Materiały źródłowe

• #1 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #2

  https://step2.medbullets.com/evidence/20082509

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #3 Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis

  https://emedicine.medscape.com/article/1192122-overview

  Numerous conditions may be associated with red eye, including conjunctivitis, blepharitis, canaliculitis, corneal injury, dacryocystitis, episcleritis, scleritis, iritis, keratitis, dry eye syndrome, glaucoma, subconjunctival hemorrhage, bacterial or viral infection, or trauma. […] Conjunctivitis, the most common cause of red eye, is characterized by vascular dilation of the superficial conjunctival blood vessels, cellular infiltration, and exudation; it must be differentiated on the basis of etiology (viral, bacterial, or allergic). […] Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. It may be spontaneous, traumatic, or related to systemic illness. The classic presentation involves a patient without eye pain or visual disturbance who discovers the red eye in the mirror or from a concerned friend or family member. […] The prognosis depends on the cause of the red eye. For example, subconjunctival hemorrhage is a self-limited condition when not associated with systemic illness or significant trauma; thus, the prognosis is excellent. Complications also depend on the cause of the red eye.

• #4 Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis

  https://emedicine.medscape.com/article/1192122-overview

  A red eye is a cardinal sign of ocular inflammation, which can result from many conditions. Subconjunctival hemorrhage, defined as blood between the conjunctiva and the sclera, is usually not secondary to inflammation. Most cases of subconjunctival hemorrhage are benign and can be effectively managed by the primary care provider. The key to management is recognizing cases with underlying disease that require ophthalmologic consultation. […] A red eye most often results from dilation of blood vessels in the anterior portion of the eye. Diagnosis may be aided by the differentiation between ciliary and conjunctival injection. Ciliary injection involves branches of the anterior ciliary arteries and indicates inflammation of the cornea, iris, or ciliary body. Conjunctival injection mainly affects the posterior conjunctival blood vessels.

• #5 Red Eye: A Guide for Non-specialists

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5443986/

  Red eye can arise as a manifestation of many different systemic and ophthalmological diseases. […] A correct assessment of the urgency of the situation is vitally important for the planning of further diagnostic evaluation and treatment. […] Primary care physicians typically see 410 patients per week who complain of ocular symptoms. Most of them have red eye as the major clinical finding. […] The duration and laterality of symptoms (uni- vs. bilateral) and the intensity of pain are the main criteria allowing the differentiation of non-critical changes that can be cared for by a general practitioner from diseases calling for elective referral to an ophthalmologist and eye emergencies requiring urgent ophthalmic surgery. […] The differential diagnosis of red eye can be narrowed down rapidly with simple baseline tests and targeted questioning. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis is in doubt.

• #6 Red Eye: A Guide for Non-specialists

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5443986/

  The duration and laterality of red eye and the presence and severity of pain are the cornerstones of diagnosis. […] Both eyes should always be examined, as the laterality of red eye may be relevant to the diagnosis. […] In a patient with painful acute unilateral red eye, presence of a foreign body must be ruled out. […] Any patient with a positive history of a foreign body or trauma should be referred as an emergency to an eye hospital. […] Painful acute bilateral red eye is often caused by viral conjunctivitis. […] Any patient with non-painful acute unilateral red eye should be seen by an ophthalmologist within 24 h for exclusion of a carotidcavernous sinus fistula. […] The patient should always be urgently seen by an ophthalmologist.

• #7 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  10 Cant Miss Diagnoses of the Red Eye […] Acute angle-closure glaucoma (AACG) […] Bacterial keratitis/ulcer […] Endophthalmitis […] Hyphema […] Hypopyon […] Iritis […] Infectious keratitis (bacterial and viral) […] Orbital cellulitis […] Scleritis […] Uveitis […] A brief differential for a PAINFUL red eye based on symptom description: […] Itching = allergies […] Burning = lid disorders, dry eye […] FB sensation = FB, corneal abrasion […] Localized lid tenderness = hordeolum, chalazion […] Deep, intense pain = corneal abrasion, scleritis, iritis, acute glaucoma, sinusitis, orbital cellulitis […] Photophobia = corneal abrasions, iritis, acute glaucoma (think about ciliary body muscle spasm or other problems from the anterior segment of the eye) […] Halo vision = acute glaucoma, uveitis (resulting from corneal edema)

• #8 Red eye (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Red_eye_(medicine)

  A reduction in visual acuity in a 'red eye’ is indicative of serious ocular disease, such as keratitis, iridocyclitis, and glaucoma, and never occurs in simple conjunctivitis without accompanying corneal involvement. […] Ciliary flush is usually present in eyes with corneal inflammation, iridocyclitis or acute glaucoma, though not simple conjunctivitis. […] The cornea is required to be transparent to transmit light to the retina. […] In an eye with iridocyclitis, the involved pupil will be smaller than the uninvolved, due to reflex muscle spasm of the iris sphincter muscle. […] Intraocular pressure should be measured as part of a routine eye examination. […] Those with conjunctivitis may report mild irritation or scratchiness, but never extreme pain, which is an indicator of more serious disease such as keratitis, corneal ulceration, iridocyclitis, or acute glaucoma. […] Of the many causes, conjunctivitis is the most common.

• #9 Approach to the Red Eye – emDocs

  https://www.emdocs.net/approach-to-the-red-eye/

  A quick review of anatomy will serve useful for understanding the pathology and treatment behind different causes of red eye. […] The most important part of the physical exam is the visual acuity. […] Hyphema refers to RBCs in the anterior chamber. The most common cause is trauma and commonly occurs along with traumatic uveitis. […] Endophthalmitis is an infection of the deep structures in the eye, particularly the aqueous and vitreous humor. It is very dangerous as it can rapidly lead to permanent vision loss. […] Conjunctivitis is defined simply as an inflammation of the conjunctiva. […] The more common form of conjunctivitis, viral conjunctivitis is most often caused by adenovirus and is self-limiting; however, it is highly contagious. […] A globe rupture is a full thickness tear of the eye and can be blunt or penetrating.

• #10 The red eye: Evaluation and management – UpToDate

  https://www.uptodate.com/contents/the-red-eye-evaluation-and-management

  The red eye: Evaluation and management […] „Red eye” is a common presenting complaint in ambulatory practice. This topic presents an approach for distinguishing patients with red eye who must be referred to an ophthalmologist, such as those with angle-closure glaucoma, from patients who can be managed by the primary care clinician, such as those with allergic conjunctivitis (table 1 and table 2). Some distinguishing features of conditions presenting as a red eye are summarized in a table (table 3). […] „Red eye” is a common presenting complaint in ambulatory practice. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated by the primary care clinician. […] Patient history, measurement of visual acuity, and findings on penlight examination are important features in determining the cause and management of red eye. The history and ocular examination provide guidance in the decision about whether to refer the patient for ophthalmologic evaluation. […] Determining who needs to be seen in person — Many patients with a red eye call to inquire whether they need to be seen by a clinician. Certain historical features or presenting complaints signal the need for clinician examination and possibly patient referral.

