Red eyes are a common reason patients seek medical care from their primary care provider or an urgent care center. Although these are great places to start, many medical providers working in these locations are less familiar with diagnosing and managing eye problems than those specializing in ocular diseases or emergency ocular treatment.
When a patient presents with an eye problem, the cause can be attributed to many different issues—such as viruses, trauma, or infections—that can range from minor to severe. While a patient complaining that their eyes are red and sore might appear minor, it is potentially a symptom of serious disease that requires immediate medical attention. Knowing how to differentiate a minor issue from a potentially eyesight-threatening trauma takes knowledge and experience to combine the patient’s history with a thorough ocular exam.
Regardless of severity, red eyes can significantly affect a patient’s quality of life, and it’s an important opportunity for healthcare professionals to improve overall health and wellness. Medical providers without specialized knowledge of ocular conditions should seek out opportunities for continuing education on red eye differential diagnosis. Premiere Education’s Diagnosis and Management of Red Eye in Primary Care course is an excellent starting point for healthcare professionals to develop the skills they need to mitigate the risk of missing a serious problem, as well as deliver meaningful care for uncomfortable conditions.
Symptoms of Red Eyes
When our eyes become irritated, the redness causes inflammation of the tiny blood vessels under the surface of the eye, or inflammation of the surrounding tissue. Fortunately, in most cases a person with red eyes looks worse than they feel.
Red eyes are so common that statistical analysis is difficult. Of the number of patients who seek healthcare services, 2-3% visit their primary care doctor for eye-related issues. While most cases are as simple as dryness and allergies, 30,000 people lose their vision every year due to serious conditions like uveitis.
This is where expert red eye differential diagnosis is key. Red eyes combined with additional symptoms like discharge, fever, or visual changes—especially when accompanied by a sudden onset or abnormalities on the ocular exam—can indicate the potential for something more serious than simple eye irritation.
Common Causes and Treatment of Red Eyes
With a little knowledge and some basic exam procedures, a wide range of conditions can be identified and treated. Here are some of the most common causes of red eyes.
Allergies, Dry Eyes, and Mild Irritation
All of these conditions can be generally managed with lubricating drops or over-the-counter allergy medication. Redness usually goes away within hours or days, and may recur depending on weather, seasonal factors, or environmental issues.
Subconjunctival Hemorrhage
A subconjunctival hemorrhage is a break in the tiny blood vessels just under the surface of the eyes. The hemorrhage may not be attributed to anything specific, and will often resolve in a couple of weeks.
Diagnosis requires a simple examination of the surface of the eye. The red area will have a patchy appearance, and will often be bright red from the blood. It may affect part of the sclera—the white part of the eye—or in severe cases, all of it. Hemorrhages are often caused by trauma, so it’s important to thoroughly examine the surrounding area for additional problems.
Blepharitis
Blepharitis is an irritation and swelling of the eyelid. This condition can be caused by blocked oil glands or a generalized irritation to the eyelid. While blepharitis is not contagious, it can potentially lead to an infection in the eye and may require treatment with antibiotics or anti-inflammatories depending on the physical examination.
Corneal Ulcer
A corneal ulcer is an open sore on the cornea of the eye, and is often accompanied by symptoms including severe pain, redness, tearing, blurred vision, and light sensitivity. A corneal ulcer can be caused by trauma to the eye or a foreign body like a contact lens. There is a risk of infection, so antibiotics are commonly used in the treatment of corneal ulcers.
Pink Eye (Conjunctivitis)
Pink eye can be caused by allergens, bacteria, or viruses, and results in inflammation of the inside lining of the eyelids. Patients with pink eye may also complain of symptoms like irritation or discomfort, tearing, and discharge from the affected eye. Pink eye can be highly contagious, and may require treatment with antibiotics or antivirals.
Herpes Keratitis
Herpes keratitis is a viral infection of the eye caused by the herpes simplex virus resulting in pain, redness, tearing, sensitivity to light, and blurred vision. Someone who already has herpes simplex can get herpes keratitis from touching their eye after touching a cold sore. Herpes keratitis can be managed with topical or oral antivirals.
Uveitis
Uveitis is an inflammation of the middle layer of eye tissue known as the uvea. It can be the result of infection, injury, or an autoimmune or inflammatory disease. However, sometimes causes can be unknown, and if left untreated it can lead to a permanent loss of vision. Symptoms may develop gradually or quickly, and early diagnosis and treatment are key.
Improve your Ability to Make a Red Eye Differential Diagnosis
Red eyes are a common complaint for patients seeking non-emergent medical care. Because red eyes are symptomatic of a wide range of conditions, it’s important that healthcare providers across all levels of care be trained in red eye differential diagnosis and management.
Diagnosis and Management of Red Eye in Primary Care offered by Premiere Education will set healthcare professionals up for diagnostic and treatment success. All our courses are created by licensed professionals. Diagnosis and Management of Red Eye in Primary Care was developed by Brianne Hobbs, OD, FAAO, Assistant Chief-Optometry Service, Salisbury VA HCS.
