Symptomdx.

Get Started

Atraumatic Eye PainAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

406 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Dysphagia And Odynophagia Throat Pain Ear Pain Foreign Body In Ear Or Nose Vision Loss Complaint Flashes And Floaters Atraumatic Eye Pain Red Eye Dental Abscess Concern Post Extraction Pain And Complications

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx50

HPI

›Symptom overview

›Atraumatic eye pain laterality

›Baseline vision and current change

›Contact lens use

›Prior ocular disease and surgery

›OPQRST

›Onset

›Sudden onset

›Gradual onset

›Provocation and palliation

›Worse with eye movement

›Worse with light

›Worse at night

›Relief with topical anesthetic

›Quality

›Deep boring pain

›Scratchy foreign body sensation

›Region and radiation

›Periocular pain

›Temporal pain

›Headache

›Severity

›Pain scale

›Functional limitation

›Timing

›Constant

›Intermittent

02Alarm Features/alarm23

Immediate vision threats

›High risk features

›Decreased visual acuity

›Severe pain with nausea or vomiting

›Fixed mid dilated pupil

›Corneal opacity

›Hypopyon

›Proptosis

›Painful ophthalmoplegia

›Afferent pupillary defect

›Vesicular rash in V1 distribution

Systemic danger features

›High risk context

›Immunocompromised state

›Pregnancy

›Anticoagulation

›Giant cell arteritis symptoms

›Jaw claudication

›Scalp tenderness

›Polymyalgia rheumatica symptoms

Escalation triggers

›Immediate escalation criteria

›If suspected acute angle closure glaucoma then immediate IOP lowering and ophthalmology

›If orbital cellulitis concern then IV antibiotics and CT orbit with contrast

›If suspected endophthalmitis then emergent ophthalmology

›If suspected giant cell arteritis then immediate steroids and urgent evaluation

03Medications/meds17

Current and recent meds

›Medication inventory

›Prescribed ocular drops

›OTC eye drops

›Topical anesthetic exposure

›Contact lens solutions

›Recent antibiotics

›Recent antivirals

›High risk medication classes

›Anticholinergics and sympathomimetics

›Corticosteroids

›Anticoagulants

›Allergy and intolerance

›Fluoroquinolone allergy

›Sulfa allergy

›Contraindication traps

›Topical steroids in suspected herpetic keratitis

›Mydriatics in suspected angle closure glaucoma

04Diet/diet7

Intake and stimulants

›Exposure patterns

›Hydration status

›Caffeine intake

›Energy drink use

›Alcohol exposure

›Recent heavy intake

›Withdrawal symptoms

05Review of Systems/ros16

Eye and neuro

›Ophthalmic ROS

›Vision loss

›Photophobia

›Floaters

›Flashes

›Diplopia

›Neurologic ROS

›Headache

›Focal deficit

›Neck stiffness

Infectious and inflammatory

›Systemic ROS

›Fever

›Sinus symptoms

›Rash

›Arthralgia

›Oral ulcers

06Collateral History and Family History/chafh7

Collateral and reliability

›Source

›Patient report reliability

›Family or caregiver input

Family history

›Relevant family history

›Glaucoma

›Autoimmune disease

›Vasculitis

07Risk Factors/rf12

Ocular and infectious risks

›Eye specific risks

›Contact lens overnight wear

›Poor contact lens hygiene

›Prior HSV or VZV

›Recent eye procedure

›Infection risks

›Diabetes mellitus (E11.9)

›Immunosuppression

Vascular and inflammatory risks

›Ischemic and vasculitic risks

›Age 50 or older

›Known polymyalgia rheumatica

›Known vasculitis

08Differential Diagnosis/ddx66

Life threatening

›Must not miss diagnoses

›Acute angle closure glaucoma (H40.212)

›Severe pain

›Halos

›Nausea or vomiting

›Mid dilated poorly reactive pupil

›Elevated IOP

›Orbital cellulitis (H05.0)

›Fever

›Pain with EOM

›Proptosis

›Decreased vision

›Endophthalmitis (H44.0)

›Recent surgery or injection

›Severe pain

›Hypopyon

›Marked vision loss

›Giant cell arteritis (M31.6)

›Temporal headache

›Jaw claudication

›Elevated ESR or CRP

›Cavernous sinus thrombosis (I67.6)

›Painful ophthalmoplegia

›Cranial nerve palsy

›Fever

Common

›Common diagnoses

09Past Medical History/pmh14

Ocular history

›Prior eye conditions

›Glaucoma

›Uveitis

›HSV keratitis

›Prior corneal ulcer

›Prior procedures

›Cataract surgery

›LASIK or PRK

Systemic history

›Systemic comorbidity

›Diabetes mellitus (E11.9)