• #11 Assessment of red eye – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/496

  Acute red eye is a common presenting complaint to primary care physicians. […] A detailed history of the presenting symptoms and previous ophthalmological and medical history can narrow the differential diagnosis and aid in the interpretation of key examination findings. […] The lack of specialist equipment in the primary care setting, along with a very broad differential diagnosis, can cause difficulty in establishing the correct diagnosis, and in such cases a specialist ophthalmological opinion should be sought. […] Serious vision-threatening conditions that present as red eye are rare and can occasionally be overshadowed by associated systemic symptoms; in light of this they should always be considered within the differential and excluded on examination.

• #12 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  When cells and flare are present in a painful hypermic eye, consider uveitis or endophthalmitis. […] Should fluorescein staining be present in the red eye, we want to appraise the cornea for any kind of dendritic appearance. […] Despite the plethora of causes for red eye(s) that present for evaluation, hopefully this guide will facilitate clinical thinking when attempting to diagnose and treat these patients.

• #13

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  Active herpes simplex keratitis is an inflammation of the corneal epithelium due to viral replication and infection causing characteristic dendritic corneal ulcers. […] Patients with suspected herpes simplex keratitis should be referred for ophthalmological assessment (or consider Optometrist triage if uncertain and the use of a slit lamp would assist in diagnosis). […] Keratitis can result from several aetiologies, including bacterial keratitis (most commonly secondary to contact lens use) or herpetic keratitis. […] Iritis (anterior uveitis) is often very painful due to ciliary muscle spasm. […] Scleritis is characterised by severe, intense eye pain, described as deep, drilling pain, like a toothache. […] Endophthalmitis is a sight- and globe-threatening internal infection of the eye.

• #14 Clinical Approach to the Canine Red Eye | Today’s Veterinary Practice

  https://todaysveterinarypractice.com/ophthalmology/clinical-approach-to-the-canine-red-eye/

  Once an examination and these diagnostics are completed, the eye’s condition can be classified as: Extraocular (conjunctival or corneal), Intraocular (glaucoma or uveitis), Ocular manifestation of systemic disease. […] Corneal ulcers result in corneal vascularization, which appears as a “red eye.” […] Diagnosis & Classification: Once an ulcer has been identified with positive fluorescein staining, further classification allows proper therapeutic interventions and prevents catastrophic complications related to lack of treatment. […] The only diagnostic sign of glaucoma is increased intraocular pressure (IOP). […] The initial medical therapy for acute primary glaucoma is aimed at rapidly reducing IOP. […] Referral to an ophthalmic specialist is appropriate for management of severe or resistant cases of uveitis. […] Correct diagnosis and treatment of the red eye are important to prevent loss of vision, the globe, or, in some cases, loss of life.

• #15 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  A brief differential for a PAINLESS red eye based on location: […] Diffusely red: conjunctivitis or episcleritis, but also consider eyelid abnormalities that may have an associated conjunctivitis (e.g., blepharitis, ectropion, entropion, eyelid lesion like tumor or stye) […] Localized redness: subconjunctival hemorrhage, pterygium, corneal foreign body (usually painful), ocular trauma (usually painful) […] Diagnosis Index and Management […] Acute Angle Closure Glaucoma […] Definition: Closure/narrowing of the AC angle, causing elevated intraocular pressure and eventual optic nerve damage […] Symptoms: HA, n/v, photophobia, blurred vision, deep pain (no improvement with topical anesthetics) […] Exam/Diagnostics: Diffuse redness and characteristic ciliary flush, elevated IOP, can also see a shallow anterior chamber (AC), mid-sized or dilated and non-reactive pupils, decreased visual acuities (VA), no fluorescein uptake […] Management Pearls: lower IOP in preparation for definitive treatment by ophthalmology

• #16 Fifty shades of red – Diagnosis and treatment of red eye | Veterinary Videos & Podcasts | The Webinar Vet

  https://thewebinarvet.com/videos/fifty-shades-of-red-diagnosis-and-treatment-of-red-eye

  Red eye is a very frequent presenting ocular complaint. Learn to differentiate between its most common causes-conjunctivitis, uveitis and glaucoma based on their clinical presentation and simple diagnostic tests. The topic of the talk is red eye, and here we have 3 different red eyes due to 3 different ophthalmic diseases. We are looking at eyes with conjunctivitis, glaucoma, and UVI, which are the most common diagnosis for red eye. These are the three most common and important differentials for red eye, but there are other differentials that you have to consider, including deep keratitis, superficial keratitis, and an orbital disease. With every red eye that presents in your clinic, you want to consider the following diagnostics and the following things that you wanna look out for. The question is obviously, how can you tell by looking at the blood vessel whether it’s a superficial blood vessel or whether it’s a deep blood vessel. Superficial blood vessels are congested in cases of conjunctivitis or in cases of superficial keratitis. Deep vessels, on the other hand, are associated with uveitis, glaucoma, deep keratitis, and orbital disease. The next thing you want to check in each and every patient presenting with dry eye is do the Schirmer tear test. In every case of red eye, please do the Schirmer test. You’ll be surprised at how many cases of dry eye you may have missed if you didn’t perform the test. The pupil is meiotic in cases of uveitis. Glaucoma, on the other hand, patients will present with a fixed dilated pupil. Aqueous flare is really an indication of uveitis. Another important diagnostic test that you want to do is tonometry or measurement of intraocular pressure. Pressure is elevated in glaucoma, that’s the very definition of glaucoma, elevation in intraocular pressure. Pressure is normal in uveitis and lower in uveitis. Significant differences between eyes are suspicious, even if both are within normal range. The most important thing I want you to remember about uveitis is that bilateral uveitis is most often due to a systemic disease. Uveitis is not a diagnosis, it’s a clinical sign. When you find enlarged submandibular lymph nodes, you don’t go, aha, I have a diagnosis. You begin working up the patient asking yourself, what causes this lymphadenopathy, and that’s what you should be doing in cases of bilateral uveitis. In dogs, conjunctivitis is usually a secondary infection or inflammation in that there is something causing chronic irritation of the eye. In cats, it is a primary disease usually caused by herpes. The most important thing I want you to remember about glaucoma is that it may be a primary or secondary disease. When you are presented with a patient with unilateral glaucoma, please ask yourself, is it a primary disease or secondary disease? When in doubt, treat the other eye.

