Red Eyes: Diagnosis, History and Examination

What is Red Eyes?

A red eye can be alarming but is often just a sign of a minor eye condition, such as conjunctivitis or a burst blood vessel. If it is painful, there may be a more serious problem. Ocular pain is often associated with a red eye.

1Subconjunctival haemorrhageTypically asymptomatic, spontaneous. May be associated with traumaUnilateral (except some trauma) contiguous red area
2Viral conjunctivitisForeign body sensation, watering, no visual loss or photophobia, ?Recent contact with person with red eye or URTIBilateral, prominent inflamed conjunctival vessels, follicles, enlarged tender preauricular lymph node
3Bacterial conjunctivitisForeign body sensation, discharge, no visual loss or photophobiaBilateral, prominent inflamed conjunctival vessels, mucopus
4Allergic conjunctivitisItch, watering, no visual loss or photophobia, history of atopyBilateral, prominent inflamed conjunctival vessels, follicles
5Iritis (anterior uveitis)Reduced vision, aching sensation, photophobia, PMH or systemic enquiry may elicit underlying diseaseUnilateral, prominent pericorneal vessels, small pupil, aqueous cells and protein (at slit lamp), hypopyon
6Acute angle-closure glaucomaSevere pain, haloes/rainbows around lights, redused vision, hypermetropic, elderlyUnilateral, pericorneal prominent vessels, semidilated (oval) pupil, corneal oedema, shallow anterior chamber (slit lamp)
7EpiscleritisMild discomfort, tenderness, no visual loss or photophobia, young adult, otherwise fit and wellUnilateral, typically sectorial prominent inflamed subconjunctival vessels (may also be nodular or diffuse)
8ScleritisSignificant aching pain, tender, photophobia, occasionally reduced vision, systemic enquiry may elicit underlying diseaseUnilateral, typically sectorial prominent inflamed deep scleral vessels (may also be nodular or diffuse)
9Becterial keratitisForeign body sensation, watering/discharge, visual loss, photophobia, ? Pre-existing ocular surface disease, recent trauma or contact lens wearUnilateral, opacity in cornea (slit lamp) stains with fluorescein
10Herpetic viral keratitisForeign body sensation, watering/dischange, visual loss, photophobia, ?Cold scores or ophthalmic shinglesUnilateral, branching linear dendrite(s) on cornea (slit lamp) stains with fluorescein
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