examination

Fluorescein drops indicate the burnt areas.  Make sure there is no debris under the top eyelid (this is very common if plaster (from plastering a wall or ceiling for instance) enters the eye. Evert the lid: text  video   text

treatment

The initial irrigation:

• For strong chemicals, the irrigation should last at least 15 minutes.
• About 2 minutes for very weak diluted washing up liquid or small amounts of food chemicals such as chilli

After the irrigation, if the eye is painful and red, it is usually burnt and it is important to attend A & E as soon as possible. Further irrigation, a full assessment, antibiotic drops, lubricant drops, steroid drops, dilating pupil drops, and others are required. Fluorescein drops indicate the burnt areas photo. 
Weaker chemicals will not burn the eye, and if the eye is comfortable and white no hospital attendance needed.

listen carefully

Agendas, worries, concerns, expectations, ideas, what was the injury?

Could there be a foreign body on the surface  of the cornea, under the lid, or even penetrated eye?

good light

Look in a good light for redness and bruising and skin tumours..

test vision

Test with distances glasses on. If the sight is reduced, test with a pinhole occluder.  video   Text

fluorescein drops

These are extremely helpful for identifying surface injury. They do not sting and can be used in children. photo

evert the top lid

If grit, a dead insect, or plaster for example gets into the eye in can get lodged under the top eye lid. The lid must be 'everted' with (for example) a cotton bud. text  video

dilate the pupil

If there is a blunt injury, the pupil should be dilated with tropicamide 1% and phenylephrine 2.5% and the retina can be examined. This is not necessary for a 'foreign body' or corneal abrasion.  video and text

retinal examination

Use an ophthalmoscope: the doctor or optometrist need to examine the retina to check it has not been damaged and remains flat.  video and text

colour vision

If an optic nerve injury suspected, or if the cause of poor vision is not clear, test the colour vision.  colour vision Ishihara test.  

treatment for foreign bodies

• The foreign body must be removed by a health professional, general practitioner, or first aider,otherwise attend A & E.
• Generally after the foreign body is removed antibiotics are needed
• Deep rust rings are removed by eye professionals video.
• Chloramphenicol ointment 3 times a day or drops 4 times a day,
• Exocin  4 times if allergic to chloramphenicol.
• When the foreign body is removed, it leaves a corneal abrasion so it still feels as though there is something in the eye until the abrasion heals, usually 1-2 days. Text     photo    under top lid
• Cyclopentolate to reduce pain,  detail
• in 2 days the eye should be much more comfortable, but if not attend again as there may be an infection

foreign bodies under the top eyelid

These need to be removed. Many family doctors or first aiders can remove these, otherwise attend A & E. Evert with a cotton bud. text  video  Treatment after removal as above.

foreign body feeling but none seen

Sometimes a 'foreign body', may be a piece of plastic or grit may have stuck to the eye, scratched it, and then dropped out leaving the scratch.

The cornea and the undersurface of the upper eyelid must be examined in a very good light, and if there is no obvious foreign body, treat the corneal injury as above. Evert with a cotton bud. text  video

lid cut near nose

This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo

examination

Look for hyphaemas, an irregular pupil. Check vision.

spiky plant..proper poke

These can be very serious injuries. Treatment must be carried out by an ophthalmologist, started within 24 hours,

hyphaema

Blood in the anterior chamber indicates a very serious injury, and must be managed by an ophthalmologist photo.  Attend A & E or an eye emergency department. Steroid and dilating (Cyclopentolate) drops are prescribed.

examination

• Test vision
• examine the eye with a good light
• If the eye sees perfectly and the pupil is round and there is no blood in the (anterior) front chamber, the front of the may be unaffected.
• After that the pupil should be dilated with tropicamide 1% and phenylephrine 2.5%.
• Examine the retina with an ophthalmoscope. This examination can be carried out in an A & E department, or an optometrist (if there is no obvious major problem). The doctor or optometrist need to examine the retina to check it has not been damaged and remains flat.

Blunt object hit eye itself

blunt object hit bone around eye

The bone around the eye protects the eye, but there can occasionally be serious injuries.

