Unilateral red eye

Clinical Features

• Unilateral red/painful eye

Differential Diagnosis

Unilateral Red Eye

• Ruptured Globe^
• Corneal Abrasion and Foreign Body
• Conjunctival laceration
• Corneal Ulcer^
• Caustic Keratoconjunctivitis^^
• Subconjunctival Hematoma
• Traumatic Iritis
• Hypema^
• Endophthalmitis^
• Corneal Abrasion
• Corneal Ulcer^
• Herpes Zoster Ophthalmicus
• Corneal erosion
• UV keratitis
• Acute Angle Glaucoma^
• Nontraumatic iritis
• Scleritis^
• Anterior Uveitis
• Ocular foreign body
• Conjunctivitis
• Keratoconjunctivits
• Episcleritis
• Subconjunctival Hematoma
• Inflamed pingueculum
• Inflamed Pterygium
• Keratoconus

Diagnosis

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

Diagnostic Algorythm

Traumatic

• Obvious Ruptured Globe^
• No obvious ruptured globe
  • Epithelial defect
    • Corneal Abrasion and Foreign Body
    • Conjunctival laceration
    • Corneal Ulcer^
    • Caustic Keratoconjunctivitis^^
    • Occult Ruptured Globe^
      • (positive Sidel's)
  • No defect
    • Subconjunctival Hematoma
    • Traumatic Iritis
    • Hypema^
      • (?occult open globe)
    • Endophthalmitis^
      • (old occult open globe)

Nontraumatic

• Epithelial defect
  • Corneal Abrasion
  • Corneal Ulcer^
  • Herpes Zoster Ophthalmicus (dendrite)
  • Corneal erosion
    • (morning pain)
  • UV keratitis
    • (SPK)
  • Scleral penetration^
• No defect
  • No pain relief w/ tropicamide
    • Acute Angle Glaucoma^
      • dilated
      • closed angle
      • inc pressure
    • Nontraumatic Iritis
    • Scleritis^
      • (localized; no move Q-tip)
    • Anterior Uveitis
      • (hypopyon, cilliary flush)
  • No pain OR pain relief w/ tropicamide
    • Foreign body
    • Conjunctivitis
    • Keratoconjunctivits
    • Episcleritis
      • (localized; move w/ Q-tip)
  • Non-uptake finding (no pain/pain relief w/ tropicamd)
    • Subconjunctival Hematoma
    • Inflamed pingueculum
    • Inflamed Pterygium
    • Keratoconus (protrude)

^Emergent diagnosises

^^Critical diagnosises

Managment

• By diagnosis

See Also

• Eye Algorithm (Main)
• Corneal Abrasion vs Ulcer
• Red Eye (Bilateral)
• Red Eye (by Sx)

Source

• Rosen
• WMS Practic Guidelines 2000)