Red eye (by symptoms)

CAUSTIC CONTAMINATION:

-caustic keratoconjunctivitis**

[anesth/irrigation until ph 7/optho]

...alkaline exp requires min 4L over 40min

PROPTOSIS or EXT SWELLING:

-blepharitis

[warm compresses 15min 4x/day, scrub w/ mild shampoo BID, outpt optho]

-chalazion

-stye (hordeolum)

[warm compress 15min 4xday, massage, optho if fails]

-dacrocystitis:inflammation lower eyelid near punctum

[oral analgesia, abx, optho]

-inflam pseudotumor: retrobulbar inflamm

[iop, systemic w/u, CT, steroids and optho]

-peri/orbital cellulitis*: orbital w/ systemic sx

[CTX/Vanco, cx, CT, admit]

-retrobulbar abscess/emphysema/hematoma**

[iop, abx, correct coagulopathy, admit]

-orbital tumor*

[iop, ct, optho]

SEVERE PAIN or FB SENSATION:

-keratitis*

[r/o penetration, tetanus, topical abx, optho referral]

-keratoconjunctivitis

-epi/scleritis

-anterior uveitis*

[optho recs]

-acute angle-closure glaucoma**

[iop, timolol, apraclonidine, prednisolone, pilocarpine, mannitol 2g/kg IV]

-hyphema*

[r/o rupture, head elevation, optho]

-endophthalmitis*

[CTX, vanco; admit to optho]

FOCAL REDNESS or BULBAR CONJUNCTIVA

-inflamed pterygium

[naphazoline/ketorolac drops, outpt referral]

-scleral penetration**

[pain relief, antiemetic, tetanus, admit optho]

-subconjunctival hemorrhage

[hx re coagulopathy, reassure will resolve 2-3 wks]

PURULENT DISCHARGE

-bacterial conjunctivitis*

[peds: polymyxin B + trimethoprim ointment 10Ds OU]

[adults: sulfacetamide or gent; cipro if pseudomonas; drops 10D OU]

ITCHING SENSATION

-allergic conjunctivitis

[naphazoline drops, oral antihistamines, outpt optho]

TOPICAL MEDS or COSMETICS

-contact dermatoconjunctivitis

-toxic conjunctivitis

[irrigate, naphazoline drops, outpt for tx failure]

IF NONE OF ABOVE: (consider)

-Chlamydia conjunctivitis

[PO erythromycin x 14D; CTX for gonorrhea]

-viral conjunctivitis

[naphazoline or ketorolac drops]

Source

Adapted from Pani