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Acute red eye

Sep 10, 2019

Acute red eye is the cardinal sign of ocular inflammation and conjunctivitis is the most common cause. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Immediate ophthalmology referral is needed in cases of blurred, reduced or loss of vision, severe eye pain and irregular pupil. There are three main types:

  • Bacterial conjunctivitis – purulent discharge, conjunctival erythema, eye lid edema, eyelids stuck together on waking
  • Allergic conjunctivitis – intense itching, conjunctival erythema, excessive lacrimation, eyelid edema
  • Viral conjunctivitis – watery discharge, mild itching, no pain, conjunctival erythema

Medications:

Bacterial conjunctivitis (stepwise treatments) –

  • Step 1 – Eye drops Ciplox (Ciprofloxacin 0.3% w/w) 1 drop 4 times a day for 7 days (Children – 1 drop twice a day for 7 days).
  • Step 2 – In severe cases add cap. Moxikind-CV 1gm (Amoxicillin 875 mg, Clavulanic acid 125 mg) – 1 tablet twice a day for 10 days. For children – Moxikind-CV Dry Syrup 228.5mg  (Amoxicillin 200 mg, Clavulanic acid 28.5 mg) 12.5 mg/kg twice a day for 10 days.
  • Step 3 – If no clinical improvement in 3 days – change to tab. Zofix CV (Cefixime 200 mg, Clavulanic acid 125 mg) – 1 tablet twice a day for 7 days. For children (less than 45 kg) – dry syrup Elfi CV 100 mg/62.5 mg (Cefixime 100 mg, Clavulanic acid 62.5 mg) 4mg/kg twice daily for 7 days.

Allergic conjunctivitis –

  • Eye drops Cromal forte (Sodium cromoglycate 4% w/w) 1 drop 4 times a day for 7 days.
  • Remove offending agent.
  • Apply cold compression.

Viral conjunctivitis –

  • Clean eyes four times a day with sterile water.
  • Apply warm compression.
  • Symptomatic treatment.

Supplementary treatments:

  • Eye drops Refresh Tears 0.5% (Carboxymethylcellulose) 2 drops in each eye 4 times a day.
  • Dolo 650 (Paracetamol 650 mg) 1 tablet thrice a day for pain relief.

General advice:

  • Cold fomentation.
  • Avoid dusty environment.
  • Wear protective goggles.
  • Wash eye regularly with clean water.
  • Apply warm compression.

Referral:

Consider referral to ophthalmologist if patient fails to respond to treatment. Immediate ophthalmology referral is needed in case of blurred, reduced or loss of vision, severe eye pain or irregular pupil.