GP · eye-presentations
The acute red eye
Also known as Red eye assessment · Conjunctivitis management · Acute eye emergency
GP-fellowship guide to the acute red eye: systematic assessment (vision, pupils, fluorescein, ciliary flush), sight-threatening emergencies (angle closure, chemical injury, contact-lens keratitis, hyphaema, hypopyon, herpes keratitis dendrite), conjunctivitis types with Cochrane antibiotic evidence and delayed-prescribing strategy, corneal abrasion patching myth debunked by RCT, subconjunctival haemorrhage workup when anticoagulated, and safety-netting for every discharged patient.
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Red flags
- Chemical injury: irrigate first, ask questions later — alkali penetrates within minutes; continue irrigation during transfer to hospital
- Contact lens wearer + red eye + pain = Pseudomonas keratitis until proven otherwise — remove lens, refer urgently, never patch
- Acute angle closure: haloes around lights + mid-fixed dilated pupil + severe pain + nausea/vomiting = ophthalmic emergency — vision loss within days if untreated
- Herpes keratitis dendritic ulcer on fluorescein staining — NEVER give steroid drops; they cause corneal melting and perforation
Overview
The acute red eye is one of the most common and most dangerous presentations in general practice. Most cases are benign conjunctivitis, but the stakes are high because the sight-threatening causes (acute angle closure, chemical injury, contact-lens keratitis, herpes keratitis, uveitis) require same-day action that only the GP can initiate.[1]
References6ShowHide
- [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
- [5]Ozturk B, et al. Contact lens-related versus non-contact lens-related Pseudomonas aeruginosa keratitis Front Med (Lausanne), 2026.PMID 42500545
- [6]Koestel E, et al. Bacterial keratitis: a global review of current practices, challenges and innovations Br J Ophthalmol, 2026.PMID 42373310