Best Approaches to Physical Diagnosis of Acute Red Eye


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Am Fam Physician. 2016 Apr 1;93(7):594.

Clinical Question

Which signs or symptoms are indicative of serious eye disease in patients with red eye or a bacterial cause in patients with presumed conjunctivitis?

Bottom Line

Eliciting photophobia via pupillary constriction and the presence of anisocoria (greater than 1 mm) in patients with an acute red eye are the best predictors of serious eye disease (e.g., uveitis, keratitis, corneal abrasion, scleritis) requiring prompt referral. Lack of morning eye matting is a fairly good way to rule out bacterial conjunctivitis, but no sign or symptom in this study consistently identifies a bacterial cause or response to antibiotic treatment. (Level of Evidence = 2a−)


The authors conducted a limited search, using only a single database

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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Oct 15, 2016

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