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If a chemical splashes into the eye, the surface of the eye may be 'burnt'.
The eye must immediately be irrigated with water. Tap water is fine. If there is no tap water, slightly dirty water/bottled juices etc can be used. Irrigating immediately should take priority...there is no time to search for clean water. For strong chemicals, the irrigation should last at least 15 minutes. Text
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
The initial irrigation:
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.
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?
Look in a good light for redness and bruising and skin tumours..
Test with distances glasses on. If the sight is reduced, test with a pinhole occluder. video Text
These are extremely helpful for identifying surface injury. They do not sting and can be used in children. photo
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
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
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
If an optic nerve injury suspected, or if the cause of poor vision is not clear, test the colour vision. colour vision Ishihara test.
Small pieces of grit, wood, glass, dead insects, or metal enter the eye. Text
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.
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
These cause a 'corneal abrasion', and are very common. They can be caused by finger nails, the end of a pencil, a gentle scratch from a spiky plant..etc. They heal, treat the corneal injury as above. See Photo Text photo. These can be treated by family doctors or an A / E department.
A large abrasion, an abrasion that is slow to heal, particularly if the patient has diabetes, should be treated by an ophthalmologist the same or next day.
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).
The eyelid can be cut after a fight for instance. Attend A & E: usually surgical repair is needed. photo
This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo
Darts or glass or many other objects can be poked right into the eye: this is termed perforating injury. Treatment must be carried out by an ophthalmologist the same day, and surgery is needed. Photo Photo
These can be very serious injuries. Treatment must be carried out by an ophthalmologist, started within 24 hours,
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.
The eye itself may be damaged with blunt injury, and sometimes the bone around the eye is broken.
Is there blood in the anterior chamber? photo. These need to be treated by an ophthalmologist the same day (attend A & E or and Eye A & E). Steroid and dilating (Cyclopentolate) drops are used. text
photo. An ophthalmologist must advise the same day.
The bone around the eye protects the eye, but there can occasionally be serious injuries.
common causes of the acute red eye
This is usually infective conjunctivitis, usually viral NHS. Photos Sight clear.
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
Bacterial conjunctivitis, with a green discharge, chloramphenicol drops are our first choice, Exocin / Fucithalmic if allergic. Chloramphenicol 4 times a day (average case), every 2 hours if severe.
If the conjunctivitis does not settle after 2 weeks, or if sexually active, consider chlamydial conjunctivitis, and medical attention is needed.
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.
The child may have a bad cold or enlarged glands around the side of the face or in the neck.
Conjunctivitis is very infectious...use separate towels, wash hands before touching other people etc.
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).
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
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
There may be a bacterial corneal ulcer. If the eye is examined, there may be a patch on the cornea. Fluorescein drops will indicate if there is an ulcer. Good Hope.
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.
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 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.
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.
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
A dry eye...the eye feels sore, scratchy and dry. Good Hope
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
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.
Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More Good hope diagram photo
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
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.
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.
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.
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.
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.
In the elderly consider occult giant cell arteritis..check crp
Test with distance glasses on video
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.
Watery eyes are caused by too many tears, poorly spreading tears, dry eyes, or by certain medical drugs Children Adults NHS diagram
This is usually caused by something irritating the eye: ingrowing eye lashes which are rubbing, a foreign body under the upper eyelid, or mild inflammation of the cornea or the eyelids. If you think there is something under the eyelid, it should be removed by a health professional or first aider. If the eye is sore and red this may need to be done in an emergency department, but usually this is not necessary. Optometrists or other health professionals are often able to remove ingrowing lashes. NHS diagram
This is very common, and is usually caused by blepharitis, inflammation of the eyelids. Often, drugs such as omeprazole or furosemide contribute. Good Hope NHS. Photo
This is common in babies Children , but adults may also have blocked tear ducts. Unless the eyelids are red this is not an emergency, GPs/family doctors can advise initially.
This is a very common cause of watery eyes. Good Hope. The tears do not spread evenly, leaving dry patches on the cornea that make the eye feel irritable or tired or watery photo.
