Differential Diagnosis of Red Eye

1. Differential Diagnosis of Red Eye

2. Differential Diagnosis of Red Eye
Pain?
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucom a
Penetrating traum a
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
An gle-clos ure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acantham oeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chem ical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hos pital eye cas ualty departm ent
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
s uperficial punctate fl
-
stain
No other ab normality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acantham oeba keratitis
Herpes Zoster keratitis
Orb ital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucom a
m id-dilated fixed pupil
corneal oedem a
diffus e circumlim bal flush
narrow/closed AC angles

Y
Urgent referral to h ospital eye casualty d epartment
P ain on eye
movement?
Orbital cellulites
Unilateral
S everely swollen lids
P roptos is

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Kerati tis
Bacteri al Conjunct ivi tis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staini ng track
Evert upper li d and check

Anaesthetise and lift off
wit h moi st sterile cott on bud
i f superfici al
Urgent referral to hospital
eye casualty department
Herpes Simplex Kerati tis
Bacteri al Conjunct ivi tis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 soluti on exposure


N
Y
Herpes Simplex Kerati tis
Bacteri al Conjunct ivi tis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 soluti on exposure
Bi lateral
Diffuse corneal punct ate
fl
-
staini ng
C/L removal
C/L removal
C old compresses
Prophylact ic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bact erial Conj unctiviti s
Bilateral
Papillae in palpebral conj
Conj i njecti on most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potent ial for
seri ous i nfect ions
Herpes Simplex
Kerat itis
Dry Eye
Episcleri tis
Herpes Simplex
Kerati tis
Unilateral
Dendriti c ulcer


Y
N
Dry Eye
Episcleri tis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Epi sclerit is
Unilat eral
Pain on palpati on
Refer to GP for Tx and
syst emi c diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quali ty
Punctate fl
-
stai ning
Diffuse RB staini ng



Refer urgently to GP
for Tx due t o the
potential for vi sual
loss
Moderate to
severe or
deep pain
Mild or
pricking
pain

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation
Itching or discomfort
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected
No pain or
discomfort

3. Moderate to severe or deep pain

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

4. Moderate to severe or deep pain,
reduced VA

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

5. Moderate to severe or deep pain,
reduced VA, history of trauma

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

6. Moderate to severe or deep pain,
reduced VA, history of blunt trauma

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

7. Moderate to severe or deep pain,
reduced VA, history of sharp trauma

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

8. Moderate to severe or deep pain, reduced
VA, history of chemical trauma

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

9. Moderate to severe or deep pain,
reduced VA, no history of trauma

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

10. Moderate to severe or deep pain, reduced
VA, no history of trauma, IOP > 40mmHg

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

11. Moderate to severe or deep pain, VA
unaffected

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

12. Moderate to severe or deep pain, VA
unaffected, history of UV exposure

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

13. Moderate to severe or deep pain, VA
unaffected, no history of UV exposure

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

14. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, pain on eye movement

Moderate or Severe
Anterior Uveitis
Angle-closure glaucoma

Type of
trauma?
N
Moderate or Severe Anterior Uveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis
Reduced Visual
Acuity? Moderate or Severe Anterior Uveitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Y
Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
History of
trauma? Y
N
Moderate or Severe
Anterior Uveitis
Penetrating trauma
Chemical burn
blunt
Moderate
or severe
anterior
uveitis
Check IOP
sharp
Penetrating
trauma
Hyphaema
Seidel’s
test
chemical
Chemical burn
Irrigate with
water
Remove solid
debris
Urgent referral to hospital eye casualty department
UV exposure?
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl
-
stain
No other abnormality

Y
Tx – oral analgesia
Ocular lubricant
Self-resolving in
24-48 hours
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

N
Raised IOP >
40mmHg?
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

Y
Urgent referral to hospital eye casualty department
Pain on eye
movement?
Orbital cellulites
Unilateral
Severely swollen lids
Proptosis

Urgent referral to hospital eye
casualty department as brain can
be affected
Y
See flow-chart 1
continuation sheet
N

15. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, no pain on eye movement
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

16. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, no pain on eye movement,
visible skin lesions on same side
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

17. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, no pain on eye movement, no
visible skin lesions on same side
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

18. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, no pain on eye movement, no
visible skin lesions on same side, deep bluish injection
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

19. Moderate to severe or deep pain, VA unaffected, no
history of UV exposure, no pain on eye movement, no
visible skin lesions on same side, no deep bluish injection
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Visible skin lesions
on same side?
Herpes Zoster keratitis
Unilateral
Superficial or deep fl
-
stain
Associated anterior uveitis

Y
Urgent referral to GP
for anti-viral treatment
Scleritis
Acanthamoeba keratitis


N
Diffuse or localised
deep bluish injection
Immobile on palpation? Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster


Urgent referral to GP
for anti-inflammatory
treatment. Thinning
may cause perforation
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgent referral to hospital
eye casualty for
treatment. Complete loss
of sight possible in 48
hours
Y N

20. Mild or pricking pain

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

21. Mild or pricking pain, history of
trauma

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

22. Mild or pricking pain, no history of
trauma

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

23. Mild or pricking pain, no history of
trauma, C/L wearer

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

24. Mild or pricking pain, no history of trauma,
C/L wearer, mucopurulent discharge

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

25. Mild or pricking pain, no history of trauma,
C/L wearer, no mucopurulent discharge

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

26. Mild or pricking pain, no history of trauma, C/L
wearer, no mucopurulent discharge, severe
conjunctival injection

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

27. Mild or pricking pain, no history of trauma, C/L
wearer, no mucopurulent discharge, mild
conjunctival injection

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

28. Mild or pricking pain, no history of trauma, not a
C/L wearer

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

29. Mild or pricking pain, no history of trauma, not a
C/L wearer, no mucopurulent discharge

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

30. Mild or pricking pain, no history of trauma, not a
C/L wearer, no mucopurulent discharge, lid
margin skin lesions

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

31. Mild or pricking pain, no history of trauma, not a
C/L wearer, no mucopurulent discharge, no lid
margin skin lesions

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

32. Mild or pricking pain, no history of trauma, not a
C/L wearer, no m/p discharge, no lid margin skin
lesions, localised sub-conjunctival redness

