Pediatric emergency medicine trisk 0581 0581
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Red eye
Corneal ulcer
Corneal abrasion
Conjunctivitis
Poor fit
Yes
i
i
i
No
I
No
Contact lens wearer ?
^(consult)
Known systemic disease ?
Fluorescein staining?
Yes
Corneal abrasion
^
Foreign body
Chemical
Allergic
conjunctivitis
Yes
No
Yes
I
Yes
Yes
Itching ?
No
Blepharitis
Yes
Iritis
Conjunctivitis
Vitritis
( Tables 27.1 and 27.3)
Yes
Lid swelling?
Fever ?
*
*
Periorbital cellulitis
Orbital cellulitis
EKC
Endophthalmitis
No
V
No
Phlyctenule
Episcleritis
*
No
Pain
Hyphema
Glaucoma
Foreign body
Subconjunctival
No
hemorrhage
-*
*
w
Trauma?
Iritis
>Chemical
Chemosis?
Yes
i
\
t
Iritis
Episcleritis/scleritis
Herpes
Foreign body
Abrasion
Dry eye
<
Focal injection?
No
i r
Phlyctenule
Trichiasis
Glaucoma (rare)
Endophthalmitis
Infectious conjunctivitis
Dry eye syndrome
Systemic disease
FIGURE 27.2 Diagnostic evaluation of red eye. EKC, epidemic keratoconjunctivitis.
In the absence of cornea/conjunctiva abrasion, foreign body, and trichiasis, the
painful red eye caused by trauma may have iritis. This may not present for up to
72 hours after the trauma. Photophobia and vision blurring may also occur. The
ipsilateral pupil may be smaller, larger, misshapen, or react poorly, from trauma to
pupillary sphincter muscle ( Fig 27.5 ). Occasionally, one will see a cloudy
inferior cornea caused by the deposition of inflammatory cells and debris on the
inner surface (keratoprecipitates). Hypopyon, layered pus or white cells in
anterior chamber, may be seen in extremely severe iritis. Iritis may also occur in
association with systemic disease or as an isolated idiopathic ocular finding. Iritis
(anterior uveitis) associated with juvenile idiopathic arthritis is characterized by
the distinct absence of signs or symptoms until the disease has progressed
significantly, thus underscoring the need for routine screening of these patients.
Other systemic causes of iritis include sarcoidosis, tuberculosis, inflammatory
bowel disease, collagen vascular disorders, systemic lupus erythematosus,
granulomatosis with polyangiitis (formerly referred to as Wegener), tubular
interstitial nephritis uveitis syndrome, and leukemia. Traumatic iritis and