• #17 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  A brief differential for a PAINLESS red eye based on location: […] Diffusely red: conjunctivitis or episcleritis, but also consider eyelid abnormalities that may have an associated conjunctivitis (e.g., blepharitis, ectropion, entropion, eyelid lesion like tumor or stye) […] Localized redness: subconjunctival hemorrhage, pterygium, corneal foreign body (usually painful), ocular trauma (usually painful) […] Diagnosis Index and Management […] Acute Angle Closure Glaucoma […] Definition: Closure/narrowing of the AC angle, causing elevated intraocular pressure and eventual optic nerve damage […] Symptoms: HA, n/v, photophobia, blurred vision, deep pain (no improvement with topical anesthetics) […] Exam/Diagnostics: Diffuse redness and characteristic ciliary flush, elevated IOP, can also see a shallow anterior chamber (AC), mid-sized or dilated and non-reactive pupils, decreased visual acuities (VA), no fluorescein uptake […] Management Pearls: lower IOP in preparation for definitive treatment by ophthalmology

• #18

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  A penetrating injury may be obvious in the case of a grossly misshapen globe or a full-thickness corneal or scleral laceration with prolapse of intraocular contents. However, subtle clues to look for include a shallowing of the anterior chamber in that eye, or tear-drop distortion of the pupil due to the iris prolapsing through an unnoticed wound, although these features may be difficult to detect without the use of a slit lamp. […] This is a medical emergency and the patient should be discussed with an Ophthalmologist immediately to determine initial management and arrange urgent assessment. […] Symptoms of raised intraocular pressure are deep eye pain (described as throbbing, drilling pain), redness, blurred vision (often with haloes around lights due to corneal oedema), headache, nausea and vomiting.

• #19 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  A brief differential for a PAINLESS red eye based on location: […] Diffusely red: conjunctivitis or episcleritis, but also consider eyelid abnormalities that may have an associated conjunctivitis (e.g., blepharitis, ectropion, entropion, eyelid lesion like tumor or stye) […] Localized redness: subconjunctival hemorrhage, pterygium, corneal foreign body (usually painful), ocular trauma (usually painful) […] Diagnosis Index and Management […] Acute Angle Closure Glaucoma […] Definition: Closure/narrowing of the AC angle, causing elevated intraocular pressure and eventual optic nerve damage […] Symptoms: HA, n/v, photophobia, blurred vision, deep pain (no improvement with topical anesthetics) […] Exam/Diagnostics: Diffuse redness and characteristic ciliary flush, elevated IOP, can also see a shallow anterior chamber (AC), mid-sized or dilated and non-reactive pupils, decreased visual acuities (VA), no fluorescein uptake […] Management Pearls: lower IOP in preparation for definitive treatment by ophthalmology

• #20

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  In general, a patient with a unilateral presentation of a red eye suggests a more serious cause than a bilateral presentation. […] There are six serious causes of red eye, which can result in visual loss: Acute angle closure glaucoma occurs when there is an obstruction to drainage of aqueous humour from the eye, rapidly causing increased intraocular pressure. […] Keratitis is inflammation of the corneal epithelium caused by infection (e.g. herpes simplex virus, bacteria, fungi or protozoa) or auto-immune processes (e.g. collagen vascular diseases). […] Iritis is inflammation of the iris that can be associated with other inflammatory disorders, e.g. ankylosing spondylitis, or occur as an isolated idiopathic condition. […] Scleritis is inflammation of the sclera. This is a very rare presentation, usually associated with autoimmune disease, e.g. rheumatoid arthritis.

• #21 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  Allergic Conjunctivitis […] Definition: A sudden-onset hypersensitivity reaction caused by environmental exposure, usually a known allergen. Can be acute or seasonal […] Symptoms: Ocular pruritus, possible burning sensation, diffuse redness, eyelid edema, +/- mild photophobia. Should not be painful. May be associated with allergic rhinitis (edema of nasal turbinates and rhinorrhea). Symptoms usually bilateral, although one eye can be affected more than the other […] Anterior Uveitis […] Definition: Inflammation of the iris, choroid, and/or ciliary body […] Symptoms: Pain (no improvement with topical anesthetics), redness, photophobia (direct and consensual), tearing, decreased vision […] Bacterial Keratitis/Ulcer […] Definition: Corneal epithelial defect with stromal haze due to microorganism […] Symptoms: Significant pain (may improve with topical anesthetic), tearing, and discharge, photophobia

• #22

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  Active herpes simplex keratitis is an inflammation of the corneal epithelium due to viral replication and infection causing characteristic dendritic corneal ulcers. […] Patients with suspected herpes simplex keratitis should be referred for ophthalmological assessment (or consider Optometrist triage if uncertain and the use of a slit lamp would assist in diagnosis). […] Keratitis can result from several aetiologies, including bacterial keratitis (most commonly secondary to contact lens use) or herpetic keratitis. […] Iritis (anterior uveitis) is often very painful due to ciliary muscle spasm. […] Scleritis is characterised by severe, intense eye pain, described as deep, drilling pain, like a toothache. […] Endophthalmitis is a sight- and globe-threatening internal infection of the eye.

• #23 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  Allergic Conjunctivitis […] Definition: A sudden-onset hypersensitivity reaction caused by environmental exposure, usually a known allergen. Can be acute or seasonal […] Symptoms: Ocular pruritus, possible burning sensation, diffuse redness, eyelid edema, +/- mild photophobia. Should not be painful. May be associated with allergic rhinitis (edema of nasal turbinates and rhinorrhea). Symptoms usually bilateral, although one eye can be affected more than the other […] Anterior Uveitis […] Definition: Inflammation of the iris, choroid, and/or ciliary body […] Symptoms: Pain (no improvement with topical anesthetics), redness, photophobia (direct and consensual), tearing, decreased vision […] Bacterial Keratitis/Ulcer […] Definition: Corneal epithelial defect with stromal haze due to microorganism […] Symptoms: Significant pain (may improve with topical anesthetic), tearing, and discharge, photophobia

• #24

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  Active herpes simplex keratitis is an inflammation of the corneal epithelium due to viral replication and infection causing characteristic dendritic corneal ulcers. […] Patients with suspected herpes simplex keratitis should be referred for ophthalmological assessment (or consider Optometrist triage if uncertain and the use of a slit lamp would assist in diagnosis). […] Keratitis can result from several aetiologies, including bacterial keratitis (most commonly secondary to contact lens use) or herpetic keratitis. […] Iritis (anterior uveitis) is often very painful due to ciliary muscle spasm. […] Scleritis is characterised by severe, intense eye pain, described as deep, drilling pain, like a toothache. […] Endophthalmitis is a sight- and globe-threatening internal infection of the eye.

