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Emergencies – refer immediately to A&E or emergency eye clinic
Frequent presentation in general practice. Conjuctiva is red and inflamed, eyes itch, burn and lacrimate, possible photophobia. Cause may be viral bacterial or allergic. Often bilateral; if unilateral consider other causes
Allergic Both eyes affected. Caused by contact with an allergen, eg, animal dander. May be seasonal, as in hay fever (pollen allergy)
Infective (viral or bacterial) Usually starts in one eye and then spreads to both.
Ophthalmia neonatorum Purulent discharge from eyes in newborn. Infection may be acquired via maternal genital tract or cross-infection. Swabs necessary for bacterial and viral culture, and close monitoring. Treatment depends on cause.
Do not try to remove. If any object has penetrated the eye, cover eye with a sterile pad and refer patient immediately to eye casualty. Advise patient to keep both eyes still.
A group of eye diseases in which increased intraocular pressure (raised pressure in the eye) develops as a result of blockage of the drainage system. More likely in people with family history of glaucoma, myopia, over 40 years of age with raised blood pressure, diabetes, almond shaped eyes eg of Chinese or Japanese origin, or of Afro-Caribbean origin.
Chronic (open-angle) The most common type of glaucoma, and often bilateral. Pressure in the eye increases slowly, generally with no pain or discomfort. Without treatment the result is gradual, irrecoverable loss of peripheral vision. Patients prescribed eye drops to control intraocular pressure must use them as directed, to avoid visual loss. They may need support to do this.
Acute (closed-angle) Occurs when the pressure in the eye rises suddenly. Symptoms may include acute, intense periocular pain with nausea, vomiting, acute loss or reduction of vision, and at times a red eye. Refer immediately.
Secondary Occurs when the aqueous outflow becomes blocked (and pressure increases) as a result of another eye condition.
Other common conditions
Congenital Often associated with underdevelopment of the chamber of the eye.
Red eye A common presentation. Most causes are relatively minor and easily treated, but a few are dangerous to vision and require urgent specialist treatment. Warning signs are associated pain and impaired visual acuity.
Macular degeneration, age-related (AMD)
A painless eye condition that generally leads to the gradual loss of central vision but can sometimes cause a rapid reduction in vision. There are two main types: Dry AMD which accounts for 9 out of 10 cases, with visual loss occurring gradually over many years, and Wet AMD develops when abnormal blood vessels develop underneath the macula. Without treatment, vision can deteriorate within days. Rarely, macular degeneration can affect younger people (juvenile macular degeneration) when it is almost always caused by an inherited genetic disorder.
NICE Pathways Eye Conditions https://pathways.nice.org.uk/pathways/eye-conditions
ABC of Eyes, 4th edn. Khaw PT, Shah P, Elkington AR. Wiley-Blackwell, 2004. Available in paperback at https://www.amazon.co.uk/ABC-Eyes-Peng-T-Khaw/dp/0727916599
Royal National Institute for the Blind (RNIB) Information on eye health and conditions www.rnib.org.uk
International Glaucoma Association (UK) www.glaucoma-association.com
NICE NG8. Glaucoma: diagnosis and management; 2017 https://www.nice.org.uk/guidance/NG81
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