›Rheumatoid arthritis (M06.9)

›Inflammatory bowel disease (K52.9)

›Sarcoidosis (D86.9)

›Thyroid disease (E07.9)

10Physical Exam/exam43

Vitals and general

›Initial assessment

›Fever

›Hemodynamic instability

›Toxic appearance

Eye exam core

›Visual function

›Visual acuity:

›Each eye separately

›With pinhole if available

›Pupils:

›Size and symmetry

›Reactivity

›Relative afferent pupillary defect

›Color vision:

›Red desaturation comparison

›Ishihara if available

›External and anterior segment

›Lids and lashes

›Conjunctiva and sclera

›Cornea clarity

›Anterior chamber depth

›Ciliary flush

›Discharge type

›EOM and orbit

›Pain with EOM

›Ophthalmoplegia

›Proptosis

11Lab Studies/labs15

Inflammatory and infectious workup

›Targeted labs by concern

›CBC with differential

›CRP

›ESR

›Blood cultures

›Interpretation thresholds

›Giant cell arteritis risk with elevated ESR or CRP

›Normal ESR does not exclude giant cell arteritis

Metabolic and immunocompromise

›Comorbidity assessment

›Glucose

›Creatinine

›Pregnancy test

Microbiology

›Culture indications

›Corneal ulcer culture if severe

›Contact lens case culture when available

12Imaging/img22

Scoring Systems

›Imaging decision framing

›No validated universal ED score for atraumatic eye pain

›Imaging driven by red flags and exam limitations

MRI

›MRI orbits and brain

›Optic neuritis concern

›Orbital apex syndrome concern

›Cavernous sinus process concern

›MRI considerations

›Contrast use local protocol dependent

›Pacemaker and metal contraindications

›CT orbit and sinuses with contrast

›Orbital cellulitis concern

›Subperiosteal abscess concern

›CT venography

›Cavernous sinus thrombosis concern

›Severe headache with cranial nerve palsy

Ultrasound

›Ocular POCUS

›Vitreous hemorrhage when fundus not visible

›Retinal detachment when fundus not visible

›Safety and pitfalls

›Avoid pressure if globe rupture concern

›Ultrasound does not exclude keratitis or uveitis

13Special Tests/spec14

Bedside ophthalmic tests

›Core tests

›Fluorescein staining

›Seidel test

›Slit lamp exam

›Lid eversion

›Interpretation pearls

›Pain relief with topical anesthetic suggests corneal surface process

›Consensual photophobia supports anterior uveitis

Tonometry and gonioscopy context

›IOP testing

›Elevated IOP supports angle closure glaucoma

›Normal IOP does not exclude uveitis

›Specialist tests

›Gonioscopy ophthalmology performed

›Anterior segment OCT ophthalmology performed

14ECG/ecg7

Cardiac considerations

›When ECG may be relevant

›Older patient with atypical pain and autonomic symptoms

›Chest pain

›Syncope

›Medication related considerations

›QT risk with some antiemetics

›Bradycardia with beta blockers for glaucoma

15Assessment/ax15

Problem representation

›Atraumatic eye pain syndrome

›Laterality

›Visual acuity status

›Presence of photophobia

›Presence of discharge

›IOP status

Severity and risk

›High risk stratification

›Vision threat suspected

›Immunocompromised host

›Contact lens related keratitis risk

›Giant cell arteritis risk

Diagnostic uncertainty

›Competing diagnoses

›Corneal process versus uveitis

›Orbital process versus superficial redness

›Headache mimic with normal ocular exam

16Plan/plan42

First 5 minutes

›Immediate priorities

›Visual acuity before drops when possible

›Analgesia

›Antiemetic if vomiting

›NPO if emergent ophthalmology likely

›Immediate consult triggers

›Suspected acute angle closure glaucoma

›Suspected corneal ulcer

›Suspected endophthalmitis

›Suspected orbital cellulitis

›Suspected giant cell arteritis with visual symptoms

Diagnostic sequence

›Testing flow

›Fluorescein staining early

›IOP after globe integrity assessment

›Slit lamp if available

›CT orbit with contrast if orbital cellulitis concern

Therapeutics

›Pain control

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 600 mg once

›Avoid topical anesthetic prescription at discharge

›Suspected bacterial keratitis or corneal ulcer

›If contact lens wearer then topical fluoroquinolone local protocol dependent

›Discontinue contact lenses

›Ophthalmology same day

›Suspected anterior uveitis

17Disposition/dispo20

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

18Discharge Instructions/di11

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

19References/r5

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

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Atraumatic Eye PainAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

