Ophthalmology: Gritty, irritable eyes

History

Find out if the problem is long standing or more acute. The patient will often volunteer that their eyes feel irritable. This tends to occur in both eyes at the same time. Ask if the eyes are sore rather than painful.1 Does the patient feel there is a foreign body or burning sensation, or do the eyes feel gritty or itchy? Ask about watering of the eyes and the presence of any discharge. The patient may have noticed that their eyelids are crusted when they wake up in the morning.

As usual, it is wise to find out about any concurrent medical condition, particularly recent infections of the upper respiratory tract, as these can frequently precede adenoviral conjunctivitis. Also take note of any systemic disease, particularly collagen vascular diseases including rheumatoid arthritis, as these conditions can be associated with gritty irritable eyes. Ask about any drugs the patient is taking because many, from the contraceptive pill to ß blockers, can cause ocular discomfort as a side effect.

Examination

Start by looking at the patient in general. Are there any telltale signs of systemic disease? (See next month's's Student BMJ for a more detailed discussion of ocular manifestations of systemic disease). Look at the facial skin, particularly around the eyes and the eyelids, for conditions such as seborrhoeic dermatitis or acne rosecea, as patients with these conditions can go …