GP KFPs / SAQs · eye-presentations
The acute red eye — KFP-style written assessment
KFP-style staged scenarios on the acute red eye: chemical injury irrigation, contact-lens keratitis urgency, Cochrane evidence for conjunctivitis antibiotic strategy, corneal abrasion patching myth debunked by RCT, and sight-threatening red flags requiring same-day ophthalmology.
On this page
Study tools
Target exams
RACGP KFPRACGP AKTMRCGP AKT
Prompt
The acute red eye: irrigate first for chemicals, refer urgently for contact lenses, delay antibiotics for conjunctivitis — systematic triage and evidence-based management
KFP 1 (10 marks)
A factory worker splashes a cleaning solution (containing sodium hydroxide) into his right eye. He arrives at your practice within five minutes. His eye is red, watering profusely, and he cannot open it. He is in severe pain. [4]
- What is your immediate action? Justify with reference to alkali versus acid penetration. (5) [4]
- How long should irrigation continue and what should you check afterwards? (3) [4]
- What is the disposition? (2) [4]
Model answers
- Irrigate immediately with copious normal saline or clean water. Alkali chemicals saponify lipid cell membranes and penetrate the cornea within minutes, continuing to damage tissue until neutralised. Acids coagulate surface proteins forming a partial barrier; alkalis do not. Do not delay irrigation for history-taking or visual acuity testing. [4]
- Continue irrigation for at least 15–30 minutes. After irrigation, check pH (aim for neutral 7.0–7.4) using litmus paper, evert lids to remove retained particles, then recheck pH. [4]
- Urgent transfer to hospital even if pain improves after irrigation, because deep tissue damage may not be immediately visible. Continue irrigation during transfer. [4]
References4ShowHide
- [1]Kaiser PK A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group. Ophthalmology, 1995.PMID 9098299
- [2]Everitt HA, Little PS, Smith PW A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice. BMJ, 2006.PMID 16847013
- [3]Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev, 2012.PMID 22972049
- [4]Lewis CJ, Al-Mousawi A, Jha A, Allison KP Is it time for a change in the approach to chemical burns? The role of Diphoterine(®) in the management of cutaneous and ocular chemical injuries. J Plast Reconstr Aesthet Surg, 2017.PMID 28330646