The Eye, Ear, Nose, and Throat (EENT) examination is a critical component of a physical assessment, requiring a systematic approach to evaluate both external structures and internal functions. When a patient presents with "red eye" or periorbital discomfort, the clinician must differentiate between benign, self-limiting conditions and sight-threatening emergencies. This article explores the various pathologies of the eyelids, conjunctiva, and cornea, and provides a framework for the differential diagnosis of red eye symptoms.
Eyelid and Periorbital Pathologies
The eyelids serve as the first line of defense for the ocular surface. Disruptions in their position or the health of the surrounding tissue can lead to significant discomfort and secondary ocular damage.
Lid Position Abnormalities
Two common positional abnormalities involve the direction in which the eyelid margin turns:
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Entropion: The eyelid margin turns inward toward the eye. This is clinically significant because the eyelashes can abrade the cornea and the globe, potentially leading to ulceration.
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Ectropion: The eyelid margin turns outward, away from the eye.
Inflammatory and Lipid Conditions
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Chalazion: This is a firm, typically painless lump caused by a blockage of the Meibomian gland. While it may be painful during the initial inflammatory phase, chronic chalazia are usually painless.
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Hordeolum (Stye): Unlike a chalazion, a hordeolum is a painful, localized abscess of the eyelash follicle, typically caused by a staphylococcal infection.
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Blepharitis: This involves chronic inflammation of the eyelid margins. Patients often present with itching, tearing, redness, and small white scales around the lid and eyelashes. It is frequently associated with seborrheic dermatitis or acne rosacea.
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Xanthelasma: These are yellowish plaques or lipid deposits located under the skin, often appearing on the inner corners of the upper eyelids. They are frequently associated with lipid abnormalities.
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