DEPARTMENT
Clinical Evaluation of Red
Eyes in Pediatric Patients
Casey Beal, MD, & Beverly Giordano, MS, RN, CPNP, PMHS
ABSTRACT
Patients with the primary symptom of a red eye are
commonly seen in pediatric primary care clinics. The differ-
ential diagnoses of a red eye are broad, but with a succinct
history and physical examination, the diagnosis can be
readily identified in many patients. Identifying conditions
that threaten vision and understanding the urgency of
referral to an ophthalmologist is paramount. Some systemic
diseases such as leukemia, sarcoidosis, and juvenile idio-
pathic arthritis can present with the chief symptom of a red
eye. Finally, trauma, ranging from mild to severe, often pre-
cipitates an office visit with a red eye, and thus understand-
ing the signs that raise concern for a ruptured globe is
essential. In the primary care setting, with a focused history,
a few simple examination techniques, and an appreciation
of the differential diagnosis, one can feel confident in manag-
ing patients with acute red eyes. J Pediatr Health Care. (2016)
30, 506-514.
KEY WORDS
Red eye, conjunctivitis, pediatric, corneal abrasion
Patients with the primary symptom of a red eye are
often seen in the pediatric primary care setting, and
because the differential diagnoses are broad, the
Casey Beal, Assistant Professor, Department of Ophthalmology,
University of Florida, Gainesville, FL.
Beverly Giordano, Pediatric Nurse Practitioner, Department of
Pediatrics, University of Florida, Gainesville, FL.
Funded in part by an unrestricted grant from Research to Prevent
Blindness, New York, NY.
Conflicts of interest: None to report.
Correspondence: Casey Beal, MD, Department of
Ophthalmology, University of Florida, PO Box 100284, Gainesville,
FL 32610; e-mail: cjbeal@ufl.edu.
0891-5245/$36.00
Copyright Q 2016 by the National Association of Pediatric
Nurse Practitioners. Published by Elsevier Inc. All rights
reserved.
Published online March 2, 2016.
http://dx.doi.org/10.1016/j.pedhc.2016.02.001
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Practice Guidelines
diagnosis can sometimes be elusive. However, with
use of a focused history and simple clinical examination
techniques, the provider can be more confident in the
diagnosis and management of red eyes in children.
Clinic visits for red eyes are common; approximately
1% of all primary care office visits are due to conjuncti-
vitis (Azari & Barney, 2013). The eye becomes red as a
nonspecific reaction to any type of insult, including
infection, allergy, trauma, dryness, or systemic inflam-
mation. The redness stems from engorgement of the
conjunctival vessels. In trauma and some types of infec-
tion, the redness can be caused by subconjunctival
hemorrhages. The red eye has a broad differential
diagnosis, but very often, a simple history and physical
examination can help elucidate the diagnosis (Table).
HISTORY
The importance of obtaining a detailed history when
evaluating a patient with a red eye cannot be
overstated. The following items in the history require
a specific focus:
 Duration of symptoms
 Presence of pain or itching
 Photophobia
 History of trauma—high or low velocity
 History of similar episodes
 Previous treatment
CONJUNCTIVITIS
Conjunctivitis is one of the most common ophthalmo-
logic disorders encountered by pediatric primary care
practitioners. The eye becomes red as a result of
dilation of the conjunctival blood vessels, which is
sometimes associated with discharge and edema.
When edema accumulates under the conjunctiva, the
conjunctiva begins to look ‘‘boggy’’; this appearance
is referred to as chemosis (Figure 1). It is important to
examine the palpebral conjunctiva—that is, the portion
that covers the inside of the eyelid—which can be seen
by pulling down on the lower eyelid or everting the up-
per eyelid. A papillary or follicular reaction may be
Journal of Pediatric Health Care
 TABLE. Differential diagnosis of red eye in children
Diagnosis Pain Itching Discharge History Other symptoms Treatment
Conjunctivitis
Viral Burning No Tearing Positive for contact Enlarged preauricular Conservative;
sensation with sick people lymph node contagious for
10-21 days
Allergic No Yes Tearing May have other Allergic shiners Artificial tears; oral
allergy symptoms antihistamines; mast
cell stabilizer/
antihistamine drops
Bacterial Yes No Copious Unilateral or bilateral Antibiotic eyedrops
Blepharitis Burning Sometimes No Chronic crusting; Eye discomfort that is Eyelid washes, warm
sensation chalazion; worse in the compresses
common in afternoons
children aged
6-10 years
Episcleritis Prominent No Tearing Occurs most often in May be associated with NSAIDS; refer to
older children/ autoimmune disease ophthalmologist
adolescents
Scleritis Severe No Tearing Connective tissue Vision loss, blue hue to Refer to ophthalmologist
disease sclera
Uveitis Usually severe No Tearing Unilateral or bilateral Photophobia, decreased Refer to ophthalmologist
vision
Trauma
Corneal abrasion Moderate No Tearing Common in contact Photophobia, pain with Fluorescein
lens wearers blinking examination, topical
antibiotic drops; no
use of contact lenses
until the abrasion
resolves
Foreign body Variable No Tearing High-velocity Pain with blinking Refer to ED or
projectile vs low- ophthalmologist
velocity objects
Subconjunctival None No No Blunt trauma, cough, None No treatment needed
hemorrhage Valsalva maneuver
Hyphema Moderate No No Blunt trauma Photophobia Refer to ophthalmologist
Ruptured globe Severe No No Penetrating trauma Decreased vision Refer to ED, keep NPO
Note. ED, emergency department; NPO, nothing by mouth; NSAIDS, nonsteroidal anti-inflammatory drugs.

