Деякі причини почервоніння ока
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Conjunctival disorders and episcleritis* | ||
Bilateral, prominent itching, possibly conjunctival bulging (chemosis) Known allergies or other features of allergies (eg, seasonal recurrences, rhinorrhea) Sometimes use of topical ophthalmic medications, from the active ingredient (particularly neomycin and brimonidine) or preservatives in the formulation | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ | |
Chemical (irritant) conjunctivitis | Exposure to potential irritants (eg, dust, smoke, ammonia, chlorine, phosgene) | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ |
Unilateral focal redness, mild irritation, minimal lacrimation | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ | |
Infectious conjunctivitis | Scratchy sensation, photosensitivity Sometimes mucopurulent discharge, eyelid edema, or papillae on tarsal conjunctiva | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ Ensure fastidious hand hygiene and cleaning of examination equipment to prevent cross-contamination |
Unilateral, asymptomatic focal red patch or confluent redness Possibly prior trauma or Valsalva maneuver Often history of use of anticoagulants or antiplatelet drugs (eg, aspirin, NSAIDs, warfarin) | History and physical examination‡ | |
Intense itching, stringy discharge Usually preadolescent or adolescent males Other atopic disorders Waxing in spring and waning in winter | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ | |
Corneal disorders† | ||
Contact lens keratitis | Prolonged wearing of contact lenses, lacrimation, corneal edema | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ |
Onset after injury (but this history may be inapparent in infants and young children) Foreign body sensation Lesion on fluorescein staining | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ | |
Often grayish opacity on the cornea, followed by a visible crater Possibly a history of sleeping with contact lenses | Ophthalmic evaluation‡ Culture of ulcer (scrapings done by an ophthalmologist) | |
Epidemic keratoconjunctivitis (adenoviral conjunctivitis with keratitis), if moderate or severe | Copious watery discharge Often eyelid edema, preauricular lymphadenopathy, chemosis (bulging of the conjunctiva) Occasionally severe temporary loss of vision Punctate pattern on fluorescein staining | History and physical examination, including ophthalmic examination if the diagnosis is unclear or vision loss present‡ |
Onset after conjunctivitis, blisters on eyelid Classic dendritic corneal lesion on fluorescein staining Unilateral | Ophthalmic evaluation‡ Viral culture if diagnosis is unclear | |
Unilateral vesicles and crusts on an erythematous base in a V1 distribution, sometimes affecting the tip of the nose Eyelid edema Red eye May be associated with uveitis Possibly severe pain | Ophthalmic evaluation‡ Viral culture if diagnosis is unclear | |
Other disorders | ||
Severe ocular ache Headache, nausea, vomiting, halos around lights Hazy cornea (caused by edema), marked conjunctival erythema Decreased visual acuity Intraocular pressure usually > 40 mm Hg | Tonometry and gonioscopy by ophthalmologist | |
Ocular ache, photophobia Ciliary flush (redness most concentrated and often confluent around the cornea) Often a risk factor (eg, autoimmune disorder, blunt trauma within previous few days) Possibly decreased visual acuity or pus in anterior chamber (hypopyon) Cells and flare on slit-lamp examination | Ophthalmic evaluation‡ | |
Severe pain, often described as boring Photophobia, lacrimation Red or violaceous patches under bulbar conjunctiva Scleral edema Tenderness of globe when palpated Often history of autoimmune disorder | Ophthalmic evaluation‡ Further testing by or in conjunction with an ophthalmologist | |
* Unless otherwise described, usually characterized by itching or scratchy sensation, lacrimation, diffuse redness, and often photosensitivity, but no change in vision and absence of pain and true photophobia. | ||
† Unless otherwise described, usually characterized by lacrimation, pain, and true photophobia. Vision affected if the lesion involves the visual axis. | ||
‡ Ophthalmic evaluation should include slit-lamp examination with fluorescein staining. | ||
NSAIDs = nonsteroidal anti-inflammatory drugs; V1= ophthalmic division of the trigeminal nerve. | ||