Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI core
Pattern and context
Onset and duration
Unilateral or bilateral
Constant or intermittent
Trauma mechanism
Chemical exposure
Foreign body exposure
Contact lens use
Recent eye surgery or injection
Recent upper respiratory infection
Sick contacts
OPQRST
OPQRST
Onset
Sudden
Gradual
Provocation and palliation
Worse with light
Worse with eye movement
Worse with contact lens wear
Improved with topical lubricants
Quality
Burning or gritty
Foreign body sensation
Deep boring pain
Itching
Region and radiation
Diffuse redness
Limbal flush
Periorbital pain
Severity
Pain scale
Functional limitation
Timing
Progressive worsening
Recurrent episodes
Associated symptoms
Eye associated symptoms
Visual change
Photophobia
Diplopia
Headache
Nausea
Vomiting
Discharge
Tearing
Foreign body sensation
Haloes around lights
Periorbital swelling
Fever
Baseline and prior episodes
Baseline status
Baseline visual acuity
Baseline eye disease
Prior similar episodes
Prior ophthalmology diagnosis
Prior response to treatment
Alarm Features
Immediate escalation triggers
Time critical red flags
Decreased visual acuity
Severe pain
Photophobia with ciliary flush
Corneal opacity
Hypopyon
Irregular pupil
Fixed mid dilated pupil
Proptosis
Pain with extraocular movements
Ophthalmoplegia
Relative afferent pupillary defect
Seidel positive
Suspected penetrating injury
Chemical injury exposure
Vital sign danger thresholds
Systemic instability
Fever with orbital signs
Hypotension
Altered mental status
High risk contexts
High risk populations
Contact lens wearer with pain
Immunocompromised
Recent ocular surgery
Anticoagulated with trauma
New vesicular rash
Known autoimmune disease
Medications
Current and recent medications
Medication exposure review
Current ophthalmic drops
Recent new systemic medications
OTC eye drops
Topical vasoconstrictors
Recent antibiotic use
Recent steroid exposure
High risk medication classes
Medication related risks
Immunosuppressants
Anticoagulants
Antiplatelets
Isotretinoin
Anticholinergics
Sympathomimetics
Contraindications to common therapies
Common traps
Topical anesthetics for outpatient use
Topical steroids without diagnosis
Contact lens wear during treatment
Diet
Exposures
Dietary and exposure context
Dehydration
Caffeine excess
Alcohol use
Trigger patterns
Symptom associated patterns
Outdoor allergen exposure
Smoke or irritant exposure
Pool or hot tub exposure
Review of Systems
Eye and ENT
Local symptoms
Rhinorrhea
Sinus pain
Ear pain
Sore throat
Infectious and inflammatory
Systemic symptoms
Fever
Chills
Myalgias
Rash
Oral ulcers
Neurologic and headache
Neuro symptoms
Severe headache
Neck stiffness
Focal neurologic deficit
Rheumatologic and autoimmune
Inflammatory features
Joint pain
Back pain
Diarrhea
Genital ulcers
Collateral History and Family History
Collateral and reliability
Source and reliability
Witnessed chemical exposure
Occupational incident report
Ability to comply with drops and follow up
Family history
Familial risk
Glaucoma
Autoimmune disease
Inflammatory bowel disease
Risk Factors
Exposure risks
Exposures
Contact lens hygiene issues
Sleeping in contact lenses
Freshwater exposure with contact lenses
Metal grinding
Woodworking
UV exposure
Chemical splash
Comorbid risks
Patient factors
Diabetes mellitus (E11.9)
Immunosuppression
HIV infection (B20)
Atopic disease
Rosacea
Procedure and device related risks
Ocular interventions
Recent cataract surgery
Recent intravitreal injection
Prior corneal transplant
Thrombosis and bleeding risks
Hemorrhage context
Anticoagulation
Coagulopathy
Differential Diagnosis
Life threatening
Cannot miss
Acute angle closure glaucoma (H40.20)
Severe pain
Halos
Nausea
Fixed mid dilated pupil
Elevated intraocular pressure
Microbial keratitis and corneal ulcer (H16.0)
Contact lens risk
Corneal infiltrate
Photophobia
Decreased visual acuity
Endophthalmitis (H44.0)
Recent surgery or injection
Severe pain
Hypopyon
Decreased vision
Orbital cellulitis (H05.01)
Fever
Proptosis
Pain with extraocular movements
Ophthalmoplegia
Decreased vision
Globe rupture and open globe injury (S05.3)
Seidel positive
Irregular pupil
Low intraocular pressure
Extrusion of ocular contents
Chemical ocular burn (T26)
Alkali exposure
Persistent pain
Corneal haze
Scleritis (H15.0)
Deep boring pain
Pain with eye movement
No blanching with phenylephrine
Common
Frequent causes
Conjunctivitis viral (B30.9)
Watery discharge
URI symptoms
Preauricular lymphadenopathy
Conjunctivitis bacterial (H10.0)
Purulent discharge
Eyelids stuck shut
Allergic conjunctivitis (H10.1)
Itching
Bilateral
Stringy discharge
Dry eye disease (H04.12)
Grittiness
Worse with screen time
Corneal abrasion (S05.0)
Foreign body sensation
Fluorescein uptake
Subconjunctival hemorrhage (H11.3)
Painless
Normal visual acuity
Less common
Other etiologies
Anterior uveitis and iritis (H20.0)
Photophobia
Ciliary flush
Cells and flare
Episcleritis (H15.10)
Mild discomfort
Sectoral redness
Blanching with phenylephrine
Herpes simplex keratitis (B00.52)
Dendritic fluorescein staining
Decreased corneal sensation
Herpes zoster ophthalmicus (B02.3)
Vesicular rash
Hutchinson sign
Blepharitis (H01.00)
Lid margin crusting
Burning
Dacryocystitis (H04.30)