Marginal lid
skin lesions?
Small foreign body
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure
Trauma?
Y
Small foreign body
Unilateral
Fl
-
staining track
Evert upper lid and check

Anaesthetise and lift off
with moist sterile cotton bud
if superficial
Urgent referral to hospital
eye casualty department
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure


C/L
wearer
?
Bacterial Conjunctivitis
Dry Eye
H202 solution exposure


N
Y
Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?
N
N
Severe conjunctival
injection? H202 solution exposure
Bilateral
Diffuse corneal punctate
fl
-
staining
C/L removal
C/L removal
Cold compresses
Prophylactic anti-
infective if staining is
severe
Resolves in 48 hours
Mucopurulent
discharge?
Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conj injection most at
fornix
Y
Y
Refer urgently to GP for Tx
due to the potential for
serious infections
Herpes Simplex
Keratitis
Dry Eye
Episcleritis
Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer


Y
N
Dry Eye
Episcleritis

N
Localised redness
beneath
conjunctiva?
N
N Y
Artificial tears
Refer to GP for Tx if severe
Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis
Y
Dry Eye
H202 solution exposure

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl
-
staining
Diffuse RB staining



Refer urgently to GP
for Tx due to the
potential for visual
loss

33. Itching or discomfort

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

34. Itching or discomfort, discharge
present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

35. Itching or discomfort, watery discharge
present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

36. Itching or discomfort, watery discharge
present, follicles present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

37. Itching or discomfort, watery discharge
present, papillae present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

38. Itching or discomfort, mucous
discharge present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

39. Itching or discomfort, mucous discharge
present, conjunctival chemosis

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

40. Itching or discomfort, no discharge
present

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

41. Itching or discomfort, no discharge
present, lid margin swollen and red

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

42. Itching or discomfort, no discharge present,
lid margin locally swollen and red

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

43. Itching or discomfort, no discharge present,
lid margin generally swollen and red

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

44. Itching or discomfort, no discharge present,
no lid swelling

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

45. Itching or discomfort, no discharge present,
no lid swelling, no AC flare/cells

Follicles
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis
Discharge? Y
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis


Lid margin
swollen/red?
Canaliculitis
Blepharitis


N
Y
C/L solution sensitivity
Mild Anterior Uveitis

Localised
swelling?
N
Y Flare and
cells in AC? Mild Anterior
Uveitis
Unilateral
Check IOP
Reassure patient
Cease C/L wear
Refer to C/L
practitioner
Y
Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Refer to GP if causing
irritation or bacterial
conjunctival infections
Blepharitis
Bilateral
Self-limiting

Reassure and advise on
use of lid scrubs
N
Refer to GP for Tx
and investigation
N
C/L solution sensitivity
Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Discharge?
Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis


Watery Mucous
Upper lid
eversion
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious


Counsel and clean
Refer to GP for sick note
Papillae
Conjunctival
chemosis
N
Cold compresses
Refer to GP for Tx
Y Allergic Conjunctivitis
Bilateral
Superficial punctate fl
-

stain

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

46. No pain or discomfort
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

47. No pain or discomfort, sectoral redness
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

48. No pain or discomfort, sectoral redness,
solid red beneath conjunctiva
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

49. No pain or discomfort, sectoral redness,
broken red
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

50. No pain or discomfort, sectoral redness, broken
red, round or oval yellow/white lesion
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

51. No pain or discomfort, sectoral redness, broken
red, triangular lesion with apex at cornea
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

52. No pain or discomfort, general redness
Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Sectoral
redness?
Y
Subconjunctival haemorrhage
Pinguecula
Pterygium
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Triangular with apex
at cornea
Solid red
beneath
conjunctiva
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days


Pinguecula
Pterygium




Y
N
Counsel patient
Refer to GP if recurrent
Shape and
colour of lesion
Round or oval,
white/yellow
Refer to GP for Tx with
artifical tears if staining
extends to cornea
Pinguecula
Bilateral
Asymmetrical
May cause local fl
-
stain
Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local fl
-

staining



Refer to hospital via GP
for Tx if lesion extends
to pupil margin or VA is
reduced
N
Refer to GP for diagnosis and
Tx if not previously detected

53. Differential Diagnosis of Red
Eye - Clinical Pearls
•Remember the importance of pain and acuity loss
–The only red-eye condition with moderate to severe
pain that does not necessarily require referral to a
hospital eye casualty is photokeratitis
•Remember pupil reflexes and size are a good clue
to distinguish between severe iritis and ACG when
the eye is too painful for IOP assessment 
•Never use anaesthetic to relieve ocular pain,
unless it is to allow irrigation (which you are
finding otherwise impossible) in the case of
chemical trauma

54. Differential Diagnosis of Red
Eye - Clinical Pearls
•Viral conjunctivitis is extremely contagious.
After the examination wash you hands and
swab all the consulting room equipment that
has been in contact with the patient 
•Remember that it is possible for two or
more red-eye conditions to co-exist 
•If in doubt refer your patient to
ophthalmological care