Most red eyes are conjunctivitis, but reduced vision, photophobia and a pupil that is irregular or poorly reactive each point away from the conjunctiva and towards keratitis, uveitis or angle closure.
Ciliary flush — redness concentrated around the cornea rather than spread across the conjunctiva — adds weight. Any of these warrants same-day slit-lamp examination; avoid starting topical steroids before the cornea has been examined.
- Check visual acuity in every red eye
- Ask about photophobia and pain rather than grittiness
- Look at the pupil shape and reaction
- Do not start topical steroids before slit-lamp examination of the cornea
Why it matters
Delayed recognition of uveitis or keratitis in primary care costs sight that early treatment saves.
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