Eye Redness with Pain: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Eyes and conjunctiva (ocular conjunctiva) [foreign body exposure?]
  • Ophthalmological examination
    • Slit lamp: assessment of conjunctiva, cornea (cornea), sclera (sclera; outer covering of the eyeball), lens, iris (iris), and corpus ciliare (ciliary or ray body; a section of the middle eye skin) and corpus vitreum (vitreous body); visual acuity determination (determination of visual acuity) and, if necessary, refraction determination (refractive value of optical correction).
    • Examination of the eye position and pupillary reaction.
    • Eye pressure, palpatory [eye pressure palpatory high: suspected acute glaucoma; emergency]

If slit lamp is not available

If a slit lamp is not available, an examination should be performed for the presence of anisocoria (side-to-side difference in pupil diameter) and for pain on pupillary contraction (contraction of the pupil/opening through which light can pass into the interior of the eye).

One study showed that anisocoria with a pupil difference of more than 1 mm is significant for the recognition of serious causes of red eye: the likelihood ratio (LR) was 6.5, i.e. patients with red eye due to a serious cause showed this symptom 6.5 times more frequently than patients with a harmless cause. Pain during pupil contraction – directly or consensually to light (light reaction of the pupil (pupil constriction even in the unexposed eye); finger-to-nose convergence test (when looking at the finger moving toward the nose, the eye muscles direct the visual axes of both eyes inward into the so-called convergence) – was associated with LR values of 8.3-28.8. With painless constriction of the pupils, the quotient dropped to as low as 0.3.

If conjunctivitis (inflammation of the conjunctiva) was suspected: if there was complete reddening of the tarsal (“belonging to the cartilage of the eyelid“) conjunctiva with disappearance of the vascular drawing, a bacterial cause was present (LR 4.6). The same was true for noted purulent secretions (3.9) and bilateral morning conglutination of the eyes (3.6). A bacterial cause was less likely if the red eye could not be seen from a distance of six meters (0.2) or if one eye did not show morning adhesions (0.3).