A red eye is a common reason to visit a primary care provider. Red eyes can range from self-limiting to vision-threatening, and it is imperative to be able to distinguish the characteristics of the most serious causes and to manage these conditions appropriately. This article reviews the differential diagnosis and management of five etiologies of red eyes that likely warrant referral.
Uveitis
Uveitis is inflammation within the uveal tract.
Anterior uveitis often presents with a unilateral red eye and a nonspecific complaint of dull ocular pain. Photophobia is common and can help differentiate uveitis from conjunctivitis. The hallmark finding in uveitis is the presence of white blood cells in the anterior chamber—a finding only visible with use of a slit lamp.
Elements of the patient's history may increase the likelihood of uveitis, including HLA-B27-related diseases, such as ankylosing spondylitis and inflammatory bowel disease, but most cases of anterior uveitis are idiopathic. Bilateral uveitis is highly suspicious for a systemic association, such as sarcoid, syphilis, or tuberculosis, and appropriate bloodwork should be ordered.
A dilated fundus exam is necessary in these patients to rule out posterior segment complications.
If left untreated, uveitis can lead to the formation of synechiae (Figure 1), macular edema, cataracts, and an aggressive form of glaucoma.
Figure 1. Posterior synechiae in a patient with anterior uveitis. Image courtesy of Pierce Kenworthy, OD.
Key symptoms. Photophobia.
Examination. Slit lamp evaluation of the anterior chamber with high magnification in very dim illumination and dilated fundus examination.
Management. Refer to an ophthalmologist or optometrist for management with immunosuppressants.
Cite this: Seeing Red: Five Eye Diagnoses Not to Miss - Medscape - Apr 23, 2018.
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