In this podcast we discuss the case of:

44 year old female who presented at 4am in the morning with an acutely red and painful right eye. She had thought that the eye had started to feel a bit irritated that evening on returning from work and it had steadily worsened from there. She came to the ED as she couldn’t get off to sleep on account of the discomfort and felt as though there was something in the eye. She described some increased tearing but no discharge and mild blurred vision. No flashers or floaters. There was an associated mild headache, with mild photophobia. She denied trauma. She had been well recently.

Contact lens wearer, often works very long hours and does not always take them out to sleep and perhaps does not change them as suggested.

Past Medical History: Nil

Drug History: Nil

Social History: Lawyer, independent, Lives alone

Examination

Looked uncomfortable

Visual acuity (corrected) LEFT 6/6, RIGHT 6/9

Full range of eye movements

Visual Fields: normal

Externally: Normal

Lids and Lashes: No erythema, no collection, no subtarsal foreign body

Anterior Chamber: No hyphema (pooling of blood between in the anterior chamber (space between the cornea and iris), no hypopion (inflammatory cells in anterior chamber), no cells/flares

Conjunctiva: Mildly injected generally, no focussed redness suggesting iritis or episcleritis

Pupil: Round and symmetrical, equal and reactive to light

Iris: Normal

Cornea: ? more opaque than LEFT although red reflex preserved, some fluorescein uptake centrally

Have a listen to the podcast for the differential diagnoses and to find out what happened.

Music by BenSound.