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Posted 09/02/2018 17:58:32

This blog looks at some of the causes of red eyes, particularly the more serious types and looks at the speed and need for treatment. It is not meant to be all inclusive.
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Red eyes or red eye-do I need to worry ?
The short answer is a red eye can be serious and unless there is some obvious benign cause like shampoo or hay fever I prefer to see patients within twenty four hours if there is no pain and the same day if there is pain.

The odd thing about eyes is that problems are often either emergencies and require urgent treatment or benign such as cataract and my be treated at leisure.

The list of possible causes of a red eye is long but here are some points for consideration.
History- is there an obvious cause such as abrasion from a twig or following hammering or quite commonly a babies finger nail in your eye ?

Is it one eye or two ? Two red eyes are often benign like conjunctivitis, allergy or dry eyes. Is the vision blurred as well, if it is it increases the urgency.

One red eye by contrast is often more serious, particularly if accompanied by pain and need seeing for assessment on an urgent basis, particularly if the pain is severe. Particular nasties to consider are

Corneal ulcer, usually causes a red painful eye. These may be viral, bacterial or fungal and need to be seen and treated at an eye hospital as a matter of urgency as the can blind if left. Provisional diagnosis is by corneal microscope .

Acute glaucoma, this is less common , I have only seen three in thirty years of practice. Here the pressure in the eye is way too high, pupil is fixed, eye is red vision poor and pain may be extreme.
This a can blind in hours if untreated. Diagnosis is by corneal microscope and tonometer- a device for measuring eye pressure.

Iritis, this is relatively common and is the result of inflammation of the tissue inside the eye, usually the iris and causes a red painful eye with blurred vision. This often goes by itself but need dilating drops to prevent the iris from sticking to the lens in the eye and may need steroid drops and or injection. Diagnosis is by corneal microscope, looking particularly for cells in the anterior chamber of the eye. Iritis often returns so patients often recognise the signs and seek treatment.

Penetrating eye injuries, may be from hammering masonry nails without safety goggles . Flying fragments can some time pass right through an eye. The best route as with the other nasties above is via A&E at an eye hospital.