Chapter 18: Common Eye Complaints

The foundation of ocular assessment begins with a detailed history addressing symptom onset, visual disturbances, ocular pain, photophobia, trauma history, discharge characteristics, and contact lens use, alongside investigation of systemic conditions that frequently present with ocular manifestations, including connective tissue disorders, autoimmune diseases, and endocrine abnormalities. Physical examination must include measurement of visual acuity, assessment of pupillary characteristics including size and symmetry, and evaluation of the light reflex. Dry eye syndrome, a multifactorial condition involving insufficient tear film quantity or quality, may result from environmental factors, medication effects, reduced blinking mechanisms, hormonal changes, or associated systemic diseases such as Sjögren's syndrome. Excessive tearing presents paradoxically as either a reflex response to ocular surface irritation or a consequence of anatomical obstructions in the lacrimal drainage system and eyelid malpositions. Eye pain requires differentiation between primary ocular causes such as corneal abrasion, conjunctivitis, and anterior uveitis versus secondary referred pain from sinus disease or neurological conditions. Red eye presentations encompass both benign entities like subconjunctival hemorrhage and emergent conditions including acute angle-closure glaucoma and orbital cellulitis. Visual disturbances including floaters and photopsia carry different clinical significance; while floaters typically result from age-related vitreous changes, the sudden onset of flashing lights warrants urgent evaluation for retinal pathology. Posterior vitreous detachment, prevalent in elderly populations, frequently causes acute floaters and carries risk for retinal tears. Recognition of red flag presentations including sudden vision loss, acute severe eye pain, photopsia with floaters suggesting retinal detachment, corneal opacification, irregular pupil morphology, and papilledema mandates immediate ophthalmologic referral to prevent permanent vision loss.