From Acute Disease to Red Flags: A Review of the Diverse Spectrum of Red Eye Encountered in the Primary Care Setting

Abstract

The general practitioner is most often the first contact physician for the patient presenting with red eye. The majority of red eye is a symptom of benign disease, such as conjunctivitis, episcleritis and sub-conjunctival hemorrhage, which can resolve on its own or by non-prescription medication and treatment in the primary care setting. Red eye caused by scleritis, keratitis, foreign bodies, trauma, chemical exposure, cellulitis and acute angle-closure glaucoma can be sight-threatening and there are a myriad of differential diagnoses, including systemic diseases, that can be life-threatening and require referral to an ophthalmologist. We provide an updated general review of the benign causes of red eye and recommend guidelines to provide a comprehensive assessment, accurate diagnosis and successful management for first contact physicians and primary care providers with the aim to reduce misdiagnoses and strengthen the referral of patients with sight- and lifethreatening disorders to ophthalmologists. Given the limited training, equipment and tools primary care providers have in ophthalmology, it is important that these clinicians can correctly assess red eye to identify benign or non-serious conditions and recognize when a case merits urgent referral, always keeping in mind that any case of red eye may require intervention by an ophthalmologist. It is important that the first contact physician or primary care provider knows the characteristics of the red eye that require an urgent assessment by an ophthalmologist. Patients whose symptoms persist, worsen, or recur after initial treatment should also be urgently referred to an ophthalmologist.