Red eye (by symptoms)

Caustic Contamination

1. Caustic Keratoconjunctivitis**

Proptosis or Swelling

1. Blepharitis
2. Chalazion
3. Stye (Hordeolum)
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. Periorbital Cellulitis*
7. Orbital Cellulitis
8. retrobulbar abscess/emphysema/hematoma**
   1. [iop, abx, correct coagulopathy, admit]
9. orbital tumor*
   1. [iop, ct, optho]

Unilateral Red/Painful

1. Corneal Abrasion
2. Corneal Ulcer
3. Foreign Body
4. Trauma

Endophthalmitis following prior surgery, with Hypopyon or pus in anterior chamber

Less Common

1. Periorbital/orbital Cellulitis
2. Acute Glaucoma: corneal clouding
3. Scleritis
4. Uveitis (recurrent in AS): keratic precipitates
   1. photophobia, perilimbal injection
5. Hyphema/Hypopyon
6. Herpes Zoster Ophthalmicus (look for concurrent skin findings)
7. Thyroid Eye Dz

Severe Pain or FB Sensation

1. keratitis*
   1. [r/o penetration, tetanus, topical abx, optho referral]
2. keratoconjunctivitis
3. Episcleritis
4. Scleritis
5. Anterior Uveitis*
6. Acute Angle-Closure Glaucoma
7. Traumatic Hyphema
8. Endophthalmitis*

Focal Redness or Bulbar Conjunctiva

1. inflamed Pterygium
2. scleral penetration**
   1. [pain relief, antiemetic, tetanus, admit optho]
3. Subconjunctival Hematoma

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

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]

None of the Above

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

See Also

• Eye Algorithm (Main)
• Red Eye (Unilateral)

Source

Adapted from Pani