• There may be internal damage to the eye from the vibtaion of the 'head injury', such as a retinal detachment. (See Blunt object hit eye itself >internal damage above.)
• There can be major fractures.
• Blow out fracture as below

less common causes of the
acute red painful eye

enlarge

very red eyes, watery discharge

Likely problem: viral conjunctivitis is very common..very red and watery eyes, and almost clear sight.  NHS. Lubricant drops make the eyes less irritable. It usually gets better in a few days, but occasionally takes weeks. Occasionally there is inflammation of the cornea, which makes the eyes very irritable indeed.  Photos

red, watery, discharging eyes: child

Viral conjunctivitis in children has a clear discharge (most common), and does not need treatment; Lubricant drops make the eyes less irritable. More. Green discharge: bacterial, needing chloramphenicol drops.

red eye and contact lens wear

A sore eye in a patient who wears a contact lens may be serious problem. text   text. If the lens has been worn in the previous 2 weeks a 'red eye' suggests a corneal ulcer may be present, and an ophthalmologist must treat the same day: this is an emergency. Opticians (and some GPs / family doctors) may be able to identify if there is an infection, and if there is no infection they can advise (if there is no infection an ophthalmologist need not see the patient).

1. if the eye becomes red for any reason the lens must be removed
2. if the eye remains sore, this indicates corneal damage.
3. the corneal damage may be like a scratch that heals, for instance if the lens is to tight and does not move enough, or is worn for too long
4. if the eye stays red for more that a couple of hours an examination is needed to check there is no infection  video
5. An abscess appears white; An early ulcer stains green with fluorescein    
6. Text and treatment

very itchy eyes

This is likely to be allergic conjunctivitis. This is very common. Usually there are other allergies such as hey fever. The eyes are very itchy, and lubricants help a little. Good Hope

sticky red discharging eyes in neonates

Conjunctivitis in neonates: any child less than 4 weeks old weeks old must be treated by an ophthalmologist or paediatrician; this is a serious condition.  photos of bad cases

corneal  ulcer

There may be a corneal ulcer. Text  photo.  If the eye is examined, here may be a patch one the cornea. Fluorescein drops will indicate if there is an ulcer. Corneal ulcers (if not dendritic) need to be treated in an Emergency Eye Clinic within 24 hours.

a contact lens ulcer

If a contact lens has been worn in the previous 2 weeks, this is termed a 'contact lens' ulcer..see red eye and contact lens above.

a dendritic corneal  ulcer

A dendritic ulcer can be treated by a family doctor: flourescein reveal an ulcer with a branching pattern . Good Hope.  Treatment is acyclovir 5 times a day for10d if available, otherwise gancyclovir 5 times a day for10d. These recur and patients who have had a recurrence should keep a tube of acyclovir or gancyclovir available to start if there is a recurrence. Regular attacks may be reduced with oral acyclovir 400mg twice daily.

eye becomes very red and sore:
corneal abrasion without injury

This may be a recurrent abrasion: the surface of the eye breaks down all by itself. This usually occurs after an injury (a corneal abrasion) that occurred weeks or months ago. Text   diagram. Initially a GP/ family doctor can treat this, but if the GP is not experienced with this problem or not available, patients should attend an emergency eye clinic. The condition is termed recurrent erosion syndrome.

peripheral ulcerative keratitis

An ulcer develops on the edge of the cornea. Occasionally this is very serious, but usually this is a sterile ulcer relate to blepharitis. Treatment is not urgent, but generally an examination within 48 hours to confirm he diagnosis is helpful. Text   diagram   photo

blood on the surface of the eye

A subconjunctival haemorrhage: blood red coloured eye that comes all of a sudden. This is common, occasionally related to high blood pressure or coughing, and gets better without treatment. Sight clear. More    Photo

patchy redness and slight ache

May be episcleritis: there is a patch of redness (but not fresh blood) and there may be a slight ache. Often it gets better itself, sometimes steroid drops are needed.  Photo  More   Sight clear.

patchy redness, gritty feeling

Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More  Good hope     diagram     photo

red eyelid, blepharitis

If there is no pain but just a very red eyelid with an irritable or gritty and sore eye, this is often 'blepharitis', and treatment can be very helpful. Text   photo

patchy redness, scratchy feeling

Phlyctenular keratoconjunctivitis: there is a patch of redness, a slight ache, and a gritty eye, but the surface is lumpy at the side of the cornea. Photos  More  

patchy redness, scratchy feeling

Inflamed pinguecula. Text  Photo  An optometrist or ophthalmologist will be above to diagnose this, and treatment is from an ophthalmologist. (Examination to confirm the diagnosis within 48 hours, but treatment not urgent.)

red eye, achy, bright lights painful:
iritis

Iritis (acute anterior uveitis). The eye is slightly red, achy and bright lights are uncomfortable (photophobia), and reading may cause an ache. Sight is usually slightly reduced or blurred.

more about iritis

Iritis is common and half of patients will have had a previous episode, or have a certain type of back ache (ankylosing spondylitis) of bowel problem including Crohns. Photo  Photos treatment protocol more . There are many other causes.