A sore irritable eye is caused by a rough surface to eye eye, like craters on the moon, instead of being smooth like glass. diagram
These are extremely helpful for identifying surface injury of the eye and the cause of the sore eye. They do not sting and can be used in children. photo.
Corneal abrasions are common. They can be caused by finger nails, the end of a pencil etc. They heal, and are treated with chloramphenicol ointment (or Exocin drops if allergic to chloramphenicol). See.. Photo Text. GPs/family doctors can treat most corneal abrasions, there is no need to attend A & E unless you have diabetic problems or healing is delayed. Smoking delays healing significantly, so it is important to stop.
Sometimes a 'foreign body', may be a piece of plastic or grit, sticks to the surface of the eye (the cornea) or sticks under the top eyelid. The foreign body may then scratch the cornea causing a corneal abrasion. The foreign body must be removed by a health professional or first aider within two days.
There may be a foreign body under the top eyelid, and these need to be removed. Many family doctors or first aiders can remove these, otherwise attend A & E within 2 days. Evert the upper lid with a cotton bud. text video
Once the foreign body has been removed, treat with chloramphenicol ointment (or Exocin drops if allergic to chloramphenicol) to prevent an infection. When the foreign body is removed, it leaves the 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
If the surface of the eye is rough it feels as though there is something in the eye, and if there is no foreign body then dry eyes are a likely cause. Good Hope. photo.
Bullous keratoapthy or another related corneal problem may cause an exquisitely sore eye: dry patches (tiny craters) form on the surface of the eye. An optometrist is the best person to conusult initially, later an eye outpatient clinic or emergency department.
'Blepharitis' is inflammation and redness of the edge of the eyelids. It is very common.
The eyelids produce chemicals ('wetting agents') that help tears to spread, and without these chemicals tears don't spread. This leaves dry patches on the surface of the eye which makes the eye uncomfortable.
The treatment is a combination of
In a child (and occasionally an adult) if the eyes are itchy and scratchy, especially if the condition has been present a few weeks, suspect more serious atopic keratoconjunctivitis. text vernal shield ulcers limbitis. If the eye is white an ophthalmologist or ophthalmic nurse will be able to advise: attend an ophthalmic outpatient clinic, or if the eye is very sore and red, an eye emergency department.
The surface of the eye breaks down all by itself. The eye will be red and sore and scratchy, and more comfortable if closed.
This usually occurs after an injury (a corneal abrasion) that occurred may months ago. Text diagram
An ulcer develops on the edge of the cornea. Occasionally this is very serious, but usually this is a sterile ulcer related to blepharitis. Treatment is not urgent, but generally an examination within 2 days to confirm the diagnosis is helpful. Text diagram photo
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
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.
Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More Good hope diagram photo
Diagram: blurred sight is commonly caused by a cataract, but may be due to any condition obstructing the light entering the eye, or its focusing. Generally people with misty vision should attend their optometrist, as this is not usually an emergency.
see achy eye . Testing the visual acuity is important...is the sight blurred
Cataracts generally take years to develop, but may develop much more quickly and suddenly become noticeable. Optometrists can advise, and if surgery is needed patients are referred to routine eye clinics. Photo diagram Good Hope animation for PC
Corneal diseases are common in poor countries due to infections. If he eye is white optometrists can advise; if the eye is red see. If the cornea is scarred or swollen, it appears as though you are looking through frosted glass.
The capsule behind the implant can thicken. This can be present immediately after cataract surgery, but generally takes years to develop. It can be noticed suddenly. It is termed 'posterior capsule' thickening and a little laser can rectify this. Photo diagram animation for PC. An optometrist will identify the problem and arrange referral to ophthalmic outpatients for laser..
This is generally a refractive error, and glasses are needed. Optometrists can advise Diagrams myopia
This is generally a refractive error, and glasses are needed. Optometrists can advise. This is usually 'presbyopia', and is a normal process age 40y or more. Diagrams presbyopia
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.
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.
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.
There are many different types of eye injuries diagram. More serious injuries require an attendance in an Eye Emergency clinic.
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
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.
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
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.
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
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
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
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
This is often a retinal vein occlusion, but there are many other causes. An urgent optometrist examination is needed, the same day or week.
