Red eye

Red eye is one of the most common ophthalmic problems presenting to GP.  There is a potentially long differential diagnosis list for red eye, but an accurate history and examination can usually determine the cause and management. Presentation

  • Ask about pain and visual loss which are suggestive of more serious conditions like:
    • corneal ulceration
    • iritis
    • acute glaucoma
  • Ask about discharge
    • if purulent- suggests bacterial conjunctivitis
    • if clear (may be mistaken for tears)- suggests a viral/allergic conjunctivitis
  • A gritty sensation is common in conjunctivitis but a foreign body in the eye must be excluded
  • Itching is common in
    • Allergic eye disease
    • Blepharitis
    • Topical drop sensitivity
  • It may also be useful to differentiate (on examination) 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 vessels, which are more superficial (so look more red), move with the conjunctiva and constrict with the application of topical vasoconstrictors

Examination and Investigation

  • Check visual acuity; extraocular movements; pupillary reflexes (and any photophobia)
  • Slit-lamp examination with fluoroscein should be performed to exclude any abrasions/ulceration etc
  • Intra-ocular pressure would be important if glaucoma is suspected

Differential Diagnosis

red eye

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