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Iritis is inflammation of the iris that can be associated with other inflammatory disorders, e.g. ankylosing spondylitis, or occur as an isolated idiopathic condition.Iritis is also known as anterior uveitis; posterior uveitis is inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema.4. Scleritis is inflammation of the sclera. This is a very rare presentation, usually associated with autoimmune disease, e.g. rheumatoid arthritis.5. Penetrating eye injury or embedded foreign body; red eye is not always a feature6. Acid or alkali burn to the eyeThe patient history will usually identify a penetrating eye injury or chemical burn to the eye, but further assessment may be necessary in order to determine whether a patient presenting with red eye has any “red flag” features which suggests one of these sight-threatening conditions.Occupational history, e.g. outdoor worker, metal fabricator, childcare workerThe presence of any other symptoms, e.g. recent or concurrent upper respiratory tract infection, skin and mucosal lesions, muscular or skeletal pain, joint stiffness, genitourinary discharge, dysuria; these symptoms may indicate an underlying systemic cause of the red eyeExamination and assessmentThe extent of the eye examination should be based on the patient’s history and suspected cause of the red eye. Examination should be very brief in the case of a chemical injury to the eye as irrigation of the eye is the priority and should begin immediately. A topical anaesthetic, e.g. tetracaine, may be used if the examination is uncomfortable for the patient.1Measure visual acuity of both eyes using a Snellen chart. Ensure good lighting, and use a pinhole to exclude any residual refractive error. The patient should wear their corrective distance glasses, if they have them. If the patient has discharge in their eye(s), ask them to blink several times before checking vision, to ensure that an accurate assessment is made.Examine the eye:Assess the extent, location and nature of the redness of the eye(s)– The pattern of injection (redness) should also be noted: conjunctival injection (Figure 1) appears as a diffuse area of dilated blood vessels, injection in a ring-like pattern around the cornea is termed ciliary injection (Figure 2) and usually indicates intraocular inflammationLook for a foreign body or lesion on the eye, including under the eyelids; eyelid eversion may be required, but do not attempt this if the mechanism of injury and/or clinical signs suggest the possibility of a penetrating eye injuryExamine the eyelids– Is lid position normal? Is lid closure complete? Any evidence of blepharitis?
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