This may be an optic neuropathy. The pupil will be slow to respond to light, colour vision may be reduced, and the optic nerve may look 'swollen'. Animation for PC pupil; test colour vision; an optometrist can examine optic nerve; family doctor needs to check there is no giant cell arteritis or polymyalgia. ION
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.
This may also be a retinal vein blockage. Text diagram An optometrist's examination can be very helpful.
Often the problem has been there many years, and may for example be due to a damaged retina photo.
if the bottom of top half (or a quarter) of the sight is missing, see below
No flashes or floaters: this may also be a retinal vein blockage. Text diagram An optometrists examination is important..
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
This is a little unusual and there are number of possibilities.
There may be retinal detachment (especially if there are flashes and floaters. Text Sight diagram. An urgent same day optometrist check is needed if this problem has occurred in the last few days.
The visual fields must be tested in both eyes to confirm the problem is in one eye. If you are a patient, COVER ONE EYE, look straight ahead, can you see top left, top right, bottom left, bottom right and test each eye separately. You need to confirm the sight is missing in one eye only. (See below if both eyes). video. An urgent optometrist's examination will usually identify the problem
This is commonly a type of stroke PC animation. It i very important to test the visual fields to 'confrontation' video video2. detail diagram. If the sight loss was within 3 hours, refer IMMEDIATELY to a stroke unit .
The sight loss is usually
There are many possible causes. An urgent optometrist's examination will usually identify the problem.
If there is a section of vision missing, and the condition has developed over the previous few days, in a middle age/older patient, there may be an optic neuropathy.
The pupil will be slow to respond to light, colour vision may be reduced, and the optic nerve may look 'swollen'. Test the pupil reaction : Animation for PC video video test colour vision. An optometrist can examine optic nerve, and a GP / family doctor needs to check there is no giant cell arteritis or polymyalgia with a blood test. ION. Usually this occurs in any one eye at a time, but it may occur in both eyes.
If there is a section of vision missing, and the condition has developed over the previous few days, in a younger person, there may be an optic neuritis or retrobulbar neuritis.
The condition usually improves itself after a few weeks, but it best to attend an eye emergency department in 1-2 days to have the diagnosis confirmed. Photo Text
Very sudden loss (or waking up with poor sight) see
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.
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.
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
If the eye is red this is an emergency such as acute glaucoma.
This is usually a macular heamorrhage. A same day examination is needed, by an optometrist or in an eye emergency department.
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
If part of the sight is missing in one eye, in a middle age or older person, there may be an optic neuropathy.
Losing part of the sight in one eye, usually over a few days, may be an optic neuritis or retrobulbar neuritis.
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
Missing side vision in both eyes (the same side) is commonly a type of stroke PC animation. It is very important to test the visual fields to 'confrontation' ; cover one eye in turn..which side is missing? video video2 detail diagram.
If the sight loss was within 3 hours, refer IMMEDIATELY to a stroke unit .
The sight loss is usually the left side of both eyes, or the right side of both eyes. But it may be the outer (temporal) part of both eyes (a pituitary problem).
This may be linked to a vasovagal (faint) episode, or any episode with a low blood pressure. The sight fully recovers. GPs / family doctors can advise.
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.
These are very common. As we get older, vitreous gel shrinks, and floaters develop, and occasionally the retina is pulled. Also, genes, large eyes (myopia), and injury may contribute to retinal detachments. Large Animation for PC Text Evening or night time flashes are common, but a lot of daytime flashes suggest a possible retinal problem.
If all of a sudden a single large floater develops, but the basic vision remains good, this is likely to be a PVD. Flashes in the evening are common, Large Animation for PC Text
Usually the floater drops out of the line of vision in 1-2 weeks. An optometrist can check in the next week.
If the basic vision remains good, this is likely to be a PVD. An optometrist's exmination may be helpful. If the flashes settle and the optometrist's examination is normal, a PVD is the like cause. If the flashes continue, consider a retina tear as below, Large Animation for PC Text .
