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For the pediatrician, a child with a red eye can be a significant challenge; the key decision is whether to refer to a pediatric ophthalmologist. The diagnosis is often reasonably clear after a careful history has been obtained. The examination may be challenging without the availability of an accurate visual acuity test for each eye, appropriate diagnostic eye drops, microscopic examination, and the distraction devices that pediatric ophthalmologists often use. Making an incorrect diagnosis in a child with a red eye can result in vision loss, and inappropriate treatment can have vision-threatening side effects. The pediatrician is occasionally tempted to treat a red eye with steroid eye drops, but this should only be prescribed by a physician able to do a complete eye examination and measure intraocular pressure. Therefore, in practice, steroids should not be prescribed by pediatricians or family physicians.

Conjunctivitis is a common problem in childhood. The conjunctiva becomes red and inflamed in response to a wide range of inciting agents, such as infections, allergens, chemicals, smoke, trauma, toxins, and systemic diseases. Red eye is not a common feature of congenital glaucoma or nasolacrimal duct obstruction. This chapter focuses on diagnosis and treatment of injected or red conjunctiva. The differential diagnosis and management of a red eye are outlined in Tables 578-1, 578-2, 578-3, 578-4. These tables do not provide exhaustive lists, but rather present the scope of problems that may lead to a red eye. History taking is more likely to lead to the correct diagnosis if this broad range of possible diagnoses is considered. Figure 578-1 provides a useful guide to evaluating a child with a red eye.


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