October 24, 2010

Q&A: Evaluation of the Painful Eye

Red eye" is a common presenting complaint in ambulatory practice. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated by the primary care clinician. There are little epidemiologic data on the red eye, and there are no evidence-based data to guide us in the management of these patients. Conjunctivitis (allergic or viral) is probably the most common cause of red eye in the community setting, but a number of more serious conditions can also occur.

This article is for Medical Students & Professionals
This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Anatomy Of The Eye article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.
In this article:
Serious vs less-serious eye conditions
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Serious vs less-serious eye conditions

There must be an approach for distinguishing patients with red eye who must be referred to an ophthalmologist, such as those with angle-closure glaucoma, from patients who can be managed by the primary care clinician, such as those with allergic conjunctivitis.

Patient history, measurement of visual acuity, and findings on penlight examination are important features in determining the cause and management of red eye. The history and ocular examination provide guidance in the decision about whether to refer the patient for ophthalmologic evaluation. Performance of the slit lamp examination may be necessary.

MCQ: clinical scenario

A 30 year old man presents with bilateral eye pain. He is thought to have conjunctivitis and is given antibiotic eye drops but the pain persists and recurs with blurriness, redness and photophobia. A slit lamp examination reveals tiny floating particles in the anterior chamber between the cornea iris and tiny dots on the back layer of the cornea. The pupil appeared stuck to the lens behind.

a) Ankylosing spondylitis
b) Reactive arthritis
c) Psoriatic arthropathy
d) Pyrophosphate arthropathy
e) Haemochromatosis

MCQ questions & answers on medicalnotes.info

MCQ: answer

The correct answer is A

MCQ: explanation

The eye is made of 3 coats. The middle coat is called the uvea. It consists of the iris in the front, the ciliary body a little further back (pars plicata + pars plana,) and the choroid at the back behind the retina. Uveitis is a broad term referring to inflammation of any of the components of the uvea.

THE SLIT LAMP MICROSCOPE: (1) In the anterior chamber between the cornea and iris - CELLS which are tiny floating particles, and FLARE which is a visible beam of light. (2) On the back layer of the cornea, tiny dots called Keratic Precipitates (KP's) which are adherent inflammatory cells. (3) The pupil can get stuck to the lens behind causing adhesions called POSTERIOR SYNECHIAE.

This patient's recurrent anterior uveitis represents an HLA-B27-associated primary spondyloarthropathy. His systemic signs and symptoms could be due to HLA-B27-associated, non-specific disease processes (undifferentiated or unclassifiable spondyloarthropathy). Or, they may not be related to the HLA-B27 antigen at all. There is a strong relationship between acute anterior uveitis and HLA-B27. Studies show that more than 50 percent of cases of acute anterior uveitis are associated with the HLA-B27 antigen.

Reference(s)
1). UpToDate: Overview of the red eye. Accessed ..20. Available online: https://www.uptodate.com/contents/overview-of-the-red-eye

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