010 by Chris Nickson
Q1. There are many causes of ‘red eye’ — how can they broken down as an approach to diagnosis and management?
Q2. What are the causes of a painless red eye?
Q3. What are the causes of a painful red eye?
Q4. What 4 features usually suggest an internal cause of a red eye?
Q5. What 6 features on history and exam suggest an external cause for red eye?
Q6. What 7 features on exam should be present if the cause of a red eye is not serious?
Q7. What is the likely diagnosis of a red eye in a middle-aged woman with the following findings?
  • Mid-dilated unreactive pupil, steamy cornea, peri-orbital pain , nausea/vomiting and increased intra-ocular pressure
  • Small irregular pupil, deep-seated eye pain that is worse on eye movement and accomodation, consensual photophobia and positive slit lamp signs of flare and cells
  • Deep-seated eye pain that is worse at rest and at night, pain on palpation of the eye and violaceous appearance of the sclera
  • Proptosis, congested chemosis, painful external ophthalmoplegia, and visual loss with a relative afferent pupillary defect
Q9. What potentially serious causes of a red eye are suggested by the following features on history or examination?
  • Severe eye aching
  • Prominent photophobia
  • Impaired vision
  • Cloudy cornea
  • Corneal opacification
  • Circumcorneal conjunctival injection
  • Cloudy anterior chamber
  • Pain on eyeball palpation
  • Proptosis
  • Impaired, or painful, extraocular eye movements
  • Fever, toxic appearance
  • Hyperpurulent discharge from an “angry” eye
  • Prominent nausea and vomiting
  • Small, irregular, poorly-reactive pupil
  • Fixed mid-dilated pupil
  • Increased intra-ocular pressure
  • History of connective tissue disease, or granulomatous disease"