• #25 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  Allergic Conjunctivitis […] Definition: A sudden-onset hypersensitivity reaction caused by environmental exposure, usually a known allergen. Can be acute or seasonal […] Symptoms: Ocular pruritus, possible burning sensation, diffuse redness, eyelid edema, +/- mild photophobia. Should not be painful. May be associated with allergic rhinitis (edema of nasal turbinates and rhinorrhea). Symptoms usually bilateral, although one eye can be affected more than the other […] Anterior Uveitis […] Definition: Inflammation of the iris, choroid, and/or ciliary body […] Symptoms: Pain (no improvement with topical anesthetics), redness, photophobia (direct and consensual), tearing, decreased vision […] Bacterial Keratitis/Ulcer […] Definition: Corneal epithelial defect with stromal haze due to microorganism […] Symptoms: Significant pain (may improve with topical anesthetic), tearing, and discharge, photophobia

• #26 Red eye (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Red_eye_(medicine)

  A reduction in visual acuity in a 'red eye’ is indicative of serious ocular disease, such as keratitis, iridocyclitis, and glaucoma, and never occurs in simple conjunctivitis without accompanying corneal involvement. […] Ciliary flush is usually present in eyes with corneal inflammation, iridocyclitis or acute glaucoma, though not simple conjunctivitis. […] The cornea is required to be transparent to transmit light to the retina. […] In an eye with iridocyclitis, the involved pupil will be smaller than the uninvolved, due to reflex muscle spasm of the iris sphincter muscle. […] Intraocular pressure should be measured as part of a routine eye examination. […] Those with conjunctivitis may report mild irritation or scratchiness, but never extreme pain, which is an indicator of more serious disease such as keratitis, corneal ulceration, iridocyclitis, or acute glaucoma. […] Of the many causes, conjunctivitis is the most common.

• #27 Red Eye: Common Ophthalmologic Disorders in Primary Care

  https://www.clinicaladvisor.com/features/red-eye-common-ophthalmologic-disorders-primary-care/

  An alarming symptom of anterior scleritis that helps to differentiate it from more benign causes of red eye is severe pain that is worse at night and may even wake the patient.3 […] Scleritis is associated with multiple complications such as corneal ulcer, uveitis, glaucoma, and keratitis and, thus, should be evaluated by an ophthalmologist within a couple of days.3 […] Acute angle-closure glaucoma (AACG) affects more than 2.7 million people aged 40 years and older.16 Glaucoma is sight-threatening and, thus, is considered a medical emergency.2 […] Red flags are useful warnings clinicians can employ in the decision-making process and should prompt referral to ophthalmology to rule out severe disorders (Table 1).17 […] Compared with bilateral erythema, unilateral eye redness has been associated with more serious diagnoses.17 Pain, acute vision loss, and decreased pupillary response often suggest AACG, an urgent ophthalmic condition.

• #28 Red Eye: Common Ophthalmologic Disorders in Primary Care

  https://www.clinicaladvisor.com/features/red-eye-common-ophthalmologic-disorders-primary-care/

  An alarming symptom of anterior scleritis that helps to differentiate it from more benign causes of red eye is severe pain that is worse at night and may even wake the patient.3 […] Scleritis is associated with multiple complications such as corneal ulcer, uveitis, glaucoma, and keratitis and, thus, should be evaluated by an ophthalmologist within a couple of days.3 […] Acute angle-closure glaucoma (AACG) affects more than 2.7 million people aged 40 years and older.16 Glaucoma is sight-threatening and, thus, is considered a medical emergency.2 […] Red flags are useful warnings clinicians can employ in the decision-making process and should prompt referral to ophthalmology to rule out severe disorders (Table 1).17 […] Compared with bilateral erythema, unilateral eye redness has been associated with more serious diagnoses.17 Pain, acute vision loss, and decreased pupillary response often suggest AACG, an urgent ophthalmic condition.

• #29 Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis

  https://emedicine.medscape.com/article/1192122-overview

  Numerous conditions may be associated with red eye, including conjunctivitis, blepharitis, canaliculitis, corneal injury, dacryocystitis, episcleritis, scleritis, iritis, keratitis, dry eye syndrome, glaucoma, subconjunctival hemorrhage, bacterial or viral infection, or trauma. […] Conjunctivitis, the most common cause of red eye, is characterized by vascular dilation of the superficial conjunctival blood vessels, cellular infiltration, and exudation; it must be differentiated on the basis of etiology (viral, bacterial, or allergic). […] Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. It may be spontaneous, traumatic, or related to systemic illness. The classic presentation involves a patient without eye pain or visual disturbance who discovers the red eye in the mirror or from a concerned friend or family member. […] The prognosis depends on the cause of the red eye. For example, subconjunctival hemorrhage is a self-limited condition when not associated with systemic illness or significant trauma; thus, the prognosis is excellent. Complications also depend on the cause of the red eye.

• #30 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  Conjunctivitis […] Definition: Infectious or non-infectious inflammation of the bulbar and palpebral conjunctiva […] Symptoms: Tearing and discharge, often associated with viral symptoms, may have mild burning pain (that improves with topical anesthetics) without photophobia (if present, should consider alternative diagnoses) […] Corneal Abrasion/Foreign Bodies […] Definition: Defect or FB of the corneal epithelium causing irritation, pain, tearing, and photophobia […] Symptoms: Pain (improves with topical anesthetic), photophobia, watering/teary eyes, sensation of FB […] Endophthalmitis […] Definition: Bacterial or fungal infection involving the vitreous and/or aqueous humor […] Symptoms: Pain (no improvement with topical anesthetics) and decreased vision, +photophobia […] Scleritis […] Definition: Painful, sight-threatening cause of acute red eye […] Symptoms: Gradual onset, severe boring pain (no improvement with topical anesthetic), typically worse at night

• #31 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Red eye is one of the most common ophthalmologic conditions in the primary care setting. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye. Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial. […] Conjunctivitis is the most common cause of red eye and is one of the leading indications for antibiotics. Causes of conjunctivitis may be infectious (e.g., viral, bacterial, chlamydial) or noninfectious (e.g., allergies, irritants). Most cases of viral and bacterial conjunctivitis are self-limiting. […] A thorough patient history and eye examination may provide clues to the etiology of red eye. […] Viral conjunctivitis caused by the adenovirus is highly contagious, whereas conjunctivitis caused by other viruses (e.g., herpes simplex virus [HSV]) are less likely to spread.

• #32 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. […] Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. […] Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. […] Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. […] Corneal abrasion is diagnosed based on the clinical presentation and eye examination. […] Subconjunctival hemorrhage is diagnosed clinically. […] Episcleritis is a localized area of inflammation involving superficial layers of episclera.

