Common presentation requiring differentiation of benign surface disease from sight-threatening pathology.
Examination
- • Visual acuity in both eyes — the key triage step
- • Pupil reactions and relative afferent defect
- • Fluorescein staining
- • Ciliary flush and photophobia suggest deep pathology
Differential diagnosis
- • Conjunctivitis (no pain, normal acuity)
- • Keratitis/corneal ulcer
- • Anterior uveitis
- • Acute angle-closure glaucoma
- • Scleritis
- • Subconjunctival haemorrhage
Management
- • Bacterial conjunctivitis: chloramphenicol drops
- • Uveitis: urgent ophthalmology, topical steroid and cycloplegic
- • Contact lens wearer with red eye: same-day ophthalmology (pseudomonal keratitis)
- • Angle closure: acetazolamide, pilocarpine, urgent referral
Clinical pearls
- • Never prescribe topical steroids without slit-lamp assessment — herpetic ulcers perforate
Related in WardRound
Educational — verify locally.
