basic exam elements that can be carried out by a non ophthalmologist in a patient presenting with a red eye?
Important information can be elicited from a focused ocular exam even without tools such as a slit-lamp or indirect ophthalmoscope. The following are basic clinical evaluations that can inform treatment and facilitate discussion with an ophthalmology consultant:
- • Visual acuity testing (reading small print at 12 inches).
- • Evaluation of external structures such as the lids and lashes (evaluating for lid swelling, blepharitis, entropion/extropion, overt proptosis, lacrimal gland enlargement).
- • Evaluation of palpebral and bulbar conjunctiva.
- • Evaluation for ciliary flush (erythema at the limbus area where the corneal dome meets the sclera).
- • Evaluation of pupillary size, shape, and response to light.
- • Gross examination of cornea for signs of corneal opacity.
- • Fundoscopic exam looking for obvious signs of retinal ischemia and/or retinal vessel abnormalities (exam may be limited due to pain or photophobia).
In a patient presenting with a red eye, certain findings by history and exam warrant immediate consultation with an ophthalmologist including extreme difficulty opening the eye (suggestive of corneal injury or keratitis), abnormal pupils (such as fixed, dilated pupils or synechiae), corneal opacities, or ciliary flush. Ciliary flush may represent significant pathology such as uveitis, keratitis, and/or acute angle closure glaucoma.
