This document provides guidance on evaluating and treating red eye. It lists important questions to ask patients about symptoms, duration, and medical history. Potential causes of red eye are grouped into categories like infection, inflammation, allergy and trauma. Based on characteristics like pain, vision changes, and whether the issue is unilateral or bilateral, the document provides differential diagnoses. It outlines examination steps and suggests considering referral for issues causing visual loss, pain, corneal involvement or no response to treatment, especially for immunocompromised patients.

1. The Red Eye
Is it serious?
Do I need to do anything about it?
Can I treat it myself ?
Do I need to send the patient
somewhere else and if so when?
Pune 2019 Michael Eckstein

2. What questions are
important?
• How long have you had it, how
is it changing?
• Symptoms? Vision ……
• Past History relevant? eg Contact
lenses, surgery, previous uveitis…

3. symptoms

4. symptoms
Pain
Photophobia
Itchiness
Irritation
Deep pain
Watering
Discharge
Sticky

5. What can you do?
-Check vision
-Check pupils
-Look at both eyes and eyelids
-Use blue light with fluorescein if you have it

6. Causes

7. Causes
• Irritation
• Infection
• Inflammation
• Allergy
• Trauma

8. Causes
• Dry eyes
• Foreign body
• Conjunctivitis
• Corneal ulcer
• Keratitis
• Uveitis
• Lid disease: blepharitis, meibomianitis
• Episcleritis
• Scleritis
• Traumatic

9. Categories
Bilateral Unilateral Painful No pain
Vision
normal
Vision
reduced

10. Bilateral Unilateral
Conjunctivitis
Infection
Allergy
Dry eyes
Blepharitis
meibomianitis
Infection
Corneal ulcer
Herpetic
Inflammation
Episcleritis
Scleritis
Marginal keratitis
Pterygium
Uveitis
trauma

11. No Pain Pain
Conjunctivitis
Infection
Allergy
Dry eyes
Blepharitis
meibomianitis
Infection
Corneal ulcer
Herpetic
Inflammation
Episcleritis
Scleritis
Marginal keratitis
Uveitis
trauma

12. Normal vision Vision affected
Conjunctivitis
Dry eyes
Episcleritis
Marginal keratitis
?scleritis
?uveitis
Corneal ulcer
?Scleritis
Uveitis
Arc eye
Severe conjunctivitis

13. Both eyes , no pain,
normal vision

14. Pain, watering, normal vision

15. One eye, no pain, normal
vision

16. One eye, pain, reduced
vision

17. One eye, pain, vision
reduced

18. One eye photophobia, reduced vision

19. One eye, pain, vision affected

20. Both eyes, pain, vision affected

21. Both eyes, normal vision,
itchy

22. One eye, irritation,
normal vision

23. When to consider
referral
• Visual loss
• Severe pain
• Purulent discharge
• Corneal involvement
• Conjunctival scarring
• No response to Rx
• Immunocompromised e.g HIV