When to refer the patient with a red eye

Question 1

When to refer the patient with a red eye

Answer 1

Uncertainty about the diagnosis

Deep central corneal and intraocular foreign bodies

Sudden swelling of an eyelid in a child

• with evidence of infection suggestive of orbital cellulitis—this is an emergency

Emergency referral is also necessary for:

• hyphaemia
• hypopyon
• penetrating eye injury
• acute glaucoma
• severe chemical burn.

Question 2

Summary for urgent referral

Answer 2

• Trauma (significant)/penetrating injury
• Hyphaema >3 mm
• Corneal ulcer
• Severe conjunctivitis
• Uveitis/acute iritis
• Behcet syndrome
• Acute glaucoma
• Giant cell arteritis/temporal arteritis
• Orbital cellulitis
• Acute dacryocystitis
• Keratitis
• Episcleritis/scleritis
• Herpes zoster ophthalmicus
• Endophthalmitis

As a general rule, never use corticosteroids or atropine in the eye before referral to an ophthalmologist.

Question 3

Practice tips for eye management

Answer 3

Avoid long-term use of any medication, esp. antibiotics (e.g. chloramphenicol: course for a maximum of 10 days)

As a general rule avoid using topical corticosteroids or combined corticosteroid/antibiotic preparations

Never use corticosteroids in the presence of a dendritic ulcer

To achieve effective results from eye ointment or drops,

• remove debris such as mucopurulent exudate with bacterial conjunctivitis or blepharitis
• by using a warm solution of saline (dissolve a teaspoon of kitchen salt in 500 mL boiled water)
• to bathe away any discharge from conjunctiva, eyelashes and lids

Beware of the contact lens ‘overwear syndrome’, which is treated in a similar way to flash burns