Pictorial case study: Painful right eye

A 35-year-old foreman presented with a painful right eye. He admitted the eye was sensitive to light but denied any discharge.

Anterior uveitis
Anterior uveitis

 

He always wore goggles at work to protect his eyes from dust and took regular painkillers for back pain. On examination he was in some discomfort. His right pupil was midsized and irregular in shape. The eye was obviously red and the acuity was reduced. There was no evidence of conjunctivitis.

Diagnosis and management

This patient has anterior uveitis. In severe cases, a hypopyon can be seen in the base of the anterior chamber. Further musculoskeletal assessment may reveal a loss of lumbar lordosis and an exaggerated thoracic kyphosis consistent with ankylosing spondylitis. Fifty per cent of cases may be associated with other medical conditions.

Treatment includes mydriatics to reduce muscular spasm and to prevent the iris adhering to the ocular lens. Topical anaesthetic may be used short term. Steroid drops are used to stop inflammation. Steroid use should be authorised by a specialist.

Possible different diagnoses

  • Trauma.
  • Glaucoma.
  • Infection.


Differential diagnosis

Glaucoma

  • Severe pain.
  • Usually older age groups.
  • Halos around light.
  • Vomiting.
  • Cornea hazy.
  • Unreactive pupil.

- Contributed by Dr Raj Thakkar, a GP in Wooburn Green, Buckinghamshire

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