If there are a lot of daytime flashes that persist more than 2 days a retina tear is possible. NHS diagram video. If you have a lot of daytime flashes and floaters for more than one week, attend an eye emergency department or an optometrist urgently. detachment tear
If there is no retinal tear, then, after 1 week the floaters reduce and the flashes stop or just occur in the evening. An examination by an optometrist is safest.
Very rarely this might appear like a faulty pixel on a computer screen: this is usually a minor retinal problem, not a tear. Large Animation for PC Text .
If there are flashes and a section of vision is missing, like a big bubble or blob, there may be a retinal detachment or a vitreous haemorrhage. Attend the eye emergency department within 24 hours. NHS detachment tear
This is likely to be a vitreous haemorrhage, especially if the diabetes has not been well controlled. If you have diabetic retinopathy, contact your ophthalmic team. If you cannot contact them, an examination by an optometrist is safest (2-3 days of symptoms) . Text animation for pc
If this occurs all of a sudden, this is likely to be a vitreous haemorrhage, Text. Attend an eye emergency department in 1-2 days.
If the floaters have been present for months and have not changed, see your optometrist: you may have a minor problem that will not get worse (asteroid hyalosis Text Good Hope), or perhaps some inflammation in your eye that needs treatment intermediate uveitis
Ophthalmologists are not headache experts, but are often asked about headaches, sometimes only to exclude eye disease. Once your eye has been examined by an optometrist or ophthalmologist, and there is no eye condition causing the headache, you can get treatment from your family doctor. If the pain is severe, you need to see a headache expert. NHS
Any patient with continued headaches needs a blood pressure test, tests for diabetes and other routine blood tests, will be helped by not smoking, an optometrist's examination including a test for spectacles, and see their family doctor for advice. Below are some types of headache, with different treatments.
these are common cause of such headaches
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.
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.
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
There are a number of drugs causing headaches angina (nitrates, nicorandil, etc). The headache affects both sides of the head/forehead.
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 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 tumours are unusual see. The headaches
These headaches see
A terribly severe really sudden headache may be due to a bleed in the brain. Immediate A & E attendance is needed (not the eye casualty). Such a headache is often followed by neck stiffness. NHS
Here are common cause of such headaches:
A red eye will cause a headache see, especially acute glaucoma.
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 is common, and there are many types. NHS Migraine Migraine causes a thumping headache, 'POUNDing'
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.
See These are a little like migraine, but don't have all the 'pounding' features and the features above.
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.
These may be cephalgias, again one sided
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.
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 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.
Smoking makes most of the problems worse. Stopping smoking reduces stress and anxiety, sinusitis, arthritis in the neck, migraine , shooting eye pains (cephalgias) . Electronic cigarettes are much safer, producing 1/20th of the damage or side effects of smoking.
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.
This is usually an infection, either a stye on the lid edge (margin) or a chalazion , a type of lump in the eyelid caused by an infection or ‘granuloma’. If there is an infection, the eyelid will be achy and red, and there will be swelling of the lid. If there is a rash over the scalp on one side or one eyellid, consider shingles.
A stye is a small, painful lump on the inside or outside of the eyelid. Treat as below (generally mild infection.)
NHS
Chalazions are usually painless unless they become infected. If they do, you may need antibiotics. NHS
If infected
The treatment of milder infection that have developed in the last few days is
More severe infections may in addition need antibiotic orally.
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).
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
The eyelid can be cut after a fight for instance. Attend A & E: usually surgical repair is needed. photo
This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo
Trichiasis. The eyelash rubs the eye and causes a corneal abrasion. The lash needs to be removed, use fine tweezers if you can see. If they keep growing, you need to be referred to an ophthalmic clinic, sometimes minor surgery can help. Text This picture here shows many lashes..surgery is needed, not urgent
Diagram Text This is an infected tear sac 'acute dacrocystitis'. Treat with
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. An optometrist can advise, this is not urgent.
See Photo Unless you feel ill this is not an emergency, but your GP needs to refer you to an ophthalmologist.
This is termed 'exophthalmos' or 'proptosis' NHS. Unless you feel ill this is not an emergency, but your GP /family doctor needs to refer you to an ophthalmologist. You may have thyroid eye disease, and you need blood tests including TSH and thyroid antibodies. It is important to stop smoking as soon as possible. Photo thyroid-eye-disease.
