This series of articles aims to provide an overview of the most commonly presenting cases of red eyes in primary care and will serve as a useful reference guide for the consulting room. It is hoped this will help support practices involved in MECS schemes.

Overview

When a patient presents with an acute problem it can sometimes be difficult to decide how urgently they should be seen. The optometrist is not always the first person the patient will speak to. With this in mind there are several very good triage forms available for support staff to use and then pass on to the optometrist who can then decide on an appropriate timescale. One is may be downloaded from https://pecsouthern.org.uk/wp-content/uploads/sites/132/2017/09/170925-PEC-Triage-Sheet.pdf.

From a practitioner point of view however, it is always important to think about why you are asking the patient the questions you are. Is it just a checklist to work through or are you trying to gain valuable information which will help you come to a diagnosis?

The first thing to do is to work out how serious the condition is and how quickly you need to see the patient. In the case of a red eye there are five key questions to ask:

  • When did this happen?
  • How is the vision?
  • Is it painful?
  • Is there any photophobia?
  • Is there any discharge?

Once this has been established good follow up questions include:

  • Is one or are both eyes affected?
  • Is it constant or intermittent?
  • Has the patient had anything like this before and, if so, what is the frequency of recurrence?
  • Are they a contact lens wearer?
  • Are there any associated symptoms or systemic conditions?
  • Is there anything which appears to exacerbate or relieve the condition?

From an examination point of view the following would be recommended:

  • Always check vision/visual acuity
  • Look at pupils and assess pupil reactions
  • Look at the pattern or distribution of the redness
  • Carefully examine the conjunctiva, including lid eversion to view palpebral conjunctiva
  • Undertake a thorough corneal slit lamp examination
  • Assess the anterior chamber (A/C) examination with appropriate illumination and magnification

Careful questioning and examination will help to differentiate between the potential causes of red eye. Essentially, we need to know the underlying cause so we can treat it. The main underlying causes of red eye to be identified are:


  • Infection
  • Inflammation
  • Trauma
  • Degeneration

By the time this approach is completed we will hopefully have an idea of what is going on and be able to formulate a management plan. The various common presentations of red eye discussed in this series have been split into painless red eye  and here  and here. Referral to these articles should help in your choice of answers to the following questions.

Colin Davidson is an independent prescriber optometrist based in Sussex.

Further Reading