Treatment for new or occasional episodes is from an eye emergency service, the same day or if late evening the next day.

very achy eye & blurred sight:
acute glaucoma

Acute glaucoma. Sometimes there are temporary episodes or a mild episode. A moderate episode: a red eye, achy, blurred vision. The eye may feel hard, the pupil is 'semidilated' and does not respond when light is shone in (an important test, compare with the other eye).

A more severe attack: sight very blurred, very achy, with nausea and vomiting and may be abdominal pain, patient feels very ill, and a fixed semidilated pupil. An emergency that needs treatment at any time. More   Photos  (test pupils Animation for PC  video video)

It is important to estimate the pressure in the eye: you can press on the eye with 2 fingers. If the eye feels hard like a stone compared to the other eye there may be a high pressure (severe glaucoma).  An accurate pressure can be measured by an optometrist, but this is not needed acute glaucoma (press one eye and feel), but it is needed for chronic glaucoma.

less common causes (adults)

white eye but achy

Asthenopia or eye strain..the eye is white but achy More.  New glasses may be needed; sometimes there is a headache. Sometimes anxiety or tiredness plays a role.  An optometrist should advise.

eye white with shooting pains

There are some unusual headaches that can cause an achy eye. In some of these the eye goes red and waters, but it is normal when a doctor or optometrist examines. More. Consider migraine.

eye white with with loss of sight

In the elderly consider occult giant cell arteritis..check crp

testing vision

Test with distance glasses on  video

testing pressure for glaucoma

To estimate the pressure you can press on the eye with 2 fingers. If the eye feels hard like a stone compared to the other eye there may be a high pressure (severe glaucoma).  An accurate pressure can be measured by an optometrist, but this is not needed acute glaucoma (press one eye and feel), but it is needed for chronic glaucoma.

test pupils

Testing pupil is important. Shine a bright light in the eye and the pupil should become smaller. Text   video   video   Adies etc     A fixed semidilated pupil and a hard eye = acute glaucoma.

where is the redness?

Testing pupil is important. Shine a bright light into the eye and the pupil should become smaller. Text   video   video 

waking up with a sore eye

Sometimes the eyelid sticks to the surface of the eye in the night, and when the eye is opened it causes an abrasion. Treat as an abrasion above, and refer eye outpatients if the problem keeps occurring. (treat as for blepharitis/dry eye).  Text    photo

patchy redness and slight ache

May be episcleritis: there is a patch of redness (but not fresh blood) and there may be a slight ache. Often it gets better itself, sometimes steroid drops are needed.  Photo  More   Sight clear.

patchy redness, gritty feeling

Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More  Good hope     diagram     photo

red eyelid, blepharitis

If there is no pain but just a very red eyelid with an irritable or gritty and sore eye, this is often 'blepharitis', and treatment can be very helpful. Text   photo

patchy redness, scratchy feeling

Phlyctenular keratoconjunctivitis: there is a patch of redness, a slight ache, and a gritty eye, but the surface is lumpy at the side of the cornea. Photos  More  

change in refraction

One of the commonest cause of blurred vision is a change in refraction, so that new spectacles are needed (or spectacles are needed for the first time).. An optometrist is the best person to help.

variable sight

There may be a fluctuating blood sugar, caused by diabetes. The sight varies and this is normal if the blood sugar level goes up and down. An optpmetrist can advise, but a blood HbA1c and glucose test are needed.

variable sight, eyelid problem

If there is a stye or chalazion, this will press on the eye and change its shape, and will change focusing and often blur the sight. An optmetrist can advise.

blurred sight after injury

There are many different types of eye injuries diagram. More serious injuries require an attendance in an Eye Emergency clinic.

central vision blurred

Test covering one eye at a time. Is the side vision good? Is it just that faces are not clear or reading is difficult? See

floaters: tadpoles or moving web

There may be lots of floaters. These move when you move your head. This may indicate a vitreous haemorrhage. vitreous haemorrhage  or a PVD.

