Red eye Microchapters
Synonyms and keywords: Bloodshot eye
Red eye is one of the most common complaints managed by primary care physicians though in some cases it heralds a serious and life-threatening condition needing urgent referral to ophthalmologist. The etiology of red eye can be infectious, traumatic, inflammatory, allergic, autoimmune and rarely secondary to tumors. Red eye stems from pathologies of eye lid, conjunctiva, cornea, sclera and uvea. Signs and/or symptoms such as photophobia, pain, visual acuity, itchiness, foreign body sensation and if the condition is unilateral or bilateral, must be documented. Whenever a red flag is identified in a patient presenting with red eye, the clinician must refer the patient for a same-day ophthalmologist consult.
There is no established system for the classification of red eye.
- The cause of red eye is diagnosed through a comprehensive eye examination and patient's history. The most common cause of red eye is conjunctivitis and the most common etiology is viral. There are other causes though, and differential diagnosis must include other diseases such as corneal abrasion, blepharitis, subconjunctival hemorrhage, foreign body, iritis, keratitis, chemical burn, glaucoma, and scleritis that may confound the physician.
- Conjunctivitis, episcleritis and subconjunctival haemorrhage make up about 70% of the primary care red eye consultations.
The most common causes of sight-threatening causes of red eye include
Differentiating Red eye from other Diseases
While evaluating patients presenting with red eye, a crucial step is to identify the patients that have sight-threatening causes. This can be evaluated by asking historical questions about associated symptoms and performing a complete ocular examination. Associated symptoms include:
- Visual acuity
- History of trauma or exposure
- History of secretion
- History of systemic symptoms
|Viral conjunctivitis||Supportive care and preservative-free artificial tears|
||Environmental antigens||Supportive care and topical antihistamines|
||Chronic inflammation of eyelids (staphyloccocal infections)|
|Subconjunctival hemorrhage||Bright red patch on sclera||
||Refer for further investigation|
||Idiopathic inflamation||Topical steroids|
|Acute angle closure glaucoma||
||Systemic diseases||Refer urgently|
In patients presenting with red eye, it is important to take a full detailed history and physical examination. In assessment of patient's red eye, the diagnosis can be narrowed by distinguishing other associated symptoms.
|Viral conjunctivitis||More than 80% of all acute conjunctivitis||Adenovirus is most common cause||
|Bacterial conjunctivitis||Up to 50% of all acute conjunctivitis||Most cases are self-limiting but|
|Allergic conjunctivitis||More than 40% of population||
|Blepharitis||More than 40% of patients presenting with red eye||
|Subconjunctival hemorrhage||About 3% of patients with red eye||
||Refer to investigate for underlying cause|
|Glaucoma||More than 70 million cases worldwide||
||Lowering intraocular pressure|
|Scleritis||Between 0.2% to 0.6% of patients with red eye||
||It can be associated with some systemic disorders|
For more information on treatment click here.
- Tarff, Andreina; Behrens, Ashley (2017). "Ocular Emergencies". Medical Clinics of North America. 101 (3): 615–639. doi:10.1016/j.mcna.2016.12.013. ISSN 0025-7125.
- Cronau H, Kankanala RR, Mauger T (January 2010). "Diagnosis and management of red eye in primary care" (2): 137–44.
- Kilduff C, Lois C (2016). "Red eyes and red-flags: improving ophthalmic assessment and referral in primary care". BMJ Qual Improv Rep. 5 (1). doi:10.1136/bmjquality.u211608.w4680. PMC 4964165. PMID 27493748.
- Narayana, Sirisha; McGee, Steven (2015). "Bedside Diagnosis of the 'Red Eye': A Systematic Review". The American Journal of Medicine. 128 (11): 1220–1224.e1. doi:10.1016/j.amjmed.2015.06.026. ISSN 0002-9343.
- Sethuraman U, Kamat D (2009). "The red eye: evaluation and management". Clin Pediatr (Phila). 48 (6): 588–600. doi:10.1177/0009922809333094. PMID 19357422.
- Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M (2017). "Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician". West J Emerg Med. 18 (3): 509–517. doi:10.5811/westjem.2016.12.31798. PMC 5391903. PMID 28435504.
- Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
- Putnam CM (2016). "Diagnosis and management of blepharitis: an optometrist's perspective". Clin Optom (Auckl). 8: 71–78. doi:10.2147/OPTO.S84795. PMC 6095371. PMID 30214351.
- Tarlan B, Kiratli H (2013). "Subconjunctival hemorrhage: risk factors and potential indicators". Clin Ophthalmol. 7: 1163–70. doi:10.2147/OPTH.S35062. PMC 3702240. PMID 23843690.
- Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
- Galor A, Thorne JE (2007). "Scleritis and peripheral ulcerative keratitis". Rheum Dis Clin North Am. 33 (4): 835–54, vii. doi:10.1016/j.rdc.2007.08.002. PMC 2212596. PMID 18037120.