Test eye movments. An oribt MRI or CT scan will identify the problem.
There are other causes of protruding eyes, and all require investigation in the ophthalmic outpatient department.
If the eye lid drops there are many causes. Text. This is not urgent, and an ophthalmologist can advise.
Unless your eye is red this is not an emergency. Surgery helps. Text diagram photo
NHS Not an emergency, surgery can help.
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.
Check with the other eye covered that both images come from only one eye.
Text Diagram It is extremely rare to have 2 clear images from one eye. Usually one image is clear, and the other is paler, termed 'ghosting'. Sometimes there are multiple ghosts, and the ghosting is variable, sometimes it is there and sometimes not.
The variability is usually due to different pupil size. There are many possible causes, none an emergency, and an optometrist should advise.
Causes include early cataracts, refractive error (spectacles or new spectacles are needed), a change in shape of the cornea, and corneal disease.
After cataract surgery a little ghosting is very common: the edge of the implant produces a second image or a reflection, or there are other optical changes.
Check with the other eye covered that one image comes from the right eye and one from the left. Test eye movements video video animation video
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.
When there are two clear images side by side, this is termed horizontal diplopia.
3rd (111rd) nerve palsy: if there is a droopy lid, and if the pupil is dilated, AND if the eye turns out (and down), this is likely to be a 3rd nerve palsy. photo video
3rd (111rd) nerve palsy: pupil sparing type. Investigations are still needed, but often in an older patient there is diabetic or vascular damage. Text
If one eye turns in and wont turn out, this is often a VI th (6th) nerve palsy Text video.. Causes: diabetes hypertension, and occasionally head trauma or raised intracranial pressure. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.
Another cause of horizontal double vision is internuclear ophthalmoplegia video Text. Often due to MS in younger patients or vascular problems in the elderly.
Thyroid eye disease causes protruding eyes, which may occur with double vision and red eyes. video photo text. page. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.
This is termed 'exophthalmos' or 'proptosis' NHS. Unless you feel ill this is not an emergency, but your GP / family docror needs to refer you to an ophthalmologist. You will need blood tests including TSH and thyroid antibodies. It is important to stop smoking as soon as possible. Photo thyroid-eye-disease.
Test eye movments. An oribt MRI or CT scan will identify the problem. See your optometrist and GP / family doctor.
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.
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.)
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
This is 'hippus' and is not usually linked to a serious problem. Text
There are other pupil problems. Initially your optometrist is the best person frequently cuase pupil probm
Optometrists refer many patients to A & E with 'swollen optic nerves'. Most patients do not have any disease, and the ophthalmologist has to determine which patient has which condition.
Photo Photo Essentially some people are born with small optic nerves, and this slows the flow of chemicals along the nerve, and 'deposits' build up. This seldom leads to any problems, but is discussed in detail here.
The main concern is confirming this is the problem, and there is no other problem such as papilloedema as below. OCT OCT text
Photo This is similar to optic disc drusen: some people are born with small optic nerves. The optic nerve looks 'crowded', there are no drusen, and the patient is usually hypermetropic. Again, the main concern is confirming this is the problem, and that there is no other problem such as papilloedema as below.
The nerve has a characteristic appearance to the expert eye.
Other terms used for this or a very similar condition are congenitally elevated optic disc or pseudopapilloedema text photo . Such optic nerves may have tortuous blood vessels photo OCT OCT text
This indicates a major problem: attend an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day.
Optic disc swelling may be caused by severe posterior uveitis and a number of other conditions, usually in one eye only. text. If the sight is reduced optometrists may refer patients to an eye emergency clinic, but if the sight is good patients may be referred to an ophthalmic outpatient clinic. A case
Hypertension is the main condition that causes this. Text hypertension Photo. There are many other less common causes.
There are a number of conditions that can cause this, such as IIH (idiopathic intracranial hypertension) photo and brain tumours. OCT. Ill patients need to attend A & E, well patients should see their GP/family doctor urgently, unless the optometrist advises otherwise.