Painful Red Eye
Authors:
Robin R. Hemphill, MD, CPT, USAF
Erin A. Doe,MD, MAJ, USA
Affiliations:
Department of Emergency Medicine, Brooke Army Medical Center
Joint Military Medical Centers Emergency Medicine Residency
San Antonio, Texas (RRH)
Department of Ophthalmology
Brooke Army Medical Center
Fort Sam Houston, Texas (EAD)
Chief complaint:
A painful red eye for one week
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History of present illness:
A 65 year old male presents
to the emergency department with one week of pain in his right
eye. The patient has had severely decreased vision in that eye
for several years from macular degeneration and did not report
any further decrease in vision. The pain started one week ago
and slowly worsened over the last few days. It radiates to the
cheek and temporal area. The patient denies discharge from the
eye and there is no history of trauma. He denied nausea or vomiting.
His past medical history included diabetes, hypertension,
and coronary artery disease. The patient had a cardiac catheterization
done ten days ago which revealed two vessel coronary artery disease.
The patient denied any new symptoms of shortness of breath or
chest pain. The patient also had a remote history of lung cancer.
His surgical history was remarkable for left upper lobectomy,
right below the knee amputation four years ago, and cataract surgery
in 1989 (OD) and 1991 (OS), with an anterior chamber lens implantation
OD. His medications include glipizide, isosorbide, metoprolol,
aspirin, and furosemide. He denied tobacco or ethanol use and
had no allergies.
Physical Examination:
The patient is a well developed male in moderate distress
from eye pain. The exam shows normal vital signs and the right
eye as shown in the picture (fig 1). The patient was able to
perceive hand motion at one foot in the right eye, and is 20/30
in the unaffected eye. There was no bony tenderness around the
orbit and the patient's ocular motility was intact. Both pupils
had surgical changes and were irregular in shape as noted in the
photograph; and, both pupils react minimally to light. Intraocular
pressures were 33 mmHg OD and 9 mmHg OS by Mentor Tono-pen. The
slit lamp exam revealed normal lashes and eyelids, an injected
conjunctiva without ciliary flush, and a clear cornea without
fluorescein uptake. There was no evidence of foreign body or
of an obvious scleral rupture. The anterior chamber was remarkable
for an anterior chamber lens, new vessels growing on the iris
and free floating red blood cells. Funduscopic exam of the affected
eye shows no gross posterior segment hemorrhage, but few retinal
details can be seen secondary to the anterior chamber hemorrhage.
The uninjured eye (OS) has a normal exam except for an irregular
pupil and intraocular lens.
The patient course, diagnosis and discussion
Disclaimer: This article represents the views of the authors
and is not to be interpreted as official, or representing the
United States Army, Air Force, or the Department of Defense.
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