observed, depending on the underlying cause of the

FIGURE 1. Chemosis—edema of the conjunctiva.
conjunctivitis. A papillary reaction creates large, flat
nodules with a central vessel that is commonly
described as ‘‘cobblestoning.’’ A follicular reaction cre-
ates smaller, dome-shaped, gelatinous-appearing le-
sions that are best seen on the palpebral conjunctiva
(Figure 2). Conjunctivitis can be caused by viral or bac-
terial infections, allergies, or chemical exposure; vi-
ruses and allergies are the most commonly
encountered causes.

Viral Conjunctivitis

Definition
Viral conjunctival infection is most commonly caused
by adenovirus types 8, 19, and 37 (LaMattina &
Photo courtesy of Phuchong Choksamai. Thompson, 2014). Some common variants of the
q123rf.com. This figure appears in color online at classic viral conjunctivitis are pharyngoconjunctival
www.jpedhc.org. fever and acute hemorrhagic conjunctivitis.

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FIGURE 2. Follicular conjunctival reaction of the
inferior palpebral conjunctiva seen here by
everting the lower eyelid with a cotton tip
applicator.
Photo courtesy of Phuchong Choksamai.
q123rf.com. This figure appears in color online at
www.jpedhc.org.
Pharyngoconjunctival fever presents with a triad of sore
throat, fever, and conjunctivitis and is caused by adeno-
virus type 3 or 7 (LaMattina & Thompson, 2014). Acute
hemorrhagic conjunctivitis, although not common, is
significant for extensive subconjunctival hemorrhages
in addition to conjunctival injection. These cases are
commonly caused by Coxsackie virus A2 and entero-
virus 70 (Wong, Lai, Chi, & Lam, 2011). Zika virus, which
has recently emerged in the Western hemisphere, also
FIGURE 3. Viral conjunctivitis—diffuse
conjunctival injection and tearing.
Photo courtesy of Phuchong Choksamai.
q123rf.com. This figure appears in color online at
www.jpedhc.org.
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can cause a viral conjunctivitis along with fever, rash,
and arthralgias (Petersen et al., 2016). Infection with
Zika virus should be suspected in a patient with a recent
history of travel to an endemic country.
History of the present illness
 Acute-onset eye redness, irritation, tearing, and a
burning sensation
 Contact with people who are sick
 One eye is often affected first, followed by the
other eye in a few days
Physical examination
 Examine the inferior conjunctiva by pulling down
on the lower eyelid to evert it, which usually shows
a follicular conjunctival reaction (Figure 2)
 External examination shows diffuse conjunctival
erythema (Figure 3)
 An enlarged preauricular lymph node is almost al-
ways noted
Diagnostic tests
 AWood’s lamp (i.e., a lamp emitting long-wave ul-
traviolet light named for Robert W. Wood) or a
direct ophthalmoscope switched to its cobalt
blue light setting and fluorescein are used to eval-
uate for corneal abrasions
 No cultures are needed in these cases
Treatment
 Symptomatic care
¤ Artificial tears as needed
¤ Cool compresses
 Counsel patient and families on contagious nature
of the disease
¤ Wash hands frequently and don’t share towels or
pillows
¤ Conjunctivitis can be contagious from 10 days to
3 weeks or as long as the eyes are red (Pinto et al.,
2014). It has been recommended that persons
who are infected stay home for 2 weeks to pre-
vent spread of the virus (Kaufman, 2011),
although this recommendation is often unrealis-
tic for working parents or patients in school. Sim-
ple precautions such as frequent hand washing
and avoiding direct contact with the eyes are
more realistic and will decrease the risk of trans-
mission. The viral load decreases exponentially
as healing occurs, and thus the infectivity will
drop significantly during the first 7 days.
¤ Antibiotics have shown no value in treating viral
conjunctivitis and should not be prescribed
(Rose et al., 2005)
¤ All contact lenses, solutions, cases, and eye
makeup should be discarded
Journal of Pediatric Health Care
Ophthalmology referral FIGURE 4. Bacterial conjunctivitis. White
 Refer for vision changes, corneal abrasions as discharge is present on the conjunctiva, seen
identified with the fluorescein examination previ- with eversion of the upper eyelid.
ously described, significant discharge that is
more likely to be bacterial, or no improvement
in 5 to 7 days
 Other viral causes of conjunctivitis include herpes
simplex virus and varicella zoster virus, which
frequently manifest with skin findings as well.
These patients should be referred to ophthal-
mology immediately for close follow-up.

