++
++
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.
++
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.
++
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.
++
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.
++
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.
+++
What Shouldn’t
Be Missed
++
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.
++
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. Prompt ...