A 21-year-old man presents with marked pain, blurred vision and redness bilaterally. He reports being sprayed with sulfuric acid in both eyes one hour prior to presentation.
The appearance of the eye is compatible with the following?
Blepharitis is a condition in which the eyelids are red, thickened and inflamed. This inflammation may be seen in conjunction with inspissated oil glands that are located at the lid margin. Blepharitis does not usually present with blurring of vision. Additionally, it is not associated with confluent redness and conjunctival blanching.
Cataract is a condition that occurs when the lens inside the eye becomes cloudy. Classically, cataract can be classified as nuclear, cortical or capsular, corresponding to the different anatomical areas of the lens. In this particular situation, cataract would be unlikely given the acute presentation, the young age of the patient and the confluent redness of the eye.
Chemical ocular injuryCORRECT
There are two types of glaucoma: open angle and angle-closure. These two types are differentiated by the morphologic status of the angle; the angle is open in open angle glaucoma (resistance to outflow of aqueous in this situation may be related to degeneration of the trabecular meshwork or other material such as cells) and closed in angle closure. The typical presentation for the vast majority of cases of glaucoma is that of painless insidious loss of peripheral visual field. Angle closure glaucoma can present with an acute red eye and blurred vision. However, it would be very unusual to have a bilateral presentation and angle closure glaucoma typically doesn’t present in this age group.
Ocular chemical burns can cause devastating ocular injury resulting in significant visual loss. Most victims are young males and exposure occurs in industrial accidents, at home, or in criminal assault1. Ocular chemical injury is responsible for up to 10% of all emergency room presentations.