Pediatric emergency medicine trisk 0583 0583
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FIGURE 27.5 Anisocoria with traumatic uveitis.
Episcleritis and scleritis may also cause a painful red eye. Episcleritis is more
commonly seen in young adults while scleritis occurs more commonly in adult
females. Although episcleritis is usually an isolated, self-limited ocular
abnormality, scleritis is often associated with an underlying systemic disease,
particularly the collagen vascular disorders. Both entities may present with focal
or diffuse inflammation. A focal nodular or diffuse elevation may be seen. The
eye is often tender, especially with scleritis, where the inflamed area may have a
bluish hue. There may also be pain on attempted movement of the eye. Scleritis is
much less common than conjunctivitis and episcleritis. Diagnosis and treatment
require slit-lamp examination and ophthalmologic consultation.
Herpetic corneal infection is another cause of painful red eye. Herpes simplex
virus infection can present as vesicular rash involving the eyelids or as a dendritic
keratitis involving the cornea causing eye pain, tearing, photophobia, and
decreased vision. Often there is a history of previous episodes. Fluorescein
staining of the cornea may reveal a linear branching pattern in dendritic keratitis (
Fig. 123.9 ) or amoeba-shaped corneal ulcer with dendritic edge in a geographic
ulcer. Herpetic corneal ulcers require urgent treatment and ophthalmology referral
as soon as possible to prevent corneal scarring and vision loss. Herpes zoster
ophthalmicus presents with a vesicular dermatomal skin rash along the first
division of the 5th cranial nerve. The rash usually does not cross the midline.
Corneal involvement may follow skin rash by several days to months.
If eye pain is relieved by a drop of topical anesthetic (see Chapter 114 Ocular
Trauma ), the patient most likely has a surface problem such as foreign body or
corneal abrasion. If the pain is not relieved and periorbital swelling and fever are
