Table 1.

Management of red eye in primary care

ACTION	CONDITION	DESCRIPTION
Referral	Acute angle closure glaucoma	Severe ocular pain, systemic symptoms (eg, nausea, vomiting, headache), decreased vision, colour haloes around lights, fixed mid-dilated pupil, cloudy cornea, and raised intraocular pressure
	Uveitis	Sudden onset pain, photophobia, blurred vision, circumcorneal congestion, tenderness on palpation, meiotic pupil, and decreased intraocular pressure with flare
	Scleritis	Severe pain, ocular tenderness, and bluish-red scleral discolouration; associated with autoimmune illnesses (eg, rheumatoid arthritis)
	Keratitis	Ocular pain, redness, decreased vision, and white lesions (ulcers); fluorescein staining is typically indicated. Often secondary to trauma or wearing contact lenses
	Other	Chemical burns, penetrating trauma, endophthalmitis, orbital cellulitis, hyphema, or conjunctivitis that does not resolve within 7-10 days of symptom development
Treatment	Herpes simplex conjunctivitis	Painful vesicular rash over V1 distribution of trigeminal cranial nerve that requires treatment with antivirals and referral to an ophthalmologist, especially if Hutchinson sign is present
	Hyperacute gonococcal conjunctivitis	Hyperacute red eye with severe purulent discharge; requires conjunctival scrapings for culture and sensitivity, then medical management of patient and contacts. Follow up daily and consider referral if there is no improvement
	Chlamydial (inclusion) conjunctivitis	Affects sexually active teens and young adults as well as neonates (typically from developing countries). Mucopurulent keratoconjunctivitis unresponsive to antibiotics. Requires treatment of local infection and assessment for systemic infection
Reassurance	Conjunctivitis	Mild discomfort, no visual changes. Bacterial—purulent discharge; viral—preauricular node; allergic—pruritus and particularly watery discharge (usually both eyes). For infectious cases, encourage good hand and eye hygiene. If suspected bacterial cause does not improve 3 days after symptoms begin, consider ophthalmic antibiotics. If symptoms do not improve in 7–10 days, refer
	Dry eye	Foreign body sensation worsened with dry air and improved with artificial tear eyedrops
	Episcleritis	Mild irritation and photophobia, hyperemia or diffuse redness in episcleral vessel, and self-limiting, with or without NSAIDs
	Blepharitis	Inflammation of eyelid margin causing red, itchy, crusted lids, with or without abnormal eyelash growth, colour, or loss. Encourage eyelid hygiene
	Subconjunctival hemorrhage	Spontaneous or traumatic. No specific treatment, but possible contributory factors
	Gland infection	Boil-like lesions on lid or more chronic rubbery, nontender chalazions (hordeolum or stye) Hot compresses might help lesions rupture and drain

NSAID—nonsteroidal anti-inflammatory drug, V1—fifth cranial nerve, ophthalmic division.