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OPTICAL INFECTIONS
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Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment.Is it conjunctivitis or is it something more serious?The most likely cause of a red eye in patients who present to general practice is conjunctivitis. However, red eye can also be a feature of a more serious eye condition, in which a delay in treatment due to a missed diagnosis can result in permanent visual loss. In addition, the inappropriate use of antibacterial topical eye preparations contributes to antimicrobial resistance.Most general practice clinics will not have access to specialised equipment for eye examination, e.g. a slit lamp and tonometer for measuring intraocular pressure, and some conditions can only be diagnosed using these tools. Therefore primary care management relies on noting key features such as pain, photophobia and reduced visual acuity, to identify which patients require referral for ophthalmological assessment. In general, a patient with a unilateral presentation of a red eye suggests a more serious cause than a bilateral presentation.There are six serious causes of red eye, which can result in visual loss:11. Acute angle closure glaucoma occurs when there is an obstruction to drainage of aqueous humour from the eye, rapidly causing increased intraocular pressure. This condition typically occurs in middle-aged to elderly, hypermetropic (long-sighted) females,2 however, it can occur in any patient.2. Keratitis is inflammation of the corneal epithelium caused by infection (e.g. herpes simplex virus, bacteria, fungi or protozoa) or auto-immune processes (e.g. collagen vascular diseases).3 Microbial keratitis is usually precipitated by a change to normal corneal epithelial health, caused by a factor such as trauma, contact lens use or tear film and/or eyelid pathology.3.
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