Red eye (by symptoms)

Caustic Contamination

1. caustic keratoconjunctivitis**
   1. [anesth/irrigation until ph 7/optho]
   2. ...alkaline exp requires min 4L over 40min

PROPTOSIS or EXT SWELLING

1. blepharitis
   1. [warm compresses 15min 4x/day, scrub w/ mild shampoo BID, outpt optho]
2. chalazion
3. stye (hordeolum)
   1. [warm compress 15min 4xday, massage, optho if fails]
4. dacrocystitis:inflammation lower eyelid near punctum
   1. [oral analgesia, abx, optho]
5. inflam pseudotumor: retrobulbar inflamm
   1. [iop, systemic w/u, CT, steroids and optho]
6. peri/orbital cellulitis*: orbital w/ systemic sx
   1. [CTX/Vanco, cx, CT, admit]
7. retrobulbar abscess/emphysema/hematoma**
   1. [iop, abx, correct coagulopathy, admit]
8. orbital tumor*
   1. [iop, ct, optho]

SEVERE PAIN or FB SENSATION

1. keratitis*
   1. [r/o penetration, tetanus, topical abx, optho referral]
2. keratoconjunctivitis
3. epi/scleritis
4. anterior uveitis*
   1. [optho recs]
5. acute angle-closure glaucoma**
   1. [iop, timolol, apraclonidine, prednisolone, pilocarpine, mannitol 2g/kg IV]
6. hyphema*
   1. [r/o rupture, head elevation, optho]
7. endophthalmitis*
   1. [CTX, vanco; admit to optho]

FOCAL REDNESS or BULBAR CONJUNCTIVA

1. inflamed pterygium
   1. [naphazoline/ketorolac drops, outpt referral]
2. scleral penetration**
   1. [pain relief, antiemetic, tetanus, admit optho]
3. subconjunctival hemorrhage
   1. [hx re coagulopathy, reassure will resolve 2-3 wks]

PURULENT DISCHARGE

1. bacterial conjunctivitis*
   1. [peds: polymyxin B + trimethoprim ointment 10Ds OU]
   2. [adults: sulfacetamide or gent; cipro if pseudomonas; drops 10D OU]

ITCHING SENSATION

1. allergic conjunctivitis
   1. [naphazoline drops, oral antihistamines, outpt optho]

TOPICAL MEDS or COSMETICS

1. contact dermatoconjunctivitis
2. toxic conjunctivitis
   1. [irrigate, naphazoline drops, outpt for tx failure]

IF NONE OF ABOVE: (consider)

1. Chlamydia conjunctivitis
   1. [PO erythromycin x 14D; CTX for gonorrhea]
2. viral conjunctivitis
   1. [naphazoline or ketorolac drops]

Source

Adapted from Pani