406 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx50

HPI

›Symptom overview

›Atraumatic eye pain laterality

›Baseline vision and current change

›Contact lens use

›Prior ocular disease and surgery

›OPQRST

›Onset

›Sudden onset

›Gradual onset

›Provocation and palliation

›Worse with eye movement

›Worse with light

›Worse at night

›Relief with topical anesthetic

›Quality

›Deep boring pain

›Scratchy foreign body sensation

›Region and radiation

›Periocular pain

›Temporal pain

›Headache

›Severity

›Pain scale

›Functional limitation

›Timing

›Constant

›Intermittent

02Alarm Features/alarm23

Immediate vision threats

›High risk features

›Decreased visual acuity

›Severe pain with nausea or vomiting

›Fixed mid dilated pupil

›Corneal opacity

›Hypopyon

›Proptosis

›Painful ophthalmoplegia

›Afferent pupillary defect

›Vesicular rash in V1 distribution

Systemic danger features

›High risk context

›Immunocompromised state

›Pregnancy

›Anticoagulation

›Giant cell arteritis symptoms

›Jaw claudication

›Scalp tenderness

›Polymyalgia rheumatica symptoms

Escalation triggers

›Immediate escalation criteria

›If suspected acute angle closure glaucoma then immediate IOP lowering and ophthalmology

›If orbital cellulitis concern then IV antibiotics and CT orbit with contrast

›If suspected endophthalmitis then emergent ophthalmology

›If suspected giant cell arteritis then immediate steroids and urgent evaluation

03Medications/meds17

Current and recent meds

›Medication inventory

›Prescribed ocular drops

›OTC eye drops

›Topical anesthetic exposure

›Contact lens solutions

›Recent antibiotics

›Recent antivirals

›High risk medication classes

›Anticholinergics and sympathomimetics

›Corticosteroids

›Anticoagulants

›Allergy and intolerance

›Fluoroquinolone allergy

›Sulfa allergy

›Contraindication traps

›Topical steroids in suspected herpetic keratitis

›Mydriatics in suspected angle closure glaucoma

04Diet/diet7

Intake and stimulants

›Exposure patterns

›Hydration status

›Caffeine intake

›Energy drink use

›Alcohol exposure

›Recent heavy intake

›Withdrawal symptoms

05Review of Systems/ros16

Eye and neuro

›Ophthalmic ROS

›Vision loss

›Photophobia

›Floaters

›Flashes

›Diplopia

›Neurologic ROS

›Headache

›Focal deficit

›Neck stiffness

Infectious and inflammatory

›Systemic ROS

›Fever

›Sinus symptoms

›Rash

›Arthralgia

›Oral ulcers

06Collateral History and Family History/chafh7

Collateral and reliability

›Source

›Patient report reliability

›Family or caregiver input

Family history

›Relevant family history

›Glaucoma

›Autoimmune disease

›Vasculitis

07Risk Factors/rf12

Ocular and infectious risks

›Eye specific risks

›Contact lens overnight wear

›Poor contact lens hygiene

›Prior HSV or VZV

›Recent eye procedure

›Infection risks

›Diabetes mellitus (E11.9)

›Immunosuppression

Vascular and inflammatory risks

›Ischemic and vasculitic risks

›Age 50 or older

›Known polymyalgia rheumatica

›Known vasculitis

08Differential Diagnosis/ddx66

Life threatening

›Must not miss diagnoses

›Acute angle closure glaucoma (H40.212)

›Severe pain

›Halos

›Nausea or vomiting

›Mid dilated poorly reactive pupil

›Elevated IOP

›Orbital cellulitis (H05.0)

›Fever

›Pain with EOM

›Proptosis

›Decreased vision

›Endophthalmitis (H44.0)

›Recent surgery or injection

›Severe pain

›Hypopyon

›Marked vision loss

›Giant cell arteritis (M31.6)

›Temporal headache

›Jaw claudication

›Elevated ESR or CRP

›Cavernous sinus thrombosis (I67.6)

›Painful ophthalmoplegia

›Cranial nerve palsy

›Fever

Common

›Common diagnoses

09Past Medical History/pmh14

Ocular history

›Prior eye conditions

›Glaucoma

›Uveitis

›HSV keratitis

›Prior corneal ulcer

›Prior procedures

›Cataract surgery

›LASIK or PRK

Systemic history

›Systemic comorbidity

›Diabetes mellitus (E11.9)

