Examination

The following points are particularly important when dealing with a patient with an external eye infection:

Examination of the face and orbit

Features to look for on examination of the face and orbit are:

• Evidence of local trauma (including insect bites)
• Swelling overlying the lacrimal sac – if so, apply gentle pressure and look for the expression of pus at the punctum that indicates dacryocystitis
• Assess the salivary glands – Mikulicz syndrome comprises dacryocystitis with dry mouth and swelling of the salivary glands. While the condition itself is benign, it is generally found in systemic disease, including systemic lupus erythematosus (SLE) and lymphoma

Examination of the eye

Inspect the eye and surrounding structures for:

• Erythema
• Swelling – localised, e.g. over the lacrimal gland, peri-orbital or confined to the eyelid
• Chemosis (conjunctival oedema)

If any or all of these are present, note the location, spread and anatomical relationships to the eye structures.

Examination of the eye must also include:

• Visual acuity measurement
• Pupillary reaction to light, including relative afferent pupillary defect (RAPD)
• Fundoscopy to assess for papilloedema
• Intraocular pressure measurement if available