• #33

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  Conjunctivitis can be viral, bacterial or allergic. […] Bacterial conjunctivitis is usually caused by Streptococcus pneumoniae, Haemophilis influenzae, Staphylococcus aureus or Moraxella catarrhalis. […] Patients with a foreign body in their eye or a corneal abrasion typically present with discomfort, watery discharge, pain associated with movement of the eye, blurring of vision and photophobia. […] Subconjunctival haemorrhage occurs when blood vessels in the space between the sclera and the conjunctiva rupture. […] Episcleritis is a local inflammation of the superficial top layer of the sclera. […] Blepharitis is a chronic inflammation of the margin of the eyelids, which can present in patients as a red eye, with burning, pruritis and discharge. […] The discomfort of dry or irritated eyes may be relieved by the use of tear replacement preparations (artificial tears) and ocular lubricants.

• #34 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. […] Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. […] Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. […] Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. […] Corneal abrasion is diagnosed based on the clinical presentation and eye examination. […] Subconjunctival hemorrhage is diagnosed clinically. […] Episcleritis is a localized area of inflammation involving superficial layers of episclera.

• #35 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  Allergic Conjunctivitis […] Definition: A sudden-onset hypersensitivity reaction caused by environmental exposure, usually a known allergen. Can be acute or seasonal […] Symptoms: Ocular pruritus, possible burning sensation, diffuse redness, eyelid edema, +/- mild photophobia. Should not be painful. May be associated with allergic rhinitis (edema of nasal turbinates and rhinorrhea). Symptoms usually bilateral, although one eye can be affected more than the other […] Anterior Uveitis […] Definition: Inflammation of the iris, choroid, and/or ciliary body […] Symptoms: Pain (no improvement with topical anesthetics), redness, photophobia (direct and consensual), tearing, decreased vision […] Bacterial Keratitis/Ulcer […] Definition: Corneal epithelial defect with stromal haze due to microorganism […] Symptoms: Significant pain (may improve with topical anesthetic), tearing, and discharge, photophobia

• #36 Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis

  https://emedicine.medscape.com/article/1192122-overview

  Numerous conditions may be associated with red eye, including conjunctivitis, blepharitis, canaliculitis, corneal injury, dacryocystitis, episcleritis, scleritis, iritis, keratitis, dry eye syndrome, glaucoma, subconjunctival hemorrhage, bacterial or viral infection, or trauma. […] Conjunctivitis, the most common cause of red eye, is characterized by vascular dilation of the superficial conjunctival blood vessels, cellular infiltration, and exudation; it must be differentiated on the basis of etiology (viral, bacterial, or allergic). […] Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. It may be spontaneous, traumatic, or related to systemic illness. The classic presentation involves a patient without eye pain or visual disturbance who discovers the red eye in the mirror or from a concerned friend or family member. […] The prognosis depends on the cause of the red eye. For example, subconjunctival hemorrhage is a self-limited condition when not associated with systemic illness or significant trauma; thus, the prognosis is excellent. Complications also depend on the cause of the red eye.

• #37 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. […] Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. […] Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. […] Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. […] Corneal abrasion is diagnosed based on the clinical presentation and eye examination. […] Subconjunctival hemorrhage is diagnosed clinically. […] Episcleritis is a localized area of inflammation involving superficial layers of episclera.

• #38 APPROACH TO RED EYE -DIAGNOSIS AND TREATMENT | PPT

  https://www.slideshare.net/slideshow/approach-to-red-eye-diagnosis-and-treatment/121086204

  14. Spontaneous subconjunctival haemorrhage Painless red eye without discharge. […] 15. acute angle closure glaucoma **Needs immediate treatment to prevent irreversible glaucomatous damage from raised intraocular pressure. […] 16. Acute Angle Closure- Symptoms – severe ocular pain, headache. […] 17. Acute Angle Closure Treatment Pilocarpine(cholinergic parasympathomimetic cause ciliary muscle to contract, and miosis). […] 18. Herpes Simplex Keratitis Reactivation of latent herpes simplex virus type 1. […] 19. Bacterial Keratitis Cause-Staph aureus, Strep pyogenes, Strep pneumoniae, Pseudomonas aeruginosa. […] 20. Anterior uveitis (Iritis) Inflammation of the anterior uveal tract. […] 21. Pre-septal and Orbital Cellulitis *Eyelid is separated into preseptal and post septal areas by the orbital septum.

• #39 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  Streamline the clinical-thinking process for assessing red eye. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing hyperemia. Red eye, or hyperemia as we refer to it in the ophthalmic world, can be the result of what seems like infinite conditions. […] This flowchart and article serve to help narrow differentials for common causes of red eye. Additionally, the information provided should help guide the practitioner in differentiating a vision-threatening diagnosis from a less severe condition. […] In an attempt to diagnose the cause of a patients red eye, the first triage question that should be asked is if the affected eye or eyes are in pain. […] If sectoral or focal, this is most likely episcleritis. Episcleritis typically either has no or only minimal pain, compared to the severe pain from scleritis. […] If the redness is diffuse but there is no associated discharge, it is likely a subconjunctival hemorrhage. […] If the diffusely hyperemic eye presents with any form of discharge, determine if there are any associated adnexal issues with the lids or lacrimal system. […] Antibiotics are often used to treat both conditions, but dacryocystitis is the more severe condition and often needs a referral for imaging or a surgical approach for treatment.

• #40 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. […] Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. […] Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. […] Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. […] Corneal abrasion is diagnosed based on the clinical presentation and eye examination. […] Subconjunctival hemorrhage is diagnosed clinically. […] Episcleritis is a localized area of inflammation involving superficial layers of episclera.

• #41 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Bacterial conjunctivitis is highly contagious and is most commonly spread through direct contact with contaminated fingers. […] Chlamydial conjunctivitis should be suspected in sexually active patients who have typical signs and symptoms and do not respond to standard antibacterial treatment. […] Allergic conjunctivitis is often associated with atopic diseases, such as allergic rhinitis (most common), eczema, and asthma. […] Dry eye (keratoconjunctivitis sicca) is a common condition caused by decreased tear production or poor tear quality. […] Corneal abrasion is diagnosed based on the clinical presentation and eye examination. […] Subconjunctival hemorrhage is diagnosed clinically. […] Episcleritis is a localized area of inflammation involving superficial layers of episclera.

