Other Eye Symptoms
See Keratoconjunctivitis Sicca for a discussion of dry eyes. The disorder is most often idiopathic or associated with older age but can also be caused by connective tissue diseases (eg, Sjögren syndrome, RA, SLE).
Discharge is often accompanied by a red eye (see Red Eye) and commonly is caused by allergic or infectious conjunctivitis, blepharitis, and, in infants, ophthalmia neonatorum (neonatal conjunctivitis). Infectious discharge may be purulent in bacterial infection, such as staphylococcal conjunctivitis or gonorrhea. Less common causes include dacryocystitis and canaliculitis.
Diagnosis is usually made clinically. Allergic conjunctivitis can often be distinguished from infectious by predominance of itching, clear discharge, and presence of other allergic symptoms (eg, runny nose, sneezing). Clinical differentiation between viral and bacterial conjunctivitis is difficult. Cultures are not usually done, but are indicated for patients with the following:
Scotomata are visual field deficits and are divided into
Negative scotomata may not be noticed by patients unless they involve central vision and interfere significantly with visual acuity; the complaint is most often decreased visual acuity (see Acute Vision Loss). Negative scotomata have multiple causes that can sometimes be distinguished by the specific type of field deficit as identified by use of a tangent screen, Goldmann perimeter, or computerized automated perimetry (in which the visual field is mapped out in detail based on patient response to a series of flashing lights in different locations controlled by a standardized computer program).
Positive scotomata represent a response to abnormal stimulation of some portion of the visual system, as occurs in migraines.