Allergic Conjunctivitis

Definition
Simple allergic conjunctivitis is extremely common,
affecting 15% to 40% of the population (Bielory,
O’Brien, & Bielory, 2012). It is caused by an inflamma- Photo courtesy of Phuchong Choksamai.
tory reaction to allergens in the environment. q123rf.com. This figure appears in color online at
www.jpedhc.org.
History of present illness
 Significant eye itching bilaterally
influenza. (See the subsequent ‘‘Ophthalmia Neonato-
 Usually a seasonal component is present, and it is
rum’’ section as well, because conjunctivitis caused by
commonly seen in conjunction with allergic
Neisseria gonorrhoeae and Chlamydia trachomatis
rhinitis and/or asthma
also can occur in adolescents.)

Physical examination History of the present illness

 ‘‘Allergic shiners’’ or dark circles under the eyes are
frequently present
 Excessive tearing is present with diffuse conjunc-
tival erythema, variable amounts of chemosis,
and a papillary reaction or ‘‘cobblestoning’’
appearance to the conjunctiva
Treatment
 Limit exposure to the inciting agent, if it is known
 Artificial tears are helpful for rinsing out any aller-
gens
 Combination mast cell stabilizer/antihistamine
eyedrops (e.g., olopatadine, 0.1% or 0.2%, or keto-
tifen, 0.035%) are the first-line treatments; these
drops can take up to 2 weeks to have their full effect,
so patients are encouraged to continue using them
for this period before evaluating their effectiveness
 Oral antihistamines
 Topical steroids or immunomodulators should
only be prescribed by an ophthalmologist
Bacterial Conjunctivitis
Definition
Bacterial conjunctival infection is less common than
viral conjunctivitis but can have significant morbidity.
The most common causes are Staphylococcus
aureus, Streptococcus pneumonia, and Haemophilus
 Acute onset conjunctival redness, tearing, and
discharge
 Unilateral or bilateral
Physical examination
 The hallmark finding is copious, usually white,
discharge (Figure 4), along with conjunctival ery-
thema; the presence of this significant discharge
helps distinguish bacterial from viral conjunctivitis
Diagnostic tests
 A culture can be obtained if significant discharge is
noted
 AWood’s lamp and fluorescein are used to evaluate
for corneal abrasions
Treatment
 Empiric treatment consists of polymyxin B sulfate/
trimethoprim drops or a fluoroquinolone eyedrop
such as ofloxacin, ciprofloxacin, or moxifloxacin
four times daily for 5 to 7 days; antibiotic choices
can be adjusted on the basis of culture results if
they are available
Ophthalmology referral
 If corneal involvement is suspected, changes in
vision occur, or no improvement is noted with

