Red eye in adults and older children requires careful evaluation to differentiate the various causes of inflammation. Purulent conjunctival discharge warrants culturing and broad-spectrum antibiotics.
Allergic conjunctivitis generally responds well to topical treatment; symptoms may manifest or worsen on initiation of systemic antihistamines.
• Orbital cellulitis requires prompt computed tomography and systemic antibiotics. Cultures should be obtained from the nasopharynx, conjunctiva, and blood.
• Iritis is characterized by pain, photophobia, miosis, and circumciliary injection and generally occurs after blunt trauma.
• A red eye in a contact lens wearer requires prompt evaluation for a corneal ulcer.
• Acute angle-closure glaucoma is an ocular emergency and requires immediate treatment by an ophthalmologist.
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