A 58 year old male presents to the eye clinic with a three week history of a painful left eye. He says that his left eye has been constantly red the last few weeks, and he has had an increasingly “dull” pain in and around the eye. He feels it is worse at night and has had difficulty sleeping, though even during the day the pain is extremely bothersome. He notes significant impairments in his work performance and has become increasingly reclusive because of the pain. He has taken acetaminophen with little relief.
The patient notes no decreased vision or other visual symptoms from the eye. The pain occasionally feels as though it’s “behind the eye,” but he has otherwise had no headache. He has had no other general symptoms, such as fever or cold symptoms. Past medical history is significant only for chronic lower back pain and stiffness he has had since a teenager, but for which he has never seen a doctor. He is on no regular medications.
On exam visual acuity is 6/6 and 6/7.5 in the right and left eyes, respectively. Pressures are 12 in the right eye and 16 in the left eye. Anterior segment exam is remarkable for the external redness shown below. The involved vessels are non-mobile when a cotton-tip applicator is applied. Fundoscopy is difficult secondary to photophobia, but appears to be normal.