Unilateral red eye

Clinical Features

• Unilateral red/painful eye

Differential Diagnosis

Unilateral red eye

• Nontraumatic
  • Acute angle-closure glaucoma^
  • Anterior uveitis
  • Conjunctivitis
  • Corneal erosion
  • Corneal ulcer^
  • Endophthalmitis^
  • Episcleritis
  • Herpes zoster ophthalmicus
  • Inflamed pinguecula
  • Inflamed pterygium
  • Keratoconjunctivitis
  • Keratoconus
  • Nontraumatic iritis
  • Scleritis^
  • Subconjunctival hemorrhage
• Orbital trauma
  • Caustic keratoconjunctivitis^^
  • Corneal abrasion, Corneal laceration
  • Conjunctival hemorrhage
  • Conjunctival laceration
  • Globe rupture^
  • Hemorrhagic chemosis
  • Lens dislocation
  • Ocular foreign body
  • Posterior vitreous detachment
  • Retinal detachment
  • Retrobulbar hemorrhage
    • Ocular compartment syndrome
  • Traumatic hyphema
  • Traumatic iritis
  • Traumatic mydriasis
  • Traumatic optic neuropathy
  • Vitreous detachment
  • Vitreous hemorrhage
  • Ultraviolet keratitis

^Emergent diagnoses
^^Critical diagnoses

Evaluation

• Evert lid and look for foreign body
• Remove contacts
• Photophobia suggests inflammation i.e. uveitis and abrasions
• Pupil: irregular with positive sidel's suggests penetrating injury

Diagnostic Algorithm

Traumatic

• Obvious Ruptured Globe^
• No obvious ruptured globe
  • Epithelial defect
    • Corneal Abrasion and Foreign Body
    • Conjunctival laceration
    • Corneal Ulcer^
    • Caustic Keratoconjunctivitis^^
    • Occult Ruptured Globe^
      • (positive Sidel's)
  • No defect
    • Subconjunctival Hematoma
    • Traumatic Iritis
    • Hyphema^
      • (?occult open globe)
    • Endophthalmitis^
      • (old occult open globe)

Nontraumatic

• Epithelial defect
  • Corneal Abrasion
  • Corneal Ulcer^
  • Herpes Zoster Ophthalmicus (dendrite)
  • Corneal erosion
    • (morning pain)
  • UV keratitis
    • (SPK)
  • Scleral penetration^
• No defect
  • No pain relief with tropicamide
    • Acute Angle Glaucoma^
      • dilated
      • closed angle
      • inc pressure
    • Nontraumatic Iritis
    • Scleritis^
      • (localized; no move Q-tip)
    • Anterior Uveitis
      • (hypopyon, ciliary flush)
  • No pain OR pain relief with tropicamide
    • Foreign body
    • Conjunctivitis
    • Keratoconjunctivitis
    • Episcleritis
      • (localized; move with Q-tip)
  • Non-uptake finding (no pain/pain relief with tropicamide)
    • Subconjunctival Hematoma
    • Inflamed pinguecula
    • Inflamed Pterygium
    • Keratoconus (protrude)

^Emergent diagnoses

^^Critical diagnoses

Management

• By diagnosis

Disposition

• Depends on causative etiology

See Also

Eye Algorithms

• Red eye
  • Bilateral red eyes
  • Unilateral red eye
  • Red eye (by symptoms)
  • Red eye (peds)
    • Neonatal conjunctivitis
• Periorbital swelling
• Acute vision loss (noninflamed)
• Acute onset flashers and floaters
• Painful eyes with normal exam
• Neonatal eye problems