creation date: 2026-06-17 21:46
tags: Workups
Red Eye
Background
Red eye is a common complaint with a small percentage requiring ophthalmologic referral.
Differential Diagnosis
Diagnoses requiring prompt ophthalmology management are:
- Angle-closure glaucoma (severe, unrelenting pain, N/V, blurred vision, hazy cornea with no stain)
- Herpes zoster ophthalmicus (Hutchinson’s sign (nose involvement))
- Corneal ulcer (severe pain, contact lens use, hypopyon)
Other conditions that require ophthalmology consultations are:
- Herpetic HSV keratitis
- Anterior uveitis, iritis
- Corneal abrasion
- Episcleritis
Less concerning conditions are:
- Subconjunctival hemorrhage (vision fine, painless, quick onset)
- Conjunctivitis (viral vs. bacterial vs. allergic)
- Dry eye with keratitis (patchy uptake of stain)
Initial Evaluation
History
Include:
- Onset
- Unilateral or bilateral
- Presence of discharge
- Presence of pain
- Vision changes
- History of trauma or infectious exposure (eg. recent URTI)
- Sensation of foreign body
- Allergic symptoms
- Photophobia
- Systemic symptoms
- Previous occurrences
Physical Exam
Eye exam consist of:
- Visual acuity
- Pupillary response (light, accomodation, RAPD)
- Extraocular movement
- Visual fiels
Additional exam includes:
- Intraocular pressure measurement
- Fluorescein staining and slit lamp exam
- Fundoscopy
Investigations
Referral to ophthalmology is indicated if:
- Vision affected
- Elevated IOP
- Pupillary anomaly
- Corneal problem (abrasion, dendrite, ulcer)
- Chronic and unresolving
- Concerning previous history