Red Eyes

These pages will help you formulate a list of differential diagnoses for some of the conditions you will face focusing upon red eyes. It should be emphasized that these are rough guidelines and each patient will have to be managed according to the specific clinical scenario.

The information in the following links is adapted from my text entitled "Ophthalmology in Primary Care" published by The Royal College of General Practitioners and available for purchase here.

Acute Angle Closure Glaucoma

Vision?

Blurred

Stickiness?

Laterality?

Unilateral

Painful?

Yes. Nausea is a predominant accompaniment to pain, related to raised intraocular pressure. The pain is often localised to the eyebrow.

Visual acuity?

Reduced to approximately 6/36 or even worse, depending on the degree of ensuing corneal oedema.

Where is the redness?

More marked around the limbus

Stain on cornea?

No, although there may be diffuse pinpoint staining over the cornea related to the corneal oedema and resulting in an unhealthy corneal epithelium.

Pupil?

Fixed and mid-dilated. If the pupil reacts normally, then the condition is not angle–closure glaucoma.

Is the cornea clear?

No, hazy with a 'ground-glass' appearance.

Conjunctival appearance?

Normal

Bacterial Conjunctivitis

Vision?

Normal – watering or purulent matter may cause slight transient blurring.

Stickiness?

Yes – eyes will be ‘matted together’ in the mornings.

Laterality?

Usually begins as unilateral, but may become bilateral.

Pain?

Visual acuity?

Normal

Where is the redness?

Redness is more pronounced in the inferior fornix. The blood vessels around the limbus are not engorged.

Stain on cornea?

No stain on cornea unless a corneal ulcer has developed.

Pupil?

Normal

Is the cornea clear?

Yes

Conjunctival appearance?

Flat but erythematous

Chlamydial Conjunctivitis

Vision?

Normal

Stickiness?

No or mild stickiness, increasing slowly with time. Usually chronic conjunctivitis with a history of several weeks duration, resistant to usual treatment. The major feature is redness, irritation and watering.

Laterality?

Often bilateral

Pain?

Visual acuity?

Usually normal

Where is the redness?

Redness is more prominent in the inferior fornix.

Stain on cornea?

Pupil?

Normal

Is the cornea clear?

Yes

Conjunctival appearance?

Numerous pronounced follicles

Corneal Foreign Bodies and Abrasions

Vision?

If the visual axis is involved, vision will be reduced.

Stickiness?

No, but usually marked epiphoria (watering eye).

Laterality?

Unilateral

Pain?

Can be extremely painful, resulting in marked blepharospasm and difficulty in opening the eyes. Patients will feel they have a foreign body in their eye.

Visual acuity?

If the central corneal epithelium is lost in the abrasion, the vision will be reduced to approximately 6/12.

Where is the redness?

The limbal vasculature will be engorged.

Stain on cornea?

Yes

Pupil?

Normal

Is the cornea clear?

In the staining area (i.e., where the corneal epithelium has been rubbed off) the underlying corneal stroma will retain its clarity. If the area under and around the abrasion is white-ish, this may indicate an infective keratitis.

Conjunctival appearance?

Normal

Corneal Ulcers

Vision?

If the central cornea is involved, vision will be dramatically reduced

Stickiness?

Not necessarily, but there may be marked purulent discharge.

Laterality?

Unilateral

Pain?

Yes. Small, mild ulcers may present solely with a foreign body sensation. Ulcers related to herpes virus, however, may be fairly painless because of damage to the corneal nerves.

Visual acuity?

If the ulcer is peripheral, then vision may be perfect. If the central cornea is involved, vision may be reduced only to the ability to count fingers or worse.

Where is the redness?

Small ulcers will be pinpointed by the presence of limbal injection in the quadrant adjacent to the position of the ulcer. If the ulcer is larger, the whole limbus will be red.

Stain on cornea?

Yes. The ulcer area will be stained, and the cornea around and under this area will be white-ish.

Pupil?

Reacts normally

Is the cornea clear?

No. The corneal tissue near to the ulcer will be white-ish.

Conjunctival appearance?

Normal