Keratitis | Viral (eg, the dendritic ulcer of herpes simplex keratitis),
bacterial ulcer, fungal, Acanthamoeba | Decreased vision, tearing, photophobia | Refer to ophthalmologist |
Contact lens–related (infection, overwear) | Contact lenses increase risk of microbial keratitis, usually
bacterial, occasionally Acanthamoeba. Giant papillary
conjunctivitis is a conjunctival foreign body response. | Conjunctival injection, pain, tearing, photophobia, white
infiltrate on cornea, giant papilla on upper lid eversion | Remove contact lens, refer to ophthalmologist |
Dry eye | Insufficient tear production (conjunctival, lid, or lacrimal
glands), poor blinking, poor lid closure | Foreign body sensation, watery eye (secondary lacrimal gland
response), sticky discharge on waking | Lubricant eyedrops and ointments; if severe, may require
punctual occlusion by ophthalmologist |
Uveitis | Juvenile idiopathic arthritis (JIA), sarcoidosis, HLA B27,
inflammatory bowel disease, Behçet disease, psoriasis,
Kawasaki acute phase, (and others), idiopathic | JIA uveitis may be asymptomatic or may present with conjunctival
injection, irregular pupil, posterior synechiae, cataract. Others
present with pain, photophobia, tearing. | Refer to ophthalmologist |
Episcleritis | Idiopathic (large majority), autoimmune vasculitis, graft-versus-host
disease | Red, circumscribed area deep to the conjunctiva, may be swollen
(nodular) or diffuse | Refer to ophthalmologist |
Scleritis | Autoimmune disease including lupus, Wegener granulomatosis,
Henoch-Schonlein purpura | Rare in children. Severe pain (often disturbs sleep). Deep
crimson or purple hue to globe in affected area, dilated vessels,
decreased vision | Refer to ophthalmologist |
Endophthalmitis | Infection—bacterial, fungal; associated with surgery
or trauma, rarely endogenous | Pain, rapid loss of vision, chemosis, hypopyon, hazy ocular
media, lid swelling | Refer urgently to ophthalmologist |
Other systemic disease | Vitamin A deficiency (eg, nutritional, cystic fibrosis),
cystinosis, Stevens-Johnson syndrome, leukemia | Depends on the cause | Refer to ophthalmologist |