Methylprednisolone IV 500 mg daily local protocol dependent
Prednisone PO 60 mg daily local protocol dependent
Monitoring and reassessment
Reassessment loop
Pain and nausea every 30 to 60 minutes
Visual acuity repeat if symptom change
IOP repeat after therapy in suspected angle closure
Disposition
Level of care
ICU level considerations
Septic shock
Cavernous sinus thrombosis
Inpatient admission criteria
Orbital cellulitis
Endophthalmitis
Uncontrolled IOP with angle closure glaucoma
Giant cell arteritis with visual symptoms
Observation criteria
Diagnostic uncertainty with persistent severe pain
Poor follow up reliability
Discharge criteria
Normal or stable visual acuity
No orbital signs
Corneal ulcer excluded or treated with urgent follow up arranged
Clear return precautions provided
Follow up timing
Specialty follow up
Ophthalmology same day for corneal ulcer
Ophthalmology within 24 hours for uveitis
Ophthalmology within 24 hours for elevated IOP concern
Discharge Instructions
Copy discharge instructions
Patient instructions
You were seen for eye pain without injury
Do not wear contact lenses until cleared
Use prescribed drops exactly as directed
Do not use numbing eye drops at home
Return now for worsening pain
Return now for any vision change
Return now for fever
Return now for swelling around the eye
Return now for severe headache
Follow up timing as arranged
References
Guidelines and key sources
Evidence base
American Academy of Ophthalmology Preferred Practice Pattern Primary Angle Closure Disease 2020
American Academy of Ophthalmology Preferred Practice Pattern Bacterial Keratitis 2024
ACEP Sonoguide Ocular Emergencies Point of Care Ultrasound 2020
Annals of Emergency Medicine The Red Eye diagnostic tool 2023
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.