red eye (pink eye, ocular erythema)
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Etiology
- blepharitis
- conjunctivitis
- subconjunctival hemorrhage
- xerophthalmia (dry eye)
- eyelid malposition or exposure
- episcleritis
- scleritis
- iritis
- keratitis
- Herpes zoster ophthalmicus
- angle-closure glaucoma
- chalazion
- foreign body
Clinical manifestations
- severe pain & reduced visual acuity suggests:
- sharp or superficial pain suggests foreign body
- deep, aching pain, nausea, vomiting suggests angle-closure glaucoma
- pain with reading &/or photophobia suggests iritis or keratitis
- decreased visual acuity suggests keratitis or iritis
- itching with mucoid or watery discharge suggests allergic conjunctivitis
- viral conjunctivitis suggested by
- preauricular lymph node tendermess[2]
- upper respiratory infection followed by one, then a second red eye
- diffuse, unilateral redness with morning crusting of eyelashes suggests bacterial conjunctivitis
- profusely purulent discharge in a sexually active adult suggests gonorrhea
- chronic red eye & periauricula adenopathy in a sexually active adult suggests chlamydia
- consititutional symptoms may be associated with
Laboratory
Diagnostic procedures
- visual acuity
- pattern of redness
- diffuse (conjunctival)
- around the cornea (ciliary flush)
- eye discharge
- corneal opacities
- anterior chamber depth
- pupillary irregularity
- intraocular pressure
Management
- red flags should prompt ophthalmology consult
- visual disturbance, including diminished visual acuity
- photophobia
- pupillary changes
- ocular pain
- trauma
- hyper-purulent conjunctivitis of gonorrhea
- keratitis, iritis, scleritis are ophthalmology emergencies
- acute angle-closure glaucoma is an ophthalmology emergency
- Herpes zoster ophthalmicus is an ophthalmology emergency
- ocular manifestations of gonorrhea or chlamydia warrant ophthalmology referral[1]
- bacterial conjunctivitis without red flags
- cold compresses
- trimethoprim/polymixin B or erythromycin ophthalmic if immunocompromised, contact lenses, healthcare worker
- viral conjunctivitis without red flags
- allergic conjunctivitis without red flags
- antihistamine, topical vasoconstrictor, mast-cell stabilizer
- episcleritis (not scleritis) without red flags
- supportive care (self limited)
- do not treat red eye with glucocorticoid[1]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 2.0 2.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010 Jan 15;81(2):137-44. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20082509
- ↑ Bal SK, Hollingworth GR. Red eye. BMJ. 2005 Aug 20;331(7514):438. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16110072 Free PMC Article
- ↑ Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. 2006 Apr;119(4):302-6. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16564769
- ↑ Leibowitz HM. The red eye. N Engl J Med. 2000 Aug 3;343(5):345-51. Review. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/10922425 <Internet> http://www.nejm.org/doi/full/10.1056/NEJM200008033430507
- ↑ Tarff A, Behrens A. Ocular emergencies: red eye. Med Clin North Am. 2017;101:615-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28372717