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 topical antibiotics, then a corneal ulcer is
suspected and the patient should be referred
immediately to an ophthalmologist
Ophthalmia Neonatorum
Definition
Bacterial conjunctivitis in the neonatal period is most
commonly caused by C. trachomatis or N. gonorrhoeae
and can cause significant morbidity and even mortality.
History of the present illness
 Conjunctival redness, discharge, and eyelid edema
in the first 14 days of life
 N. gonorrhoeae classically presents in the first 3 to
4 days of life
 C. trachomatis classically presents a little later than
N. gonorrhoeae, at around 1 week of life
Physical examination
 Significant conjunctival erythema, edema, and
discharge
 C. trachomatis typically results in thin, ‘‘ropy’’
white discharge, whereas N. gonorrhoeae results
in exuberant purulent white discharge
Diagnostic tests
Gram stain with culture or polymerase chain reaction
for C. trachomatis and N. gonorrhoeae should be ob-
tained from conjunctival discharge.
Treatment
 Treatment for C. trachomatis includes administra-
tion of oral or intravenous (IV) erythromycin and
use of erythromycin ophthalmic ointment four
times daily for 14 days, and an ophthalmology
consultation should be obtained
 Treatment for N. gonorrhoeae infection requires
hospital admission, saline solution irrigation of
the eyes every hour until the discharge clears,
administration of ceftriaxone IV or intramuscu-
larly, and an ophthalmology consultation
(American Academy of Pediatrics, 2015)
 The mother and her sexual partner(s) also should
be treated
 The infection should be reported to the local
health department
 N. gonorrhoeae and C. trachomatis conjunctivitis
can also occur in adolescents and should be sus-
pected if severe or chronic discharge is present.
C. trachomatis conjunctivitis in the adolescent is
treated with oral doxycycline, azithromycin, or
erythromycin in addition to topical erythromycin
ophthalmic ointment. N. gonorrhoeae conjuncti-
vitis in the adolescent is treated with intramuscular
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ceftriaxone, oral azithromycin, or doxycycline, as
well as saline solution lavage of the conjunctiva.
INFLAMMATORY EYE CONDITIONS
Blepharitis
Definition
Blepharitis, an inflammation of the eyelid margins
involving the eyelashes, is very common in the pediat-
ric patient population. Most patients are completely
asymptomatic, but blepharitis can cause significant
eye pain and even vision loss in some children. Ble-
pharitis is a type 3 hypersensitivity reaction to bacterial
exotoxins, most commonly staphylococcal skin flora
located at the lid margin.
History of the present illness
 Chronic burning, itching, and tearing of the eyes
that is worse toward the end of the day; it is always
bilateral but can be asymmetric
 Typical age of onset is between 6 and 10 years
(Gupta, Dhawan, Beri, & D’souza, 2010; Teo,
Mehta, Htoon, & Tan, 2012)
 Recurrent chalazia or red, swollen areas of the eye-
lids also are common in these patients
Physical examination
 Crusting at the base of the eyelashes and erythema
of the eyelid margins with diffuse reactive conjunc-
tival erythema
 An examination with a Wood’s lamp and fluores-
cein staining should be performed to evaluate for
corneal abrasions
In severe forms, corneal scarring and neovasculariza-
tion can be seen as white areas on the otherwise trans-
lucent cornea. Although these lesions might be seen
without use of a Wood’s lamp, they become more
apparent upon its use with fluorescein.
Treatment
 Wash the eyelashes daily with a mild baby
shampoo
 Apply warm compresses to the eyelids twice daily
or more often for associated chalazia
 Apply topical erythromycin ointment to the eye-
lashes nightly as needed
 Provide a referral to ophthalmology if no improve-
ment occurs with conservative treatment or if
corneal scarring is noted
Episcleritis and Scleritis
Definition
Episcleritis is inflammation of the episclera (which lies
just posterior to the conjunctiva), and scleritis is
Journal of Pediatric Health Care
inflammation of the deeper, avascular, white sclera. FIGURE 5. Nodular scleritis. A discrete raised
These conditions are commonly idiopathic in origin conjunctival nodule with surrounding erythema.
but can be associated with a systemic autoimmune dis-
order. Thirty-seven percent of patients with scleritis
have an associated systemic connective tissue disease
(Wieringa, Wieringa, ten Dam-van Loon, & Los, 2013).
Scleritis, as opposed to episcleritis, is exceedingly rare
in the pediatric population, with the largest case series
consisting of only 13 patients (Cheung & Chee, 2012).

