Assessment of the red eye

	Acuity	Foreign-body sensation	Photophobia	Discharge	Cardinal feature	Treat/refer
Lids/lashes
Stye/hordeoleum	Normal	-	-	None	Tender	Treat
Chalazion	Normal	-	-	None	Nontender	Treat
Blepharitis	Normal	-	-	Dry crusting	Chronic	Treat
Conjunctiva
Conjunctivitis
Bacterial	Normal	-	-	Mucopurulent	Discharge all day	Treat
Viral	Normal	-	-	Mucoserous	None/URI	Treat
Allergic	Normal	-	-	Mucoserous	Itching	Treat
Nonspecific (toxic or dry eye syndrome)	Normal	-	-	Watery
Episcleritis	Normal	-	-	None	Sectoral injection, dull ache	Treat
Subconjunctival hemorrhage	Normal	-	-	None	Extravasated blood	Treat
Cornea
Abrasion	Normal or decreased	+	+	Watery	History/trauma defect revealed by fluorescein	Treat
Contact lens overwear	Normal or decreased	+	+	Watery	History	Treat
Foreign body	Normal or decreased	+	+	Mucoserous	History/trauma	Treat initially by attempt to remove by irrigation or swab; refer if still present after 24 hours
Infectious keratitis
Bacterial	Normal or decreased	+	+	Muco-purulent	White spot on cornea spots stains with fluorescein	Emergency referral (same day)
Viral	Normal or decreased	+	+	Watery	Gray, branching opacity dendrite; dendrite revealed with fluorescein	Urgent referral (1 to 2 days)
Anterior chamber/iris
Iritis	Normal or decreased	-	+	None/watery	Ciliary flush, very small pupil	Urgent referral (1 to 2 days)
Hyphema	Normal or decreased	-	+/-	None/watery	RBC "level"	Emergency referral (same day)
Hypopyon	Normal or decreased	-	+/-	None/purulent	WBC "level"	Emergency referral (same day)
Iris/lens
Angle closure	Normal or decreased	-	+/-	None/watery	Fixed, mid-dilated pupil	Emergency referral (same day)

URI: upper respiratory infection; RBC: red blood cell; WBC: white blood cell.

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