Ophthalmology – Red Eye: By Stephanie Baxter M.D.

A red eye can be caused from pathology in
one of four places: The conjunctiva
The cornea The extra-ocular structures; or
The intraocular structures A worrisome sign that a red eye is caused
by a serious intraocular cause is the presence of peri-limbal injection – otherwise known
as a ciliary flush. This is a clinical sign that you cannot afford to miss. Limbal flush with associated vision loss can
be seen with a few conditions where emergent referral is necessary and minutes or hours
can make the difference between visual preservation and blindness. Two of these conditions are
angle closure glaucoma and endophthalmitis. Patients presenting with angle closure glaucoma
quickly develop a red eye and frequently have nausea and vomiting. Their eye pressure can
be very high because the iris completely closes the eye’s drainage system. Eyes have peri-limbal
injection, cloudy cornea, and a mid-dilated pupil. Emergent referral is necessary as laser
surgery to create a hole in the peripheral iris can quickly lower the eye pressure and
prevent permanent blindness. The second condition that can cause a painful
red eye that needs emergent referral is endophthalmitis – which is an inflammation of all chambers
of the eye. Here, vision is often finger counting or worse and most have developed a bacterial
infection after intraocular surgery within the preceding 1-7 days. Eyes may have significant hypopyon or vitreous
inflammation. Because this aggressive inflammation can quickly destroy the eye, the patient should
be emergently referred for intravitreal injection of antibiotics or vitrectomy surgery.


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