The ocular examination begins with the eyelids and lashes. One should look for evidence of lid margin erythema, telangiectasia, thickening, scaling, and/or lash collars. The sclera and conjunctiva are then examined for the presence of redness (injection). Certain characteristics that can assist in pinpointing the diagnosis are characterized here.
Subconjunctival hemorrhages spontaneously occur after coughing, sneezing, or straining as a result of spontaneous rupture of a conjunctival or episcleral capillary. A painless focal area of solid redness surrounded by normal white sclera on all sides characterizes it. It commonly resolves without any intervention.
Scleritis tends to develop progressively over the course of several days and is associated with several systemic autoimmune disorders, particularly rheumatoid arthritis and Wegener's granulomatosis. Major signs and symptoms of scleritis include moderate to severe ocular pain, tender and inflamed conjunctiva, and thickened and injected sclera.
Uveitis is a significant ocular condition that requires immediate ophthalmological evaluation. One of the signs of this disorder is circumcorneal injection (ciliary flush), which is often described as a ring of redness that completely encircles the edge (limbus) of the cornea. Pupil size is also extremely helpful in formulation of the diagnosis of a red eye. In iritis, the affected pupil is usually smaller and sluggish. In acute-angle closure glaucoma attacks, the pupil is usually mid-dilated and sluggish or fixed.
The cornea is examined next. A corneal opacity, seen as a whitish infiltrate, is often a sign of a bacterial corneal ulcer. Corneal ulcer is an ophthalmological emergency. Fluorescein stains help to differentiate among punctate epithelial defects (diffuse punctate staining), herpes simplex keratitis (dendrite-like shaped staining), and abrasion (large solid area of staining seen after trauma).
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