Unilateral red eye

Diagnosis

1. Evert lens and look for foreign body
2. Remove contacts
3. Photophobia suggests inflammation i.e. uveitis and abrasions
4. Pupil: irregular with positive sidel's suggests penetrating injury

Trauma

1. Obvious Ruptured Globe^
2. No obvious ruptured globe
   1. Epithelial defect
      1. Corneal Abrasion
      2. Corneal Ulcer^
      3. Caustic Keratoconjunctivitis^^
      4. Occult Ruptured Globe^
         1. (positive Sidel's)
   2. No defect
      1. Subconjunctival Hematoma
      2. Traumatic Iritis
      3. Hypema^
         1. (?occult open globe)
      4. Endophthalmitis^
         1. (old occult open globe)

Nontraumatic

1. Epithelial defect
   1. Corneal Abrasion
   2. Corneal Ulcer^
   3. Herpes Zoster Ophthalmicus (dendrite)
   4. Corneal erosion
      1. (morning pain)
   5. UV/welders keratitis
      1. (SPK)
   6. Scleral penetration^
2. No defect
   1. No pain relief w/ tropicamide
      1. Acute Angle Glaucoma^
         1. dilated
         2. closed angle
         3. inc pressure
      2. Nontraumatic Iritis
      3. Scleritis^
         1. (localized; no move Q-tip)
      4. Anterior Uveitis
         1. (hypopyon, cilliary flush)
   2. No pain/pain relief w/ tropicamide
      1. Foreign body
      2. Conjunctivitis
         1. Viral
         2. Bacterial^
            1. (purulent-->?GC)
         3. Allergic
         4. Contact
         5. Toxic
         6. Chlamydial
      3. Keratoconjunctivits
      4. Episcleritis
         1. (localized; move w/ Q-tip)
   3. Non-uptake finding (no pain/pain relief w/ tropicamd)
      1. Subconjunctival Hematoma
      2. Inflamed pingueculum
      3. Inflamed Pterygium
      4. Keratoconus (protrude)

^Emergent diagnosises

^^Critical diagnosises

Painful

1. Corneal Abrasion
2. Corneal Ulcer
3. Foreign Body
4. Trauma

Endophthalmitis following prior surgery, with Hypopyon or pus in anterior chamber

Less Common

1. Periorbital/orbital Cellulitis
2. Acute Glaucoma: corneal clouding
3. Scleritis
4. Uveitis (recurrent in AS): keratic precipitates
   1. photophobia, perilimbal injection
5. Hyphema/Hypopyon
6. Shingles (look for concurrent skin findings)
7. Thyroid Eye Dz

Painless

1. Conjunctivitis
2. Subconjunctival Hemorrhage: h/o trauma or valsalva, DM, HTN
3. Episcleritis
4. Allergic Reaction

See Also

• Corneal Abrasion vs Ulcer
• Red Eye (Unilateral) 2
• Red Eye (Bilateral)
• Red Eye (by Sx)

Source

DONALDSON (adapted from Rosen, WMS Practic Guidelines 2000)

Pani