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The Problem
“My child’s eye is red.”
Common Causes
Conjunctivitis
Infectious
Allergic
Trauma
Corneal abrasion/foreign body
Blunt trauma
Contact lens related
Poor fit
Infection
Other Causes
Episcleritis
Iritis
Acute glaucoma
KEY FINDINGS
History
Conjunctivitis
Infectious
Exposure to other infected children
Recent upper respiratory infection
Allergic
Itching
Atopic history
Trauma
History of incident
Not always readily available (due to age, attempting to hide story due to fear of punishment, etc.)
Contact lens related
History of contact lens wear
Poor lens hygiene
Continued wear despite discomfort
Examination
Conjunctivitis
Infectious
Watery (viral) or purulent (bacterial) discharge
Conjunctival swelling
Cornea usually clear
Allergic
Mild conjunctival swelling
Watery discharge
Trauma
Corneal abrasion or corneal foreign body
Hyphema
Subconjunctival hemorrhage
Contact lens related
Conjunctival inflammation
Corneal clouding
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The main decision in evaluating a patient with a red eye is whether the disorder is likely to recover without sequela or whether there is a potentially serious problem. If the patient has bacterial conjunctivitis, the cornea is clear, and the patient is not significantly uncomfortable, then they should be treated with topical antibiotics. A culture is usually not necessary unless the discharge is hyperpurulent. Patients with allergic conjunctivitis can be treated with topical medication, although oral allergy medication is often better tolerated in children.

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If a patient has a corneal abrasion, the cornea is otherwise clear, and there is no suspicion of an intraocular foreign body, then treatment with topical antibiotics is indicated. Small foreign bodies can sometimes be removed with topical anesthetic and gentle manipulation with a cotton-tipped applicator. If a foreign body cannot be removed, or if there is any clouding of the cornea, referral is indicated.

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Patients with direct ocular injuries, such as from a ball or fist, should be evaluated for a hyphema, corneal damage, and orbital fracture. Referral is indicated for most patients with nontrivial blunt ocular trauma.

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Patients with red eyes who wear contact lenses should be instructed to stop wearing the lenses immediately. There is an increased risk of corneal infections in these patients, and they should be referred promptly to their eye care provider.

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For any of these conditions, patients with marked pain that cannot be readily explained (e.g., from an uncomplicated corneal abrasion), or whose vision is significantly decreased, should be referred to a pediatric ophthalmologist.

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What Shouldn’t Be Missed

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If a patient has a corneal abrasion that does not heal in 1 to 2 days, this raises the possibility of a foreign body. Small fragments of items such as clear plastic or glass may be difficult to visualize. If the cornea becomes cloudy in any patient with a red eye, prompt referral is indicated.

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Although it is rare, meninogoccal conjunctivitis may present with hyperpurulent discharge. This organism has the potential for rapid dissemination, which may progress to meningitis and sepsis. ...

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