APPROACH TO PATIENTS WITH ACUTE CONJUNCTIVITIS: PRINCIPLES OF MANAGEMENT
HistoryCertain historical features can help narrow the diagnostic etiology of a red eye and rapidly determine the need for patient referral. The medical history should include questions regarding the following:- Change of vision (“Can you read ordinary print with the affected eye?”)- Eye pain- Photophobia- History of eye trauma- Contact lens use- Time course of illness- Environmental or work-related exposures- Eye itching- Eye discharge- History of upper respiratory tract infection- Sexual history/history of sexually transmitted diseases- Medication history- Allergies- History of eye disease
Ocular ExaminationThe patient with a red eye should be examined in a well-lit room. The physician should carefully observe and examine the face and eyelids and search for regional lymphadenopathy. The ocular examination should focus on the following:- Measurement of visual acuity – If acuity is diminished, the physician should suspect a more worrisome diagnosis (angle closure glaucoma, infectious keratitis, uveitis) and immediately refer the patient to an ophthalmologist.- Examination of the pupils – The size and reactivity of the pupils should be closely observed. A fixed or nonreactive pupil should prompt immediate referral to an ophthalmologist.- Examination of the anterior segment – The clinician should note the presence of any discharge, appearance of the cornea, and pattern of redness. If either ciliary flush (circumcorneal injection) or hypopyon (a layer of leukocytes in the anterior chamber) are seen, urgent referral to an ophthalmologist is required.- Fundoscopic examination – This is usually not helpful in the differential diagnosis of the red eye.*32/348/5*