12.2.15 VA Ambulatory Report Pearls – Anterior Chamber Uveitis + Acute Eye Pain

Anatomy of the Eye

Eye Anatomy

Differential of the Red Eye + Pain

We discussed the differential and triage of eye pain and that an anatomic approach can be helpful in building your differential and pursuing additional workup as well as triaging to our ophthalmology colleagues. Here is a table that I adapted from Yale Ambulatory Curriculum on “The Red Eye” that can be helpful.

Anatomic Component Pathology Initial Referral to Ophthalmology Pain/irritation
Eyelid Stye No Yes (typically localized to stye)
Chalazion No Yes (typically eyelid)
Blepharitis No Yes (can be localized to eyelash or described as irritation)
Conjunctiva Conjunctivitis, Bacterial No Yes
Conjunctivitis, Viral No Yes
Conjunctivitis, Allergic No Yes
Pterygium No; unless causing visual impairment Typically painless
Dry eye (“sicca”) syndrome No Typically described as irritation > pain
Subconjunctiva Subconjunctival hemorrhage No Typically painless
Cornea Abrasion Possibly Yes
Contact lens damage Possibly Yes
Foreign body Possibly Yes
Infectious keratitis, bacterial Yes, emergent Yes
Infectious keratitis, viral Yes, urgent Yes
Anterior chamber Uveitis Yes, emergent Typically yes
Iris Iritis Yes, urgent Yes
Iris/Lens Angle closure glaucoma Yes, emergent Yes
Sclera Scleritis Yes, urgent Yes
Vasculature Retinal vein occlusion Yes, emergent Can be painful 2/2 increased intraocular pressure though rare to have pain
Retinal artery occlusion Yes, urgent Typically no
  • Anterior Uveitis

Anterior uveitis can be related to a variety of underlying systemic conditions. Here are some of the top categories to consider:

  • Autoimmune disorders – sarcoidosis, ankylosing spondylitis, Behcet’s disease
  • Inflammatory disorders – Crohn’s disease, ulcerative colitis
  • Infection – HSV, syphilis, tuberculosis, vector-borne disease (Lyme disease, West Nile virus)
  • Malignancy – lymphoma
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