It is usually best to first attend an optometrist who will be able to assess the cause and urgency of the problem.

loss of sight in the last day

The floaters move when you move your head. A vitreous haemorrhage. It is usually best to first attend an optometrist who will be able to assess the cause and urgency of the problem. vitreous haemorrhage

sudden loss

see

in the elderly

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

in the elderly, rapid change

A rapid change in vision over days may be wet macular degeneration. An urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  NHS. Often the changes are slower, and he condition may be wet or dry macular disease: an OCT examination will tell the difference. Wet needs treatment NHS. Test with the Amsler grid video  this page   video    

younger patients, rare, rapid

This is unusual: an urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  Test with the Amsler grid on video  this page  

central vision distorted, months

An optometrists examination can be very helpful. This may an aging change of the retina, a type of wrinkling termed 'epiretinal membrane'. text   diagram   PC animation

central vision distorted, days/months

An optometrist's examination can be very helpful. Text  diagram    Amsler with amd. video  Here is a complete grid to use for the test. Larger This may be due to

• a small retinal vein blockage
• macular hole
• dry macular degeration (dry ARMD)
• wet macular degeration (wet ARMD)

rapid change

A rapid change in central vision over days may be wet macular degeneration (see). An urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  NHS. Often the changes are slower, and the condition may be wet or dry macular degeneration, or a small retinal vein blockage, a macular hole. An optometrist's examatination or OCT examination will identify the problem, although only wet ARMD needs urgent treatment NHS.  Test with the Amsler grid.             

blob or patch days/months

This may also be a retinal vein blockage. Text  diagram   An optometrist's examination can be very helpful.

central blob/ distortion

• A macular hole may have developed.
• there may be dry or wet macular degeration
• An optometrist's examination will usually identify the problem. Text   photo

patch/faded in centre, months

A patch of slight faded vision like looking through water may be due to fluid accumulating. CSR  This is in younger patients (If elderly this may be macular degeneration.). Text    photo.
An optometrist's examination can be very helpful.

over days or months

No flashes or floaters: this may also be a retinal vein blockage. Text  diagram   An optometrists examination is important..

over days/week

There are many different causes. It is important to see an optometrist urgently.

If there are flashes or floaters, there may be a retinal detachment  field. An urgent (same day) optometrist examination is needed, or attend an eye emergency department. The combination of flashes, floaters, and a patch of missing sight indicates the retina is being pulled off and needs surgery.  Occasionally this follows an injury (although most injuries do not cause this problem).  Text    Sight  diagram

very rapid loss

A retinal artery occlusion occurs very rapidly, although usually it happens overnight and people notice it when they wake up. If noticed within three hours, attend an emergency eye department immediately as there may be treatment. The doctor can often see the blocked artery and there is a pupil defect 

Animation for PC  video video. Video of an occlusion. Photo  Text

All the sight, top sight, bottom sight, or part of the sight might be affected.

over hours

Much more commonly there may be a retinal vein occlusion. If noticed within three hours, attend an emergency eye department immediately just to have the diagnosis made (there is no immediate treatment), otherwise an optometrist can advise. diagram    text   video

red eye

If the eye is red this is an emergency such as acute glaucoma.

very rapid central vision loss

This is usually a macular heamorrhage. A same day examination is needed, by an optometrist or in an eye emergency department.

over days/week

If there are flashes or floaters, this may be a retinal detachment  field. An urgent (same day) optometrist examination is needed, or attend an eye emergency department. The combination of flashes, floaters, and a patch of missing sight indicates the retina is being pulled off and needs surgery. Occasionally this follows an injury (although most injuries do not cause this problem).   Text    Sight  diagram

partial sight ONE EYE, older

If part of the sight is missing in one eye, in a middle age or older person, there may be an optic neuropathy.

• The pupil will be slow to respond to light, Animation for PC pupil; 
• colour vision may be reduced, test colour vision
• and the optic nerve may look 'swollen'. 
• Attend an eye emergency department the same day.
• You will be checked for giant cell arteritis or polymyalgia. and none-arteritic ischaemic optic neuropathy.
• Usually this occurs in any one eye at a time, but it may occur in both eyes.

partial sight ONE EYE, younger

Losing part of the sight in one eye, usually over a few days, may be an optic neuritis or retrobulbar neuritis.

