Unilateral red eye
Background
- This page describes a general approach to the complaint of unilateral eye redness
Clinical Features
- Unilateral red/painful eye
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Evaluation
- Evert lid 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 Algorithm
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
- Hyphema^
- (?occult open globe)
- Endophthalmitis^
- (old occult open globe)
- Epithelial defect
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 with tropicamide
- Acute Angle Glaucoma^
- dilated
- closed angle
- inc pressure
- Nontraumatic Iritis
- Scleritis^
- (localized; no move Q-tip)
- Anterior Uveitis
- (hypopyon, ciliary flush)
- Acute Angle Glaucoma^
- No pain OR pain relief with tropicamide
- Foreign body
- Conjunctivitis
- Keratoconjunctivitis
- Episcleritis
- (localized; move with Q-tip)
- Non-uptake finding (no pain/pain relief with tropicamide)
- Subconjunctival Hematoma
- Inflamed pinguecula
- Inflamed Pterygium
- Keratoconus (protrude)
- No pain relief with tropicamide
^Emergent diagnoses
^^Critical diagnoses
Management
- By diagnosis
Disposition
- Depends on causative etiology
See Also
Eye Algorithms
- Red eye
- Periorbital swelling
- Acute vision loss (noninflamed)
- Acute onset flashers and floaters
- Painful eyes with normal exam
- Neonatal eye problems