• #42 Red eyes: List of common causes

  https://www.medicalnewstoday.com/articles/316179

  The causes of red eye range from a minor irritation to a more serious condition or infection, including conjunctivitis and corneal ulcers. […] Red or bloodshot eyes occur when small blood vessels on the surface of the eye become enlarged and congested with blood. […] However, if there is also eye pain, watering, dryness, or impaired vision, this can indicate a serious medical problem. […] A doctor will usually diagnose pink eye by looking at the symptoms and assessing the type of discharge present. […] Treatment options depend on the cause of the conjunctivitis. […] Without appropriate treatment, corneal ulcers can lead to vision loss, so this is a medical emergency. […] Chronic dry eye can cause the surface of the eye to become red, inflamed, and irritated. […] If red eyes occur with other symptoms, a person should contact a doctor.

• #43 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #44 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #45

  https://step2.medbullets.com/evidence/20082509

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #46 Red Eye (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/red-eye

  Red eye is a common presentation in primary care and is a sign of inflammation. Most cases will be due to relatively benign problems. The most common cause of red eye presenting in a primary care setting is conjunctivitis. A small proportion of red eye cases are serious and need urgent treatment. The challenge lies in discerning one from the other. […] This article looks at the diagnostic algorithms which help health professionals distinguish the benign from the more serious, and reviews the conditions which should be considered in the diagnostic sieve. More detailed information on specific conditions and their management can be found in the linked articles. […] For diagnostic purposes the causes of red eye are commonly divided into those which are painful and those which are not. […] Urgent referral is warranted for potentially serious problems. Features suggestive of a serious condition which may warrant urgent referral include: Acute glaucoma, Moderate-to-severe eye pain or photophobia, Marked unilateral redness. The greater the redness, the more likely it is that the cause is serious. Ciliary injection, which is not always obvious, is suggestive of inflammation of deeper structures. It is indicated by redness and dilated blood vessels that can be seen between the sclera and the iris. Reduced VA. Photophobia or seeing coloured haloes around point sources of light. Copious purulent discharge (particularly in neonates). Corneal laceration. Corneal foreign body. Intraocular foreign body. Corneal ulcer. Contact lens-related ulcer. Known or suspected eye trauma. Endophthalmitis. Recent ocular surgery. Pupillary distortion or abnormal reaction. Herpes simplex or herpes zoster. Neonatal conjunctivitis. Recurrent episodes. Proptosis. Contact lens wear. […] Chemical burns are an ophthalmic emergency and should be immediately irrigated before any steps are taken. Common agents include cement, plaster powder and oven cleaner, all of which are alkaline. Refer once pH has stabilized, even if there are no residual symptoms.

• #47 Red Eye (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/red-eye

  Red eye is a common presentation in primary care and is a sign of inflammation. Most cases will be due to relatively benign problems. The most common cause of red eye presenting in a primary care setting is conjunctivitis. A small proportion of red eye cases are serious and need urgent treatment. The challenge lies in discerning one from the other. […] This article looks at the diagnostic algorithms which help health professionals distinguish the benign from the more serious, and reviews the conditions which should be considered in the diagnostic sieve. More detailed information on specific conditions and their management can be found in the linked articles. […] For diagnostic purposes the causes of red eye are commonly divided into those which are painful and those which are not. […] Urgent referral is warranted for potentially serious problems. Features suggestive of a serious condition which may warrant urgent referral include: Acute glaucoma, Moderate-to-severe eye pain or photophobia, Marked unilateral redness. The greater the redness, the more likely it is that the cause is serious. Ciliary injection, which is not always obvious, is suggestive of inflammation of deeper structures. It is indicated by redness and dilated blood vessels that can be seen between the sclera and the iris. Reduced VA. Photophobia or seeing coloured haloes around point sources of light. Copious purulent discharge (particularly in neonates). Corneal laceration. Corneal foreign body. Intraocular foreign body. Corneal ulcer. Contact lens-related ulcer. Known or suspected eye trauma. Endophthalmitis. Recent ocular surgery. Pupillary distortion or abnormal reaction. Herpes simplex or herpes zoster. Neonatal conjunctivitis. Recurrent episodes. Proptosis. Contact lens wear. […] Chemical burns are an ophthalmic emergency and should be immediately irrigated before any steps are taken. Common agents include cement, plaster powder and oven cleaner, all of which are alkaline. Refer once pH has stabilized, even if there are no residual symptoms.

• #48 The Red Eye – International Emergency Medicine Education Project

  https://iem-student.org/the-red-eye/

  In most cases, laboratory tests are rarely indicated or of much utility. […] The two most common scenarios of obtaining imaging of the red eye include facial fracture and penetrating foreign body. […] As stated previously, any eye that has come into contact with a chemical should be irrigated with 1-2L of NS until the pH of tears has returned to neutral. […] The overall goal is to reduce intraocular pressure by decreasing aqueous production and increasing outflow. […] Most cases of conjunctivitis will be due to allergic or viral causes and can be treated with artificial tears 5-6 times per day. […] The vast majority of patients presenting for red-eye will be discharged home.

• #49 Diagnostics Test for Red Eyes Symptom | Sprint Diagnostics Hyderabad

  https://www.sprintdiagnostics.in/symptoms/red-eyes

  To diagnose the cause of red eyes, a healthcare professional may: […] Perform a comprehensive eye examination: The doctor will examine the eyes using specialized tools to assess the health of the eyes, check for any abnormalities, and identify the underlying cause. […] Ask about symptoms and medical history: Providing information about your symptoms, recent activities, and any known allergies or pre-existing eye conditions can assist in the diagnosis. […] Conduct additional tests: In some cases, additional tests such as swabs, cultures, or imaging studies may be necessary to determine the specific cause of the red eyes. […] While red eyes are often a benign and temporary condition, they can occasionally be a symptom of a more serious underlying condition. If red eyes are persistent, severe, or accompanied by severe pain, vision changes, or discharge, it is important to seek medical attention for proper evaluation and diagnosis. […] It is recommended to seek medical attention for red eyes if: […] The redness persists or worsens over time. […] You experience severe pain, vision changes, or discharge from the eyes. […] The red eyes are accompanied by other concerning symptoms or are affecting your daily activities.

• #50 The Red Eye – International Emergency Medicine Education Project

  https://iem-student.org/the-red-eye/

  In most cases, laboratory tests are rarely indicated or of much utility. […] The two most common scenarios of obtaining imaging of the red eye include facial fracture and penetrating foreign body. […] As stated previously, any eye that has come into contact with a chemical should be irrigated with 1-2L of NS until the pH of tears has returned to neutral. […] The overall goal is to reduce intraocular pressure by decreasing aqueous production and increasing outflow. […] Most cases of conjunctivitis will be due to allergic or viral causes and can be treated with artificial tears 5-6 times per day. […] The vast majority of patients presenting for red-eye will be discharged home.

