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Vision loss in a child with red eyes is always a danger sign: anterior uveitis, one type of glaucoma.

HILTON HEAD ISLAND, S.C. -- Vision loss is always an ominous sign in a child with red eyes, Dr. Irene Tien said at a meeting on clinical pediatrics sponsored by Boston University.

Two specific diagnoses--anterior uveitis and acute angle-closure glaucoma--should be considered in a child with red eyes and vision loss, said Dr. Tien, a pediatric emergency physician at Boston Medical Center.

Anterior uveitis often is associated with systemic illnesses such as juvenile rheumatoid arthritis or sarcoid, or with trauma. The eye is painful, photophobic, and mildly injected, with a characteristic "ciliary blush" surrounding the cornea. The pupil on the affected side may be smaller and may dilate poorly. Tearing may occur, but discharge and lid swelling are usually absent.

Treatment for anterior uveitis includes topical steroid drops, cycloplegics, and possibly oral steroids. Only an ophthalmologist should administer these therapies.

No specific treatment is indicated prior to referral, she said. Anterior uveitis can result in glaucoma, pupillary abnormalities, cataract formation, and macular dysfunction.

Acute angle-closure glaucoma is rare in children, but can occur. Tearing, photophobia, corneal clouding, and mid-dilated pupil are common, while discharge and inflamed conjunctiva are unusual. In children younger than 2 years of age, the affected eyeball may be larger and may feel firmer to palpation than the opposite eye, she said.

Permanent vision loss can occur within hours without administration of agents--such as acetazolamide or miotics--to lower intraocular pressure. But again, ophthalmologic expertise is needed. "Just refer," Dr. Tien said.

Other indications for emergent ophthalmic referral in a child with red eye include:

* Blurred vision that doesn't disappear with blinking.

* Halos.

* Pain.

* Photophobia.

* Any contact lens-associated symptom.

* Ciliary flush.

* Corneal haze.

* Abnormal pupils.

* Elevated intraocular pressure.

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Title Annotation:Clinical Rounds
Author:Tucker, Miriam E.
Publication:Pediatric News
Article Type:Brief Article
Geographic Code:1USA
Date:Dec 1, 2003
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