Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Red eye - Management
How do I manage a person with red eye?

  • Refer the person for same-day specialist assessment by an ophthalmologist or optometrist if any of the following features are present:
    • Moderate-to-severe eye pain or photophobia.
    • Marked redness of one eye: the greater the redness, the more likely that the cause is serious. Ciliary injection, which is not always obvious, occurs with inflammation of deeper structures. It is indicated by redness, and dilated blood vessels that can be seen between the white of the eye and the coloured part (iris) of the eye.
    • Reduced visual acuity: any loss of visual acuity, as measured with a Snellen chart or the near vision testing card (for bedside measurement).
  • Refer the person for same-day specialist assessment for:
    • Suspected penetrating eye injury — which may or may not produce a red eye. Refer for same-day assessment if there is a history of a possible penetrating eye injury or embedded foreign body.
    • Irritant conjunctivitis — refer immediately if acid or alkali burns are suspected. Otherwise, refer for same-day assessment and management if: the conjunctivitis is severe; a highly irritating substance such as cement is the cause of the conjunctivitis (immediate and copious irrigation of the eye should be undertaken prior to referral); or surgical correction of eyelid abnormalities, including entropion and trichiasis, is required.
    • Neonatal conjunctivitis.
    • Scleritis.
  • If there are no features to suggest a serious cause of red eye, consider the following diagnoses and manage accordingly:
    • Irritant conjunctivitis — this should settle once the chemical or mechanical irritant is removed (although may be sufficient to compromise the ocular surface and increase the risk of infection).
    • Subconjunctival haemorrhage — check blood pressure. Check international normalized ratio (INR) if on warfarin, and full blood count and clotting if there is any unexplained bruising on skin. If there are no abnormalities, reassure the person, and explain that the redness will take several weeks to fade.
    • For other causes of red eye, see the CKS topics on Blepharitis, Conjunctivitis - allergic, Conjunctivitis - infective, and Corneal superficial injury.
  • Always document the history and findings of an eye examination (including negative findings). This is particularly important when management of a unilateral red eye is going to take place in primary care. The important findings to document are pain, photophobia, visual acuity measured using a Snellen chart, whether the condition is unilateral or bilateral, and where appropriate, the results of fluorescein staining. In all cases use clinical judgment with regards to the level of detail to document.

© NHS Institute for Innovation and Improvement