• #51 Differential Diagnosis of Red and Painful Eye

  https://ddxof.com/red-and-painful-eye/

  Keratitis can be caused by infection, ultraviolet light exposure, or contact lens use. […] A critical process occurring in the anterior chamber is angle-closure glaucoma. […] An ocular examination mimicking orbital cellulitis with evidence of anterior chamber involvement, particularly in a patient with a history of recent ocular surgery or trauma suggests endophthalmitis. […] Advanced imaging may be useful in the diagnosis of traumatic and non-traumatic orbital pathology. […] Ocular ultrasound may aid with the diagnosis of a wide variety of ocular pathology including vitreous hemorrhage, retinal detachment, central retinal arterial/venous occlusions, foreign body identification, lens dislocation and retrobulbar hematoma.

• #52 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  Streamline the clinical-thinking process for assessing red eye. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing hyperemia. Red eye, or hyperemia as we refer to it in the ophthalmic world, can be the result of what seems like infinite conditions. […] This flowchart and article serve to help narrow differentials for common causes of red eye. Additionally, the information provided should help guide the practitioner in differentiating a vision-threatening diagnosis from a less severe condition. […] In an attempt to diagnose the cause of a patients red eye, the first triage question that should be asked is if the affected eye or eyes are in pain. […] If sectoral or focal, this is most likely episcleritis. Episcleritis typically either has no or only minimal pain, compared to the severe pain from scleritis. […] If the redness is diffuse but there is no associated discharge, it is likely a subconjunctival hemorrhage. […] If the diffusely hyperemic eye presents with any form of discharge, determine if there are any associated adnexal issues with the lids or lacrimal system. […] Antibiotics are often used to treat both conditions, but dacryocystitis is the more severe condition and often needs a referral for imaging or a surgical approach for treatment.

• #53 The Red Eye – International Emergency Medicine Education Project

  https://iem-student.org/the-red-eye/

  A 27-year-old female with no past medical problems presents to the emergency room complaining of 2 days of a red, itchy and burning left eye. […] The initial step in the assessment is to determine if there is chemical exposure. […] If there has been no chemical exposure, a thorough history and physical should be obtained. […] If the eye is painful, break it down based on the anatomic structure involved. […] If the red eye is painless, determine if the erythema is localized or diffuse. […] A thorough history should be obtained by paying particular attention to the following: […] The patients description of eye sensation can also help with the evaluation of the red-eye. […] The ocular examination has numerous components, requires particular technical skill and therefore should be approached systematically so that no part of the exam is overlooked.

• #54 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  Streamline the clinical-thinking process for assessing red eye. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing hyperemia. Red eye, or hyperemia as we refer to it in the ophthalmic world, can be the result of what seems like infinite conditions. […] This flowchart and article serve to help narrow differentials for common causes of red eye. Additionally, the information provided should help guide the practitioner in differentiating a vision-threatening diagnosis from a less severe condition. […] In an attempt to diagnose the cause of a patients red eye, the first triage question that should be asked is if the affected eye or eyes are in pain. […] If sectoral or focal, this is most likely episcleritis. Episcleritis typically either has no or only minimal pain, compared to the severe pain from scleritis. […] If the redness is diffuse but there is no associated discharge, it is likely a subconjunctival hemorrhage. […] If the diffusely hyperemic eye presents with any form of discharge, determine if there are any associated adnexal issues with the lids or lacrimal system. […] Antibiotics are often used to treat both conditions, but dacryocystitis is the more severe condition and often needs a referral for imaging or a surgical approach for treatment.

• #55 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  Streamline the clinical-thinking process for assessing red eye. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing hyperemia. Red eye, or hyperemia as we refer to it in the ophthalmic world, can be the result of what seems like infinite conditions. […] This flowchart and article serve to help narrow differentials for common causes of red eye. Additionally, the information provided should help guide the practitioner in differentiating a vision-threatening diagnosis from a less severe condition. […] In an attempt to diagnose the cause of a patients red eye, the first triage question that should be asked is if the affected eye or eyes are in pain. […] If sectoral or focal, this is most likely episcleritis. Episcleritis typically either has no or only minimal pain, compared to the severe pain from scleritis. […] If the redness is diffuse but there is no associated discharge, it is likely a subconjunctival hemorrhage. […] If the diffusely hyperemic eye presents with any form of discharge, determine if there are any associated adnexal issues with the lids or lacrimal system. […] Antibiotics are often used to treat both conditions, but dacryocystitis is the more severe condition and often needs a referral for imaging or a surgical approach for treatment.

• #56 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  Streamline the clinical-thinking process for assessing red eye. Use this guide, with a comprehensive downloadable flowchart, to learn the latest on diagnosing hyperemia. Red eye, or hyperemia as we refer to it in the ophthalmic world, can be the result of what seems like infinite conditions. […] This flowchart and article serve to help narrow differentials for common causes of red eye. Additionally, the information provided should help guide the practitioner in differentiating a vision-threatening diagnosis from a less severe condition. […] In an attempt to diagnose the cause of a patients red eye, the first triage question that should be asked is if the affected eye or eyes are in pain. […] If sectoral or focal, this is most likely episcleritis. Episcleritis typically either has no or only minimal pain, compared to the severe pain from scleritis. […] If the redness is diffuse but there is no associated discharge, it is likely a subconjunctival hemorrhage. […] If the diffusely hyperemic eye presents with any form of discharge, determine if there are any associated adnexal issues with the lids or lacrimal system. […] Antibiotics are often used to treat both conditions, but dacryocystitis is the more severe condition and often needs a referral for imaging or a surgical approach for treatment.

• #57 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  If a patient exhibits discharge in the affected red eye but appears to have no adnexal issues, assess the frequency and quality of the discharge. […] If the discharge is mucopurulent in nature, the red eye or eyes are likely the result of a type of bacterial conjunctivitis. […] Generally, gonococcal and chlamydial conjunctivitis are treated with systemic antibiotics while bacterial conjunctivitis from the majority of other organisms may be treated with topical antibiotic therapy. […] When the red eye presents with a more serous or watery discharge, consider a viral or allergic conjunctivitis. […] Moving on to diagnoses of red eyes with constant severe pain, first consider checking for a foreign body in the eye if the patient has a history of any kind of recent ocular trauma or foreign body sensation. […] If the patient has a markedly elevated intraocular pressure (IOP), typically with an evidently narrow or closed anatomical angle, they are likely experiencing an acute angle closure glaucoma attack.

