Red Eye

An photo of a red eyeThere are many possible causes for a red eye, some are innocuous, some are serious.

We often receive calls from patients enquiring whether they should come to us or go to their GP to have their eye(s) looked at- sometimes they want to know why. In Ireland, because Optometrists are not allowed to diagnose or treat any eye problems, the first port of call should be their GP, but given that most GPs do not have the equipment optometrists would have to examine the front of the eye, there are arguments that the Optometrist should be the first point of call. Though we cannot treat, we can at least refer to the GP with a letter “suggesting” what the diagnosis might be.

There are various possible causes for a red eye-

Innocuous causes;

  • Subconjuntival haemorrhage- a small capillary burst under the conjunctiva, the clear tissue over the white of the eye – can look spectacular, but usually is completely harmless.
  • Conjuntivitis- can be allergic, bacterial or viral. Usually will be self limiting, even without treatment, but could be cleared up quicker with the correct treatment.
  • Episcleritis- a self limiting inflammation of the front of the eye, it may feel completely normal, or a little uncomfortable.
  • Foreign Body- most would be aware of a sensation of having something in the eye, and a definite time it started. While a foreign body could be innocuous, if it started in association with any activities such as hammering, chiseling or power tool use, the risk of a penetrating eye injury must be considered.
More serious causes;
  • Anterior Uveitis, also called Iritis is a painful inflammation of the iris. Usually causes severe light sensitivity, it is as an ocular emergency.
  • Acute Glaucoma -Extremely painful red eye with a  non reactive often oval shaped pupil. Another emergency.
  • Keratitis- inflammation of the cornea, again can be an emergency depending on the type. Causes can be toxic, viral, bacterial.
  • Scleritis- a painful inflammation of the front of the eye. Can sometimes be mistaken for the less serious episcleritis.

It is important, that if you have been using any drops or creams from the doctor or pharmacist, that you bring them in with you- or at least tell us the names of them. Most people do not recall the names of the eye medicines they are using, but when someone complains that their eyes are getting worse, or not getting better, we need to know what they have been using- occasionally the drops can make the problem appear to deteriorate, if there is sensitivity to the drug or the preservatives.

Questions we will ask among others are;

  • is there any pain? Conjunctivitis is uncomfortable, gritty maybe, but not painful.
  • is there any discharge? yellow green discharge is suggestive of bacterial infection.
  • is there any light sensitivity? Called photophobia it is suggestive that there inflammation inside the eye, in the iris.
  • is the vision affected?
  • How long has it been like that?
  • Anyone else, friends or family, work colleagues complaining of similar symptoms? Some causes of Red eye are very infectious.

By examining the inside of the eye, the front of the eye, externally and internally using a Slit Lamp Biomicroscope, usually using dyes to highlight any problems, by looking at where the eye is maximally red, is it both eyes or one, and by measuring the pressure inside the eye we can be sure to find the cause of the problem.

By contrast, and with no disrespect, many GPs will prescribe antibiotic eye drops for a week as standard treatment for red eye- in many cases the red eye will be gone within the week, even where there was no infection. Unfortunately there are cases where treatment with antibiotic drops can delay urgently required treatment, so we would suggest that the Optometrist should be the first port of call for any eye related problem – We have the equipment to examine the eyes in the required detail to arrive at a conclusion. Even though we are unable to treat in Ireland, we can refer, sometimes directly to casualty if necessary.

Unfortunately though Medical card holders can be seen free at the GP, as and when necessary, Optometrists are severely limited in only being able to see Medical Card holders when authorised for an eye examination. Earlier appointments can be requested, but when there is a nine week waiting list to have a medical card authorised, if you wish to be seen sooner, unfortunately you will need to be seen privately.



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