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FOCUSED SHIFT VIEW

Red Eye & Eye Emergencies

Vision + pain + halos = ophthalmology tonight.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Chemical burn: irrigate until pH 7.0–7.4, then examine.
  2. Visual acuity in every other red eye.
  3. Pain, halos, or a white spot (especially contact-lens wearers) is ophthalmology tonight.

2 · Escalate now if

  • Any loss of visual acuity
  • Moderate-severe pain, photophobia, or halos
  • Contact-lens wearer with pain or a white spot
  • Proptosis, limited/painful movement, fever
  • Abnormal pupil or afferent pupillary defect
  • Chemical splash — irrigate immediately, no exceptions

3 · Immediate workup

  • Acuity, fluorescein staining; tonometry when glaucoma is suspected
  • Chemical splash: irrigate first, then measure pH until 7.0–7.4

4 · Don’t miss

  • Chemical burn (alkali worse than acid)
    Immediate copious saline irrigation until conjunctival pH is 7.0–7.4 (often 30+ min / litres). Check pH after, then assess. Do not wait for a full exam.
  • Acute angle-closure glaucoma
    Painful red eye, halos, mid-dilated fixed pupil, cloudy cornea, vision loss — lower IOP + ophthalmology NOW.
  • Infectious keratitis (bacterial / herpetic)
    Contact lens + pain + white corneal infiltrate = ulcer; never patch, never start topical steroids, urgent ophthalmology.
  • Orbital cellulitis
    Proptosis, painful eye movement, fever — CT orbits + IV antibiotics (preseptal is milder).
  • Endophthalmitis
    Post-surgery/injection severe pain with hypopyon — emergency intraocular therapy.

5 · Disposition lane

Urgent ophthalmology (same day)

Keratitis, uveitis, retinal-detachment symptoms, hyphema, preseptal cellulitis.

Emergency ophthalmology / admission / stroke pathway

Chemical burn (after irrigation), angle-closure glaucoma, endophthalmitis, orbital cellulitis, CRAO.