• #58 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  If a patient exhibits discharge in the affected red eye but appears to have no adnexal issues, assess the frequency and quality of the discharge. […] If the discharge is mucopurulent in nature, the red eye or eyes are likely the result of a type of bacterial conjunctivitis. […] Generally, gonococcal and chlamydial conjunctivitis are treated with systemic antibiotics while bacterial conjunctivitis from the majority of other organisms may be treated with topical antibiotic therapy. […] When the red eye presents with a more serous or watery discharge, consider a viral or allergic conjunctivitis. […] Moving on to diagnoses of red eyes with constant severe pain, first consider checking for a foreign body in the eye if the patient has a history of any kind of recent ocular trauma or foreign body sensation. […] If the patient has a markedly elevated intraocular pressure (IOP), typically with an evidently narrow or closed anatomical angle, they are likely experiencing an acute angle closure glaucoma attack.

• #59 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  If a patient exhibits discharge in the affected red eye but appears to have no adnexal issues, assess the frequency and quality of the discharge. […] If the discharge is mucopurulent in nature, the red eye or eyes are likely the result of a type of bacterial conjunctivitis. […] Generally, gonococcal and chlamydial conjunctivitis are treated with systemic antibiotics while bacterial conjunctivitis from the majority of other organisms may be treated with topical antibiotic therapy. […] When the red eye presents with a more serous or watery discharge, consider a viral or allergic conjunctivitis. […] Moving on to diagnoses of red eyes with constant severe pain, first consider checking for a foreign body in the eye if the patient has a history of any kind of recent ocular trauma or foreign body sensation. […] If the patient has a markedly elevated intraocular pressure (IOP), typically with an evidently narrow or closed anatomical angle, they are likely experiencing an acute angle closure glaucoma attack.

• #60 How To Diagnose Red Eye – with Downloadable Flowchart

  https://eyesoneyecare.com/resources/how-to-diagnose-red-eye-with-downloadable-flowchart/

  When cells and flare are present in a painful hypermic eye, consider uveitis or endophthalmitis. […] Should fluorescein staining be present in the red eye, we want to appraise the cornea for any kind of dendritic appearance. […] Despite the plethora of causes for red eye(s) that present for evaluation, hopefully this guide will facilitate clinical thinking when attempting to diagnose and treat these patients.

• #61 Red Eye: A Guide for Non-specialists

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5443986/

  Red eye can arise as a manifestation of many different systemic and ophthalmological diseases. […] A correct assessment of the urgency of the situation is vitally important for the planning of further diagnostic evaluation and treatment. […] Primary care physicians typically see 410 patients per week who complain of ocular symptoms. Most of them have red eye as the major clinical finding. […] The duration and laterality of symptoms (uni- vs. bilateral) and the intensity of pain are the main criteria allowing the differentiation of non-critical changes that can be cared for by a general practitioner from diseases calling for elective referral to an ophthalmologist and eye emergencies requiring urgent ophthalmic surgery. […] The differential diagnosis of red eye can be narrowed down rapidly with simple baseline tests and targeted questioning. Patients with ocular emergencies should be referred to an ophthalmologist at once, as should all patients whose diagnosis is in doubt.

• #62 The Red Eye – Core EM

  https://coreem.net/core/the-red-eye/

  10 Cant Miss Diagnoses of the Red Eye […] Acute angle-closure glaucoma (AACG) […] Bacterial keratitis/ulcer […] Endophthalmitis […] Hyphema […] Hypopyon […] Iritis […] Infectious keratitis (bacterial and viral) […] Orbital cellulitis […] Scleritis […] Uveitis […] A brief differential for a PAINFUL red eye based on symptom description: […] Itching = allergies […] Burning = lid disorders, dry eye […] FB sensation = FB, corneal abrasion […] Localized lid tenderness = hordeolum, chalazion […] Deep, intense pain = corneal abrasion, scleritis, iritis, acute glaucoma, sinusitis, orbital cellulitis […] Photophobia = corneal abrasions, iritis, acute glaucoma (think about ciliary body muscle spasm or other problems from the anterior segment of the eye) […] Halo vision = acute glaucoma, uveitis (resulting from corneal edema)

• #63 Red and Painful Eye – Unilateral and Bilateral (Diagnosis and Treatment) : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/red-and-painful-eye-unilateral-and-bilateral-diagnosis-and-treatment/

  Red and Painful Eye – Unilateral and Bilateral (Diagnosis and Treatment) […] Critical not to miss sight-threatening conditions such as acute angle-closure glaucoma, endophthalmitis, scleritis, uveitis, iritis, keratitis. […] The differential diagnosis is wide and ranges from benign presentations (subconjunctival hemorrhage) to sight threatening conditions (acute angle-closure glaucoma). […] Narrowing down the diagnosis of red and painful eye involves a thorough history and ophthalmologic examination with the following elements: Visual acuity, Penlight examination, Intraocular pressure, Skin and lid examination, Slit lamp examination, Fluorescein examination. […] The diagnostic process and treatments for vision-threatening and common causes of red and painful eye are outlined below. […] Emergent ophthalmological consultation indicated for patients with suspected acute angle-closure glaucoma, endophthalmitis, scleritis, uveitis, iritis, keratitis.

• #64 Diagnosis and Management of Red Eye in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p137.html/Accessed

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #65

  https://step2.medbullets.com/evidence/20082509

  Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. […] The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

• #66 The red eye: Evaluation and management – UpToDate

  https://www.uptodate.com/contents/the-red-eye-evaluation-and-management

  The red eye: Evaluation and management […] „Red eye” is a common presenting complaint in ambulatory practice. This topic presents an approach for distinguishing patients with red eye who must be referred to an ophthalmologist, such as those with angle-closure glaucoma, from patients who can be managed by the primary care clinician, such as those with allergic conjunctivitis (table 1 and table 2). Some distinguishing features of conditions presenting as a red eye are summarized in a table (table 3). […] „Red eye” is a common presenting complaint in ambulatory practice. A small percentage of patients with red eye need urgent ophthalmological referral and treatment, although the vast majority can be treated by the primary care clinician. […] Patient history, measurement of visual acuity, and findings on penlight examination are important features in determining the cause and management of red eye. The history and ocular examination provide guidance in the decision about whether to refer the patient for ophthalmologic evaluation. […] Determining who needs to be seen in person — Many patients with a red eye call to inquire whether they need to be seen by a clinician. Certain historical features or presenting complaints signal the need for clinician examination and possibly patient referral.

• #67

  https://bpac.org.nz/bpj/2013/august/redeye.aspx

  Most cases of red eye seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are red flags that a sight-threatening condition may be present. […] In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. […] The most likely cause of a red eye in patients who present to general practice is conjunctivitis. However, red eye can also be a feature of a more serious eye condition, in which a delay in treatment due to a missed diagnosis can result in permanent visual loss.

Zobacz więcej