History of the present illness

 Eye pain that is acute to subacute in onset along
with redness, which is usually unilateral

Physical examination
 Persons with episcleritis will have localized or
diffuse conjunctival erythema that is tender to
palpation (Figure 5); in contrast, simple conjuncti-
vitis is more ‘‘irritating’’ rather than ‘‘tender to
palpation’’
 Scleritis is characterized by inflammation of the
deeper eye structures and will have localized ery-
thema, tenderness to palpation, and a bluish
discoloration underlying it
Treatment
 Patients should be referred to ophthalmology for
treatment and management; artificial tears, steroid
eye drops, oral nonsteroidal anti-inflammatory
drugs (NSAIDs), and sometimes systemic immuno-
suppression are the treatments of choice
Uveitis
Photo courtesy of Phuchong Choksamai.
q123rf.com. This figure appears in color online at
www.jpedhc.org.
Physical examination
 Diffuse conjunctival erythema that is most promi-
nent near the cornea
 Direct and consensual photophobia (i.e., pain in the
affected eye when light is shown in the normal eye)
 Most cases are unilateral, although uveitis can be
bilateral
Diagnostic tests
 If recurrent or severe disease is present, rule out in-
fectious/inflammatory causes, including syphilis,
sarcoidosis, Lyme disease, tuberculosis, and HLA-
B27 seropositivity

Definition Treatment
Uveitis is an inflammatory disorder of the uveal tract  If uveitis is suspected, the patient should be
that includes the iris, ciliary body, and choroid. It is clas- referred to an ophthalmologist for evaluation and
sified as anterior, intermediate, posterior, or pan uveitis treatment including topical steroids, cycloplegic
based on the portion of the eye that is involved. Anterior drops, and systemic immunomodulators
uveitis, also known as iritis, is the most common type
that should be considered when a pediatric patient pre-
sents with an acute red eye, and therefore we will focus EYE INJURIES
on that type or uveitis in this article. Uveitis occurs in Corneal Abrasion
11% to 13% of all patients with juvenile idiopathic
arthritis (JIA) and can cause significant ophthalmic Definition
morbidity (Tappeiner et al., 2015). It is more common A corneal abrasion is an epithelial defect on the surface
in patients with pauciarticular JIA and those who are of the cornea that is most commonly associated with
positive for antinuclear antibodies. The uveitis associ- trauma.
ated with JIA can be low grade and asymptomatic,
and thus these patients require frequent routine eye ex- History of the present illness
aminations by an ophthalmologist.  Acute-onset, severe eye pain associated with blunt
trauma or rubbing of the eye
History of the present illness  Pain worsens with blinking
 Acute or subacute onset severe photophobia, eye
redness, and a ‘‘boring’’ type pain with blurry Physical examination
vision  Diffuse mild conjunctival erythema, tearing

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FIGURE 6. A corneal abrasion with fluorescein History of the present illness
staining under a Wood’s lamp.  The inciting event usually can be recounted by the
patient
 The speed and size of the foreign body are crucial
for determining the object’s potential for damaging
the eye; if it was a high-velocity object, such as a
piece of metal from a circular saw, it is likely that
it is more deeply embedded and therefore more
difficult to remove than a low-velocity object,
such as vegetative matter or dirt blown up in the
wind

Physical examination
 The foreign body usually can be seen easily on the
surface of the cornea or conjunctiva (Figure 7)
 Evert the upper and lower eyelids to ensure that no
other foreign bodies are present
Photo courtesy of Casey Beal, MD. This figure
appears in color online at www.jpedhc.org.
Treatment
 Pain improves with instillation of topical  If a foreign body is seen, refer the patient to the
ophthalmic proparacaine drops in the clinic; these emergency department or urgently to an ophthal-
drops should never be provided to patients mologist
because they can lead to corneal melting if used
frequently
Subconjunctival Hemorrhage
 Evert the upper and lower eyelids to evaluate for
foreign bodies
Definition
A subconjunctival hemorrhage is rupture of a small
Diagnostic tests conjunctival capillary with resultant bleeding into the
 Use a Wood’s lamp and fluorescein staining of the subconjunctival space. Commonly, eye rubbing,
cornea to diagnose the abrasion and evaluate its cough, the Valsalva maneuver, or blunt trauma cause
extent (Figure 6) subconjunctival hemorrhages. These hemorrhages
can be very alarming to patients and their family
because of their size, color, and acute onset. However,
Treatment
they do not affect vision and do not cause any signifi-
Treatment entails use of a topical antibiotic drop or oint-
cant pain.
ment four times daily for 3 to 5 days; options include
polymyxin B/trimethoprim, ciprofloxacin, moxifloxa-
cin, erythromycin, or bacitracin ophthalmic drops or
FIGURE 7. A corneal foreign body.
ointment
 Follow-up should be scheduled for 48 hours to
evaluate for improvement
 Patching the eye is not recommended
 Contact lenses should not be worn until the abra-
sion heals
 If an underlying infection is associated with the
abrasion, the patient should be referred to ophthal-
mology

Corneal and Conjunctival Foreign Bodies

Definition
Corneal and conjunctival foreign bodies become
embedded in the conjunctival or corneal epithelium. Photo courtesy of Phuchong Choksamai.
Commonly seen foreign bodies include vegetative mat- q123rf.com. This figure appears in color online at
ter and metal shavings. www.jpedhc.org.

