Acute red eye is a common presenting complaint to primary care physicians.[1] A detailed history of the presenting symptoms and previous ophthalmic and medical history can narrow the differential diagnosis and aid in the interpretation of key examination findings. The lack of specialist equipment in the primary care setting, along with a very broad differential diagnosis, can cause difficulty in establishing the correct diagnosis, and in such cases a specialist ophthalmic opinion should be sought.[1] Serious vision-threatening conditions that present as red eye are rare and can occasionally be overshadowed by associated systemic symptoms; in light of this they should always be considered within the differential and excluded on examination.[2]
Summary
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Trichiasis
Entropion
Ectropion
Blepharitis
Dry eye (stained with fluorescein)
Bacterial conjunctivitis
Viral conjunctivitis
Allergic (vernal) keratoconjunctivitis
Subconjunctival hemorrhage
Subtarsal foreign body: vertical corneal abrasions seen with fluorescein stain
Corneal ulcer seen with fluorescein stain
Dendritic ulcer seen with fluorescein stain
Corneal foreign body
Corneal abrasion seen with fluorescein stain
Anterior uveitis with posterior synechiae
Scleritis
Episcleritis
Penetrating corneal injury with iris prolapse
Angle-closure glaucoma: central corneal edema with an oval-shaped mid-dilated pupil
A newborn with gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection
Chlamydial conjunctivitis
Gonococcal conjunctivitis
Gonorrheal conjunctivitis: resulted in partial blindness
Conjunctivitis: consequence of reactive arthritis
A patient with left herpes zoster ophthalmicus affecting the forehead and side of the nose (positive Hutchinson's sign; yellow arrows). The crusted skin rashes follow the V1 dermatomal distribution and do not cross the vertical midline
Citations
Cheung AY, Choi DS, Ahmad S, et al. Conjunctivitis preferred practice pattern. Ophthalmology. 2024 Apr;131(4):P134-204.[Full Text]
Rhee MK, Ahmad S, Amescua G, et al. Bacterial keratitis preferred practice pattern. Ophthalmology. 2024 Apr;131(4):P87-133.[Full Text]
Amescua G, Ahmad S, Cheung AY, et al. Dry eye syndrome preferred practice pattern. Ophthalmology. 2024 Apr;131(4):P1-49.[Full Text]
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