eTable 1. Classification of the causes of red eye by disease site.
Characteristics | Diseases of the ocular surface | ||||||||
Conjunctivitis | Allergy | Dry eye | Subconjunctival hemorrhage | Erosion | Corneal ulcer | Photokeratitis | Episcleritis/scleritis | ||
Bacterial | Viral | ||||||||
Incidence | +++ | + | +++ | +++ | + | ++ | – | ++ | – |
(U)nilateral/ (B)ilateral |
U/B | U/B | B | B | U | U | U | B | U |
Worsening of vision |
+ | +++ | + | + | – | ++ | ++ | +++ | + |
Photophobia | (+) | +++ | + | (+) | – | + | + | +++ | + |
(L)ocalized/ (D)iffuse reddening |
D | D | D | D | L | D | D | D | L |
(S)uperficial/ (D)eep reddening |
S | S | S | S | S | S | S | S | S/D |
Secretion: (P)urulent/ (W)atery/ (M)ucinous |
P | W | W | M/W | – | W | W/P | W | W |
Conjunctival hemorrhage |
– | (+) | – | – | + | – | – | – | – |
Conjunctival chemosis |
+ | +++ | ++ | – | – | – | – | +++ | (+) |
Corneal lesions | (+) | – | (+) | + | – | + | ++ | + | – |
Foreign body event |
– | – | – | – | + / – | + / – | – | – | – |
Elevated ocular pressure |
– | – | – | – | – | – | – | – | – |
Further features | Gradual onset, often initially unilateral | Extreme symptoms, first on one side and then bilaterally | Ask about causative agent, seasonal accumulation, general history: atopy | Chronic problem, often with a long history | Arterial hypertension, blood pressure crises, trauma, foreign body event | Trauma, foreign body, eyelid malposition, eyelid closure defect | Nerve palsy, eyelid malposition, eyelid closure defect | Welding in the previous 6–8 h | Frequently recurrent, deep injection of the sclera, investigate for systemic diseases |
Urgency of definitive diagnosis | Normal referral to ophthalmologist | Immediate referral to ophthalmologist following notification and hygiene measures | Normal referral to ophthalmologist | Normal referral to ophthalmologist | Normal referral to ophthalmologist | Urgent referral to ophthalmologist | Emergency, consult ophthalmologist immediately | Normal referral to ophthalmologist | Urgent referral to ophthalmologist |
Incidence: +++ very often, ++ often, + occasionally, – rarely
Remainder of table: (+) may occur, +/– can occur with or without changes