Acute red eye

Causes of acute red eye, clinical features and management

 ophthalmology

conjunctivitisglaucomasubconjunctival haemorrhageuveitis
historyitching, pain and dischargeintense pain, rainbow / halos, headache, blurred vision. Attack starts in darkened conditions (dilated pupil).alarming usually sudden onset of red patch sometimes with bleedingprevious autoimmune disease, dull aching pain, photophobia
examinationconjunctival rednessconjunctival redness, raised intraocular pressurelocalised patch of haemorrhage360-degree perilimbal injection
pupilnormalmid-sized pupil not reactive to lightnormalsmall pupil
pathologyviral (mild symptoms, watery discharge), bacterial (more severe symptoms, mucopurulent discharge), allergic (less pain more itching, cobblestone papillae under upper eyelid)acute angle-closure glaucomaantiplatelet / anticoagulant therapy, spontaneousunderlying systemic disease in half of patients. Granulmatous / non-granulomatous disease.
managementmost will settle, consider antibacterials / anti-inflammatory treatmentbetablocker / alphablocker eye drops, pilocarpine. Oral / IV acetazolamideno specific treatment needed. Will reabsorb over a few weeks.corticosteroids
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Further reading:

Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician 2010 Jan;81(2):137–144. Available from: http://www.aafp.org/afp/2010/0115/p137.html



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