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FIGURE 8. Subconjunctival hemorrhage.  If the patient has sickle cell disease or trait, the sick-
ling of the red blood cells in the anterior chamber
of the eye can clog the drainage system of the
eye and cause an acute rise in intraocular pressure,
which can precipitate permanent vision loss

Physical examination
 Blood, which may be seen in the anterior chamber
of the eye overlying the iris, is usually settled infe-
riorly because of the effect of gravity

Photo courtesy of Phuchong Choksamai.
q123rf.com. This figure appears in color online at
www.jpedhc.org.
History of the present illness
 A sudden onset localized area of subconjunctival
blood
 Specifically inquire about trauma, coughing, or
eye rubbing
 No photophobia, pain, or vision changes are pre-
sent
Physical examination
 A localized area of subconjunctival blood
(Figure 8) that does not involve the cornea
Treatment
 No treatment is required, although patients may
use artificial tears for any discomfort
 If a child has recurrent or large subconjunctival
hemorrhages, a bleeding disorder (Khaja,
Pogrebniak, & Bolling, 2015) or nonaccidental
trauma should be suspected
Hyphema
Definition
A hyphema is defined as red blood cells that are present
in the anterior chamber of the eye just posterior to the
cornea. Most commonly, hyphemas are caused by
blunt trauma; however, rarely, a hyphema can present
spontaneously without a history of trauma, and this pre-
sentation raises concern for leukemia or juvenile xan-
thogranuloma (Samara et al., 2015).
History of the present illness
 Inquire about a history of trauma and whether the
patient has sickle cell disease
Treatment
 All patients with hyphemas should be referred ur-
gently to an ophthalmologist for further manage-
ment and care with steroid and cycloplegic
eyedrops. A main concern is the risk for recurrent
hemorrhage as the blood clot begins to dissolve.
Recurrent hemorrhage is most likely in the first
5 days after the injury, and thus patients should
be instructed to avoid any strenuous activity,
keep their head elevated, and avoid NSAIDs to
reduce this risk.
Ruptured Globe
Definition
A ruptured globe is the result of any breach in the struc-
tural integrity of the eye, including corneal or scleral
full-thickness lacerations. A ruptured globe is the result
of direct trauma to the eye.
History of the present illness
 The speed, size, type, and shape of the projectile
determines the extent of the injury
 Other associated head or facial injuries
Physical examination
 If a ruptured globe is suspected based on history, it
is important to avoid applying any pressure to the
eye during the examination
 Signs of a ruptured globe include an irregularly
shaped pupil, a shallow anterior chamber or
exposed iris, or dark choroidal tissue showing
through the white sclera
 Almost always, a significant decrease in visual acu-
ity is found
Treatment
 If a ruptured globe is suspected, a Fox shield
(i.e., a metal eye shield named for Sidney Fox,
MD) should be taped across the eye to protect
it without applying any pressure to the eye; a Sty-
rofoam cup also can be used if a Fox shield is not
available

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  The patient should be directed to ingest nothing by
mouth and should be sent directly to the nearest
emergency department for emergent evaluation
by an ophthalmologist for surgical repair
CONCLUSION
Patients with the chief symptom of a red eye are
commonly encountered in the pediatric primary care
setting, but with a focused history and examination,
the diagnosis and management can be accomplished
with confidence. Understanding the pathophysiology
of each disease manifestation and when to utilize spe-
cial tests such as fluorescein staining is essential to diag-
nosing and treating these patients. Certain signs that
indicate that sight might be threatened are important
to identify and require referral to an ophthalmologist.
These signs include corneal abrasions, corneal opaci-
ties, recurrent or chronic symptoms, severe pain,
photophobia, vision changes, or concern that the globe
may be ruptured. In addition, topical anesthetic medi-
cation should never be provided to the patient, and
topical corticosteroids should only be prescribed
upon consultation with an ophthalmologist. With use
of some simple techniques, pediatric patients present-
ing with a red eye can be fully evaluated in the primary
care setting and treated or triaged with confidence.
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Village, IL: American Academy of Pediatrics.
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