Update in office management
Management of the Red Eye for the Primary Care Physician

https://doi.org/10.1016/j.amjmed.2005.07.065Get rights and content

Abstract

For the primary care physician, the occurrence of a red eye is a frequent and prominent finding of a disease process in patients. A careful history and simple examination with the observation of typical clinical signs are important for the management of this common disorder. The causes can be classified as painful red eye, trauma, and other common conditions. The most frequent causes of a red eye, such as dry eye, conjunctivitis, keratitis, iritis, acute glaucoma, subconjunctival hematoma, foreign bodies, corneal abrasion, and blunt or penetrating trauma, are described in this article. Simple diagnostic methods and an emergency management with some useful topical ophthalmic preparations are included. Although several conditions can be treated by the primary care physician the clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.

Section snippets

Conjunctivitis

The causes to consider in patients with suspected acute conjunctivitis are allergic; bacterial (staphylococci, pneumococci, gonococci, haemophilus); viral (adenovirus, herpes viruses); and chlamydial. The most prominent signs are generalized conjunctival injection with gritty discomfort, mild photophobia, and variable discharge but no loss of visual acuity.

Allergic conjunctivitis usually presents with itching tearing, large cobblestone papillae under the upper lid, and conjunctival swelling

Subconjunctival Hematoma (Hyposphagma)

Two types of subconjunctival hematoma can be presented: spontaneous and traumatic. In spontaneous cases with no other subjective complaints, this may arise from coughing and straining or from atherosclerotic vessels, particularly in the elderly, and can be associated with hypertension or a bleeding diathesis (Figure 2). Check the blood pressure and reassure the patient that the blood will disperse within 2 weeks. No further treatment is needed.

In traumatic cases this may be the result of a

Dry Eye

The typical sign of common dry eye is a foreign body sensation, and the feeling can be exacerbated by dry air such as air conditioning. Dry eye is found in patients with Sjögren’s syndrome.

Artificial tear eyedrops can be used without prescription. If the symptoms persist, a consultation by an ophthalmologist is recommended.

Blepharitis

Blepharitis is a frequent chronic inflammation of the eyelid margin causing red, itchy, and crusted lids. Styes and chalazions can be associated.

In chronic cases, cleaning

References (0)

Cited by (47)

View all citing articles on Scopus
View full text