Emergency Medicine

Painful, Red Eye

Ophthalmic Emergencies 419

2 The patient is usually unwell and in pain. The eye may be involved, resulting
in blepharitis, conjunctivitis, keratitis, uveitis, secondary glaucoma,
ophthalmoplegia or optic neuritis.

3 Treatment of the varied ocular problems is awkward, as eyelid swelling
makes topical therapy difficult and pain may be incapacitating. Ideally it
should be started wit hin 72 h of onset.

4 Start aciclovir 800 mg orally five times daily with 3% aciclovir ophthalmic
ointment, or famciclovir 250 mg orally t.d.s. to decrease pain, corneal
damage and uveitis.

5 Refer the patient to the ophthalmology team for inpatient care.

PAINFUL, RED EYE

There are five important causes to consider:

● Acute conjunctivitis
● Acute keratitis
● Acute iritis
● Acute episcleritis and scleritis
● Acute glaucoma.

Acute conjunctivitis

DIAGNOSIS

1 The causes are:
(i) Allergic or irritative, e.g. from dry eyes.
(ii) Viral, particularly adenovirus or enterovirus.
(iii) Common bacterial, e.g. staphylococci, streptococci or
Haemophilus.
(iv) Uncommon bacterial, e.g. gonococcal or chlamydial.

2 There is generalized conjunctival injection, with gritty discomfort, mild
photophobia and variable discharge. Vision should be normal.

MANAGEMENT

1 Advise the patient to clean away the discharge with moist cotton-wool balls,
and avoid irritating cosmetics and eye lotions.

2 Allergic conjunctivitis responds to non-steroidal anti-inf lammatory drugs
(NSAIDs), sodium cromoglycate (cromoglicate), or steroid eye drops, but the
latter should only be prescribed by an opht ha lmologist.
(i) Initially prevent secondary bacterial infection with antibiotic
drops and refer the patient to the ophthalmology clinic.