👁️ OphthalmologyOphthalmologyStudentInternResident

Acute Red Eye

Also known as: red eye · conjunctivitis · pink eye · eye emergency

A common presentation ranging from benign conjunctivitis to sight-threatening emergencies. The key skill is spotting the dangerous red eye.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Anyone; contact-lens wearers and people with autoimmune disease are at higher risk of serious causes.

Red flags — escalate / refer

Pain (not just grittiness), reduced vision, marked photophobia, a fixed/irregular or mid-dilated pupil, a hazy cornea, or a contact-lens wearer with a red painful eye → sight-threatening (acute angle-closure glaucoma, keratitis, uveitis, scleritis): urgent ophthalmology.

Work-up / diagnosis

1ALWAYS check visual acuity.
2Assess the redness pattern, pupil, and cornea (fluorescein for abrasions/ulcers), and the presence of pain/photophobia.
3Distinguish benign causes (conjunctivitis, episcleritis, subconjunctival haemorrhage) from dangerous ones.

Management — overview

Conjunctivitis: usually self-limiting + hygiene; bacterial → a topical antibiotic; allergic → antihistamine/mast-cell stabiliser; viral → supportive.
Corneal abrasion: topical antibiotic + analgesia; remove any foreign body.
Sight-threatening causes → urgent ophthalmology: acute angle-closure glaucoma (emergency IOP lowering), microbial keratitis (esp. contact-lens — do not patch), anterior uveitis (steroid + cycloplegic under ophthalmology), scleritis (systemic work-up).

In-depthFull dosing & advanced protocol

Drug dosing

Topical antibiotic (e.g. chloramphenicol)

Bacterial conjunctivitis / corneal abrasion

Adult dose: Topical, per product
Route: Topical (eye)

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Acute angle-closure glaucoma — emergency IOP lowering

Sudden painful red eye + reduced vision + fixed mid-dilated pupil

Adult dose: Refer immediately; IOP-lowering therapy per ophthalmology
Route: —

Caution: Do NOT give topical steroids without ophthalmology (herpes/keratitis risk); never patch a contact-lens-related red eye.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

The dangerous red eye

Acute angle-closure glaucoma: sudden pain, haloes, nausea, a hazy cornea and a fixed mid-dilated pupil — an emergency.
Microbial keratitis in a contact-lens wearer: scrape and treat; do not patch or steroid.
Anterior uveitis: pain, photophobia, small pupil — needs slit-lamp assessment and a systemic-cause review.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute Angle-Closure GlaucomaA sudden rise in intraocular pressure from blockage of aqueous drainage — a painful red eye with blurred vision, haloes around lights, headache and nausea/vomiting, with a fixed mid-dilated pupil. A sight-threatening emergency.CataractClouding of the lens causing gradual, painless blurring of vision, glare and faded colours — the leading cause of reversible blindness worldwide, and cured by surgery.ConjunctivitisInflammation of the conjunctiva — a red eye with discharge, usually NON-painful and with normal vision. Causes are viral (commonest), bacterial and allergic; the key skill is excluding the sight-threatening causes of a red eye.

Loading…

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Topical antibiotic (e.g. chloramphenicol)

Acute angle-closure glaucoma — emergency IOP lowering

📈 The dangerous red eye

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Topical antibiotic (e.g. chloramphenicol)

Acute angle-closure glaucoma — emergency IOP lowering

📈 The dangerous red eye

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

The dangerous red eye

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

The dangerous red eye

References