Infections, allergies and injuries inflame the eye and cause a red eye.

Common causes

• Conjunctivitis
• Corneal ulcer or keratitis
• Acute iritis
• Acute glaucoma

Acute red eye may have a history of injury to the eye or there may be no history of injury.

History of injury is straight forward. There may be a foreign body on the cornea or on the conjunctiva, under the eyelid. A blunt injury may cause a subconjunctival haemorrhage or bleeding into the anterior chamber (hyphaema).

Acute red eye with no history of injury

TREATMENT

Therapeutic objectives

• To treat the infection and prevent blindness, in the case of acute conjunctivitis and corneal ulcer
• To relieve pain and redness and refer immediately to the specialist for urgent management to prevent blindness, in the case of acute iritis and acute glaucoma

Non-Pharmacological Treatment

Acute conjunctivitis

• Take a conjunctival swab for culture and sensitivity.
• Frequent, (2 hourly), washing of face and eyes to get rid of discharge.

Pharmacological Treatment

(Evidence rating: C)

Acute conjunctivitis

• 1% Tetracycline ointment applied every 8 hours for 72 hours. If no improvement, refer. or
• 0.5% Chloramphenicol eye drops, 2 hourly for 48 hours. If no improvement, refer. If improving, reduce chloramphenicol eye drops to 6 hourly for 7 days.

Corneal ulcer

• Apply 1% Tetracycline eye ointment and refer to the specialist immediately.

REFER

Refer corneal ulcer, acute iritis and acute glaucoma immediately to the eye specialist.