• The pupil will be slow to respond to light;  Animation for PC pupil
• colour vision is always reduced, test colour vision; 
• and the optic nerve may look 'swollen'. 
• there is usually a slight pain with eye movements
• it may be part of MS
• usually detailed vision is reduced (very variable)
• An MRI is essential if there is no recovery in 4 weeks, but is not usually required as the sight normally recovers
• occasionally this occurs ion both eyes

The condition usually improves itself after a few weeks, but it best to attend an eye emergency department in1-2 days to have the diagnosis confirmed. Photo  Text

headache, white eye

Asthenopia or eye strain..the eye is white but achy More.  New glasses may be needed; sometimes there is a headache. Sometimes anxiety or tiredness plays a role.  An optometrist should advise. The headache affects both sides of the head/forehead.

headache and loss of sight

This indicates a major problem: and an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day. There are many causes, and in the elderly giant cell arteritis has to considered.

dehydration

Not drinking enough is a frequent cause of headaches...a drink of water will make the headache go. The headache affects both sides of the head / forehead.  NHS

drugs in normal doses

There are a number of drugs causing headaches  angina  (nitrates, nicorandil, etc). The headache affects both sides of the head/forehead.

Paracetamol

Medication overuse headache is very common. Using too much will cause a rebound headache see  . The headache affects both sides of the head/forehead.

stress

Stress or anxiety is a common cause of headaches. The headache affects both sides of the head/forehead. Exercise, new hobbies, going out with friends, dancing, all reduce stress, see  NHS   If you have anxiety, mindfulness, CBT etc help. If you have severe anxiety then expert help is needed NHS.  Smoking increases stress and anxiety significantly (although smoking immediately reduces stress, after that the stress levels increase a lot)

brain tumour

Brain tumours are unusual see. The headaches

• throbbing
• worse in the morning
• aggravated by bending, straining or coughing
• increase over months
• there may be vision disturbances lasting seconds
• similar headaches are caused by IIH below or a number of other brain conditions

IIH (idiopathic intracranial hypertension)

These headaches  see

• throbbing, worse in the morning
• aggravated by bending, straining or coughing
• reduce as the intracranial pressure is reduced, and increase as it rises
• there may be vision disturbances lasting seconds
• the condition is caused by being overweight (usually female) and certain genes that lead to accumulation of  CSF (cerebrospinal fluid) in the brain

red eye

A red eye will cause a headache see, especially acute glaucoma.

headache and loss of sight

This may indicate a major problem: and an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day. There are many causes, and in the elderly giant cell arteritis has to considered.

Migraine (see below) often presents as a visual disturbance that then recovers, which is then followed by a headache.

migraine

Migraine is common, and there are many types.   NHS     Migraine   Migraine causes a thumping headache, 'POUNDing'

• pulsating
• duration 4-72 hours
• Unilateral
• Nausea
• Disabling

There may be visual changes, such as scintillating lines moving out from the centre, diagram  The pain is one sided that moves a little, and there is usually sensitivity to light and sound .One in eight migraine sufferers have more attacks affair eating red wine, chocolate or cheese.
If attacks are frequent, a migraine specialist should advise (you will need referring). GPs/ family doctors can advise. If attacks are frequent or severe then referral to a migrain specialist may help.

atypical migraine

See   These are a little like migraine, but don't have all the 'pounding' features and the features above.

shooting pains, one side

Svere shooting eye pains may be trigeminal neuralgia: like a knife stabbing, with the twinges coming more some days than others.  See   NHS. Very mild twiges may be a 'dry' eye.

shooting eye pains

These may be cephalgias, again one sided

• these last minutes - 3 hours
• 8 episodes a day or less
• therapeutic-overview/ 
• there is often watering of the eye or nose, or swelling of the eye,
• cluster and related headaches attacks (SUNCT and SUNA)

ache one side with rash

A one sided pain around the eye and forehead, especially if there is a rash (vesicles) and pins and needles, may be shingles. The treatment should be begun by family doctor, the same day/next morning if possible, (Acyclovir 800mg fives times a day or an equivalent drug, for 1 week, but at least 2 weeks for a more severe attack, or if immunosuppressed). See

Most people with shingles around the eye do not get a 'uveitis' (inflammation in the eye), but a few do: if the eye itself becomes red, the eye must be checked for uveitis as on this page. The uveitis develops quickly in severe cases, and may take 3 weeks in less severe. A white eye with good vision is unlikely to have shingles uveitis. Patients with shingles around the eye with a white eye can attend their optician for an examination. photo.

neck

The cause of the pain may be arthritis in the neck. See.  This is more likely if you have pain in the neck when you turn or move your head.

sinusitis

Sinusitis is a common cause of headache NHS. It nearly always follows a cold, it can recur, if you press on your sinuses they will be tender., and us ally gets better itself. Antibiotics are now not recommended unless the attack is severe or prolonged. The pain is usually focused on the particular sinus that is infected or blocked.

