GuidelinesOther guideline
The Painful Red Eye
The Painful Red Eye
Key history
- Unilateral or bilateral
- Pain – only irritation or severe pain?
- Vision
- Other symptoms – itch, photophobia, discharge
Key Examination
DO
- Visual acuity in both eyes
LOOK FOR
- Presence/type of discharge
- Redness
- Corneal clarity
- Pupil size and reaction
| History | Visual acuity | Examination | Diagnosis | Investigations/referral |
| Uni or bilateral, purulent discharge, irritation only | Normal or clears with blink | Diffuse redness, purulent discharge, normal VA | Bacterial conjunctivitis | Topical chloramphenicol return if pain or reduced VA |
| Usually bilateral, watery discharge, irritation only | Normal or clears with blink | Diffuse redness, | Viral conjunctivitis | Topical chloramphenicol return if pain or reduced VA |
| Trauma, sharp pain, watery discharge | May be reduced, improves with pinhole | Clear cornea defect that stains with fluorescein | Corneal abrasion | Topical chloramphenicol pad, review in 24 hours |
| Reduced vision, irritation/pain. | Reduced | Branching corneal ulcer that stains with fluorescein | Herpetic keratitis | Topical acyclovir and semi urgent referral |
| Reduced vision, pain | Reduced | White infiltrate in cornea with fluorescein staining overlying | Bacterial keratitis | Urgent |
| Aching pain, photophobia | Reduced | Redness around cornea, small pupil | Uveitis | Semi urgent referral |
| Severe pain, nausea | Reduced, may see haloes around lights | Hazy cornea, mid dilated, non reactive cornea | Acute angle closure glaucoma | Urgent referral |
| Irritation, mild pain | Normal | Focal or diffuse tender conjunctival redness | Episcleritis | Semi urgent referral |
| Severe pain with boring quality that may wake patient | Normal or reduced | Deep redness | Scleritis | Urgent referral |