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Red Eye Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Jan 15, 2016
 

Approach Considerations

The key to management is making the correct diagnosis in a timely fashion. Uncomplicated cases of blepharitis, conjunctivitis, foreign bodies, corneal abrasion, and subconjunctival hemorrhage may be managed by the primary care physician.[3, 20, 21, 22, 23] However, other possible causes of red eye require ophthalmologic consultation within an appropriate time period. Corneal ulcers, iritis, endophthalmitis, penetrating foreign bodies, and other conditions must be seen by a specialist promptly.[24]

All patients with acute changes in vision require immediate consultation. Primary care physicians should refrain from treating any patients with corticosteroids without first obtaining an appropriate consultation. Referral to an internist or a family physician should be made as indicated for hypertension or bleeding diathesis.[1, 2]

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Cause-Specific Management

All cases of conjunctivitis are treated with antibiotic drops to address the bacterial cause or prevent secondary bacterial infection. The common practice of prescribing a topical antibiotic ointment creates poor compliance owing to patient frustration with ointment application, as well as poor clinical response due to the limited sensitivity spectrum of the most commonly available ophthalmic ointments. Allergic conjunctivitis is treated with topical antihistamines and pulse vasoconstrictors, when indicated, occasionally in conjunction with antibiotic drops. Vasoconstrictors should never be prescribed on a long-term basis owing to the high risk of dependency. Herpes conjunctivitis and keratitis require systemic treatment with acyclovir (800 mg orally 5 times daily) and with 3% acyclovir ophthalmic ointment, topical trifluridine, or topical ganciclovir.

Red eye caused by conjunctivitis may be contagious. Washing hands and avoiding use of contaminated tissues or washcloths helps prevent spread to the other eye or to other individuals.

In blepharitis, cleaning the eyelids with soap eyelid-specific soapy applicators (Avenova, Ocusoft, Oasis brands) several times a day usually leads to symptomatic improvement. Antibiotic drops or pills may also be necessary.

Treatment of episcleritis and scleritis involves administration of nonsteroidal anti-inflammatory drugs (NSAIDS) such as diclofenac 50 mg orally 3 times daily and referral to an ophthalmologist.

Patients with iritis should be promptly (ie, within 1-2 days) referred to an ophthalmologist. Topical steroids are usually initiated by the ophthalmologist, along with cycloplegic agents to prevent synechiae.

For keratitis, the use of antibiotic eye drops or the appropriate topical antiviral agent is indicated, depending on the etiology, along with referral to an ophthalmologist.

Angle-closure glaucoma is a medical emergency that may lead to blindness; therefore, prompt treatment and evaluation by an ophthalmologist are warranted. Temporizing treatment consists of miotic drops (eg, pilocarpine 1% or 2% every 5 minutes up to 1 hour), acetazolamide (500-1000 mg orally or intravenously [IV]), antiemetics, analgesia, and, in some cases, IV mannitol. Peripheral iridotomy, usually performed with a YAG laser, is essentially curative.

In cases of subconjunctival hemorrhage with no history of trauma, no treatment is required. Artificial tears can be used 4 times per day for mild irritation. Elective use of aspirin products or NSAIDs should be discouraged. With time and blood breakdown, the hemorrhage may become green or yellow, like a bruise, spreading around the circumference of the globe. Usually, this disappears within 2 weeks. Patients are told to return if the bruiselike appearance does not fully resolve, if pain ensues, or if the hemorrhage recurs.

Treatment of red eye from a corneal or conjunctival foreign body consists of removal of the foreign body, administration of antibiotic drops, and follow-up with an ophthalmologist to monitor for the development of an infection. An Alger brush or metal rotating burr is often required to remove the painful and cicatrizing residual rust ring seen commonly after iron-containing metallic foreign body removal.

Treatment of red eye caused by dry eye syndrome (DES), or keratoconjunctivitis sicca (KCS), consists of administration of artificial tear drops and referral to an ophthalmologist if symptoms persist.

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Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Coauthor(s)

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Vivian Monsanto, MD 

Vivian Monsanto, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Acknowledgements

Gino A Farina, MD Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine

Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Judith Flaherty-Arnoux, MD Resident Physician, Department of Emergency Medicine, Long Island Jewish Medical Center

Disclosure: Nothing to disclose.

Kilbourn Gordon III, MD, FACEP Urgent Care Physician

Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Gregory I Mazarin, MD Assistant Professor, Department of Emergency Medicine, Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine; Consulting Staff, St Vincent's Midtown, North Shore University Hospital

Gregory I Mazarin, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Follicular conjunctivitis and subconjunctival hemorrhage.
Symblepharon secondary to epidemic keratoconjunctivitis.
Blepharitis. Courtesy of Wikipedia Commons.
Scleritis. Courtesy of Wikipedia Commons.
Acute dacryocystitis.
Canaliculitis of the left lower lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
Corneal abrasion.
This photograph depicts a child with a bilateral eye condition known as interstitial keratitis (IK), a stigma related to congenital syphilis.
Conjunctivitis. Courtesy of Wikipedia Commons.
 
 
 
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