diagram

enlarge

small lid infection: stye, poke

A stye is a small, painful lump on the inside or outside of the eyelid. Treat as below (generally mild infection.)
NHS

lid lump: chalazion (meibomian cyst)

Chalazions are usually painless unless they become infected. If they do, you may need antibiotics. NHS

If infected

• If infected, treat as below ( mild infection.)
• Treat cellulitis if present..see more lid infection as below.
• If not infected, the cyst may be unsightly but usually disappears itself in 3-6 months. In Birmingham there is no NHS funding for removal of most chalazion, but GPs/ family doctors can advise. They can be surgically removed under local anaesthetic.
  Childen are generally best waiting for the chalzion to disappear itself, but if it persists more than 6 months and is ugly then surgery should be considered.
• If the chalazion has been prevent a while an optometrist of family doctor may need to check to ensure there is no skin cancer.
  

mild infection styes/chalazion

The treatment of milder infection that have developed in the last few days is

• hot bathing with a warm compress, for about 5 minutes 3 times a day NHS, and
• Chloramphenicol ointment 3 times a day or drops 4 times a day (Fucithalmic twice daily if allergic)

more severe lid infection

More severe infections may in addition need antibiotic orally.

• Flucloxacillin if not allergic to penicillin: flucloxacillin  adult dose: 250mg/500mg 4 times a day.
• if allergic to clarithromycin (generally 250mg twice day adults) or clindamycin
• BMEC.pdf
  

entire lid red and swollen

Preseptal cellulitis: this is an infection of the lid, usually from a a stye or chalazion as above. It is common in children. It is a painful swelling ‘oedema’ of the eyelid, which is infected.

The top, bottom, or both  lids of one eye is affected. Indeed, the eyelid might drop and cover the eye itself. You need to see a doctor the same day. If the eye movements and pupils and normal, then usually it is only the eyelid that is infected.

Treat as more severe lid infection above. technical    patient.info   very technical . photo mild   more severe (could be orbital cellulitis).

top and bottom lids swollen

This could be preseptal cellulitis as above, but could be 'orbital cellulitis' : It is important to attend A & E. Text    Photo
If the eye sees well, movements are normal, pupils are normal, then this is probably preseptal cellulitis, that is a severe lid infection as immediately above. If eye the movements and sight are reduced, this could be an infection from sinuses spreading forwards. An ENT opinion and orbit x-ray are needed. Most patients are children and need to be under the care of a paediatrician in hospital. Babies particularly may need admission and intravenous antibiotics

lid cut near nose

This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo

lid too high

This is usually part of 'Exophthalmos' as above NHS. Photo

lid too low: 'ptosis'

If the eye lid drops there are many causes. Text. This is not urgent, and an ophthalmologist can advise.

1. It is usually a natural or aging problem, or follows eye surgery.
2. You may be born with it.
3. It may be variable, and if so may be part of myasthenia (especially if there is double vision or you feel weak).  NHS
4. If it occurs suddenly with double vision, and a large pupil, it may be serious, as part of a 3rd nerve palsy.    Text         Detail      Photo
5. If there is a sightly large pupil and a slight ptosis, this may be part of 'Horners' text       photo

lid turning in, entropion

Unless your eye is red this is not an emergency. Surgery helps. Text   diagram   photo

lid turning out, ectropion

NHS    Not an emergency, surgery can help.

one image above the other

If one image is above the other this is termed vertical diplopia. This is often a IV th  (4th) nerve palsy  video animation   video. Text   video. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.

two images side by side

When there are two clear images side by side, this is termed horizontal diplopia.

large pupil all of a sudden

If one pupil goes large one day and stays large, and you have not used any new eye drops, you may have an Adies pupil  Text.  Your near vision will be worse, and an optometrist can help confirm the problem, and provide new glasses for reading. There is usually a gradual improvement.

(The commonest cause or a large pupil is caused  be some dilating eye drops getting into the eye by mistake, such as atropine.)

slightly small pupil / droopy lid

Initially your optometrist is the best person to advise. This may be 'Horners' syndrome. It has usually been present for a long time and just suddenly becomes noticed, but if it is is a new problem, after seeing your optometrist you may be referred to an eye clinic .  Text and photo
If you have had a recent neck injury you should attend A/E or and ophthalmic A/E if there is one near you. text

pupil changes size all by itself

This is 'hippus' and is not usually linked to a serious problem. Text

other

There are other pupil problems. Initially your optometrist is the best person frequently cuase pupil probm