›Rheumatoid arthritis (M06.9)

›Inflammatory bowel disease (K52.9)

›Sarcoidosis (D86.9)

›Thyroid disease (E07.9)

10Physical Exam/exam43

Vitals and general

›Initial assessment

›Fever

›Hemodynamic instability

›Toxic appearance

Eye exam core

›Visual function

›Visual acuity:

›Each eye separately

›With pinhole if available

›Pupils:

›Size and symmetry

›Reactivity

›Relative afferent pupillary defect

›Color vision:

›Red desaturation comparison

›Ishihara if available

›External and anterior segment

›Lids and lashes

›Conjunctiva and sclera

›Cornea clarity

›Anterior chamber depth

›Ciliary flush

›Discharge type

›EOM and orbit

›Pain with EOM

›Ophthalmoplegia

›Proptosis

11Lab Studies/labs15

Inflammatory and infectious workup

›Targeted labs by concern

›CBC with differential

›CRP

›ESR

›Blood cultures

›Interpretation thresholds

›Giant cell arteritis risk with elevated ESR or CRP

›Normal ESR does not exclude giant cell arteritis

Metabolic and immunocompromise

›Comorbidity assessment

›Glucose

›Creatinine

›Pregnancy test

Microbiology

›Culture indications

›Corneal ulcer culture if severe

›Contact lens case culture when available

12Imaging/img22

Scoring Systems

›Imaging decision framing

›No validated universal ED score for atraumatic eye pain

›Imaging driven by red flags and exam limitations

MRI

›MRI orbits and brain

›Optic neuritis concern

›Orbital apex syndrome concern

›Cavernous sinus process concern

›MRI considerations

›Contrast use local protocol dependent

›Pacemaker and metal contraindications

›CT orbit and sinuses with contrast

›Orbital cellulitis concern

›Subperiosteal abscess concern

›CT venography

›Cavernous sinus thrombosis concern

›Severe headache with cranial nerve palsy

Ultrasound

›Ocular POCUS

›Vitreous hemorrhage when fundus not visible

›Retinal detachment when fundus not visible

›Safety and pitfalls

›Avoid pressure if globe rupture concern

›Ultrasound does not exclude keratitis or uveitis

13Special Tests/spec14

Bedside ophthalmic tests

›Core tests

›Fluorescein staining

›Seidel test

›Slit lamp exam

›Lid eversion

›Interpretation pearls

›Pain relief with topical anesthetic suggests corneal surface process

›Consensual photophobia supports anterior uveitis

Tonometry and gonioscopy context

›IOP testing

›Elevated IOP supports angle closure glaucoma

›Normal IOP does not exclude uveitis

›Specialist tests

›Gonioscopy ophthalmology performed

›Anterior segment OCT ophthalmology performed

14ECG/ecg7

Cardiac considerations

›When ECG may be relevant

›Older patient with atypical pain and autonomic symptoms

›Chest pain

›Syncope

›Medication related considerations

›QT risk with some antiemetics

›Bradycardia with beta blockers for glaucoma

15Assessment/ax15

Problem representation

›Atraumatic eye pain syndrome

›Laterality

›Visual acuity status

›Presence of photophobia

›Presence of discharge

›IOP status

Severity and risk

›High risk stratification

›Vision threat suspected

›Immunocompromised host

›Contact lens related keratitis risk

›Giant cell arteritis risk

Diagnostic uncertainty

›Competing diagnoses

›Corneal process versus uveitis

›Orbital process versus superficial redness

›Headache mimic with normal ocular exam

16Plan/plan42

First 5 minutes

›Immediate priorities

›Visual acuity before drops when possible

›Analgesia

›Antiemetic if vomiting

›NPO if emergent ophthalmology likely

›Immediate consult triggers

›Suspected acute angle closure glaucoma

›Suspected corneal ulcer

›Suspected endophthalmitis

›Suspected orbital cellulitis

›Suspected giant cell arteritis with visual symptoms

Diagnostic sequence

›Testing flow

›Fluorescein staining early

›IOP after globe integrity assessment

›Slit lamp if available

›CT orbit with contrast if orbital cellulitis concern

Therapeutics

›Pain control

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 600 mg once

›Avoid topical anesthetic prescription at discharge

›Suspected bacterial keratitis or corneal ulcer

›If contact lens wearer then topical fluoroquinolone local protocol dependent

›Discontinue contact lenses

›Ophthalmology same day

›Suspected anterior uveitis

17Disposition/dispo20

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

18Discharge Instructions/di11

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

19References/r5

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

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.