Evaluation Symptoms and Signs

Patients who complain of a red eye generally can tell the physician whether the eye irritation occurred rapidly or progressed slowly. This information is important because a small foreign body, such as a grain of sand, lodged in the conjunctival sac produces a rapid hyperemia, whereas a viral or allergic conjunctivitis, or an iritis, generally produces a slowly progressive redness. Ocular pain is an important symptom (Table 41-1). Irritation of the superficial layer of the cornea, as caused by a small foreign body, is accompanied by a superficial "grain of sand" sensation in the eye. Deeper inflammatory processes, such as iritis or iri-docyclitis, or a deeper penetrating foreign body in the cornea, present with more severe, dull pain in the eye.

Abnormal light sensitivity (photophobia) is a third danger symptom that must be elicited by the family physician. Photophobia occurs with corneal inflammation, iritis, and angle-closure glaucoma. Patients who have conjunctivitis usually do not have abnormal light sensitivity (Box 41-1).

Patients who complain of a red eye often complain of discharge from the eye (Table 41-2). If they do not complain of eye discharge spontaneously, the physician must inquire about the presence, type, and quantity of discharge. Purulent (creamy white or yellow watery) discharge suggests a bacterial cause. A serous or clear discharge suggests a viral cause. Scanty, white, stringy exudate occurs most often with allergic conjunctivitis. The absence of discharge indicates an unusual cause for red eye, such as iridocyclitis, ultraviolet (UV) light keratitis (snow blindness), or acute angle-closure glaucoma. A complaint of diminished visual acuity is a serious danger sign and must be elicited in the history.

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