Red Eye, Eye Pain, and Vision Loss




Abstract


This chapter reviews some of the most common causes of eye pain, eye redness, and vision loss, as well as a brief overview of the initiation evaluation and treatment.




Keywords

blindness, chalazion, conjunctivitis, contact lens, eye, eye pain, eye redness, fluorescein, glaucoma, hordeolum, hyphema, pinkeye, stye, vision loss

 




1


How does the anatomy of the eye affect the way a patient will present for an ophthalmologic emergency?


Although patients present for “eye pain” or “eye redness,” it is important to differentiate between symptoms affecting the soft tissues surrounding the eye and those affecting the orbit specifically.




2


How should the eye be examined?


Start with a visual acuity, followed by examination of the soft tissue around the eye. This is best performed in a dark room using a slit lamp, or at least an ophthalmoscope and a blue light (e.g., Wood lamp).




3


How can you differentiate between periorbital and orbital cellulitis?


Periorbital cellulitis does not cause pain with eye movement and is treated with outpatient oral antibiotic therapy. Orbital cellulitis causes pain with eye movement and is treated as an inpatient.




4


What is the treatment for a chalazion (cyst) and a hordeolum (stye) ( Fig. 2.1 )?


Both present with swelling, pain, and erythema of the affected eyelid. Neither require antibiotic treatment. Both are best treated with frequent warm compresses and antiinflammatory pain medication.




Fig. 2.1


Chalazion vs. Hordeolum.

Adapted from Image 2. Styes and Chalazions Guide: Causes, Symptoms, and Treatment Options. [n.d.]. Available at: https://www.drugs.com/health-guide/styes-and-chalazions.html . Accessed 15.07.16.




5


What is blepharitis and how is management different from chalazion and hordeolum?


Blepharitis is an infection of the eyelash and can extend into the eyelid; it should be treated with topical antibiotic drops or ointment. Oral antibiotics are typically not indicated.




6


Which method should be used to examine the underside of the eyelid for a foreign body?


Place a cotton-tip swab against the skin along the margin between the orbital and the superior orbital bone. Holding the patient’s upper eyelashes, the lid can then be everted by rolling the skin over the cotton-tip swab. Repeat on the lower lid.




7


How many places can a contact lens hide?


Careful examination of the cornea and sclera of a patient who has “lost” a contact lens in the eye may not reveal the missing contact. After anesthesia, evert the eyelid and sweep the upper fornix while the patient is looking down. Fluorescein stain can be used to help locate a missing lens in the eye, but staining of the lens is permanent.



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Sep 15, 2018 | Posted by in EMERGENCY MEDICINE | Comments Off on Red Eye, Eye Pain, and Vision Loss

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