Medial canthus tenderness
Purulent reflux with lacrimal sac pressure
Mimics and pitfalls
Mimics
Migraine with photophobia
Normal eye exam
Headache phenotype
Cluster headache
Unilateral autonomic features
Normal slit lamp
Cavernous sinus thrombosis (G08)
Fever
Cranial neuropathies
Proptosis
Past Medical History
Ocular history
Eye history
Glaucoma
Prior uveitis
Herpetic eye disease
Contact lens use history
Ocular trauma history
Medical history
Systemic conditions
Autoimmune disease
Inflammatory bowel disease
Diabetes mellitus (E11.9)
Atopy
Surgeries and procedures
Ocular procedures
Cataract surgery
Refractive surgery
Corneal transplant
Baseline function
Functional baseline
Baseline vision limitation
Baseline assistance needs
Physical Exam
General and vitals
First look
Temperature
Heart rate
Blood pressure
Respiratory rate
Oxygen saturation
Toxic appearance
Visual function
Vision assessment
Visual acuity right
Visual acuity left
Visual acuity with pinhole if available
Color vision if optic neuropathy concern
Visual fields gross
Pupils and motility
Neuro ocular exam
Pupils size and symmetry
Direct response
Consensual response
Relative afferent pupillary defect
Extraocular movements
Pain with extraocular movements
Diplopia in gaze
External and lids
Periorbital exam
Proptosis
Periorbital edema
Lid erythema
Vesicular rash
Lid margin crusting
Lacrimal sac tenderness
Conjunctiva and sclera
Redness pattern
Diffuse conjunctival injection
Sectoral injection
Ciliary flush
Chemosis
Subconjunctival hemorrhage
Cornea and anterior chamber
Slit lamp findings
Corneal clarity
Corneal infiltrate
Corneal epithelial defect
Anterior chamber cells
Anterior chamber flare
Hypopyon
Fluorescein and pressure
Bedside ophthalmic tests
Fluorescein staining pattern
Seidel sign
Intraocular pressure if safe
Fundus
Posterior segment
Red reflex
Optic disc edema
Vitreous haze
Pitfalls
Common misses
Visual acuity not measured
Contact lens retained
Foreign body under upper lid
Lab Studies
When systemic infection or inflammation suspected
Targeted labs
CBC for fever or orbital signs
CRP for suspected orbital cellulitis
ESR for suspected giant cell arteritis
Microbiology
Culture and swab considerations
Corneal culture for suspected corneal ulcer prior to antibiotics when feasible
Blood cultures for severe orbital cellulitis with systemic toxicity
Pregnancy and medication safety
Special populations
Pregnancy test when systemic therapy planned and status unknown
Renal function for acetazolamide planning
Imaging
Scoring Systems
Imaging decision logic
Local protocol dependent pathways
Escalation criteria based on orbital signs
MRI
MRI indications
Cavernous sinus thrombosis concern
Intracranial complication concern
MRI limitations
Availability and time to scan
Motion artifact in pain and agitation
CT
CT orbit and sinus
Orbital cellulitis concern
Suspected abscess
Suspected orbital fracture
Suspected intraorbital foreign body
CT considerations
Contrast allergy risk
Radiation exposure
Ultrasound
Ocular POCUS
Retinal detachment concern with vision loss
Vitreous hemorrhage concern
Ultrasound contraindications and pitfalls
Avoid globe pressure if open globe concern
Operator dependence
Special Tests
Bedside ophthalmic tests
Essential tests
Fluorescein staining
Seidel test
Eyelid eversion
Foreign body sweep
Differentiation maneuvers
Targeted differentiation
Phenylephrine blanching for episcleritis
No blanching for scleritis
Corneal sensation testing for herpetic keratitis
Specialty diagnostics
Ophthalmology tests
Slit lamp with cobalt blue
Dilated fundus exam
Gonioscopy for angle closure
ECG
When relevant
Indications driven by systemic illness
Sepsis physiology with tachycardia
Chest pain with vasculitic concern
Medication safety
Baseline rhythm considerations
Arrhythmia history before systemic beta blocker use
Conduction disease history before systemic beta blocker use
Assessment
Problem representation
Red eye syndrome
Pain severity stratification
Visual acuity change present or absent
Corneal involvement present or absent
Orbital signs present or absent
Working diagnosis
Leading diagnosis
Conjunctivitis (H10)
Corneal abrasion (S05.0)
Keratitis (H16)
Uveitis (H20)
Acute angle closure glaucoma (H40.20)
Complications to exclude
High risk complications
Corneal ulcer progression
Vision threatening infection
Orbital cellulitis extension
Diagnostic uncertainty
Alternate diagnoses
Scleritis (H15.0)
Endophthalmitis (H44.0)
Plan
First 5 minutes
Stabilization workflow
Visual acuity prioritized
Eye shield if trauma concern
Immediate irrigation for chemical exposure
Analgesia if severe pain
Antiemetic if vomiting
Diagnostic sequencing
Targeted testing
Fluorescein before antibiotics when corneal ulcer suspected and safe
Tonometry only if no open globe concern
CT orbit if orbital signs
Therapeutics
Condition directed treatment
Chemical injury
Irrigation until ocular surface neutral
Topical antibiotic prophylaxis per local protocol dependent
Cycloplegic per ophthalmology
Conjunctivitis viral
Lubricating drops
Cold compress
Hygiene measures
Conjunctivitis bacterial
Topical antibiotic per local protocol dependent
Contact lens removal
Allergic conjunctivitis
Topical antihistamine mast cell stabilizer
Oral antihistamine if systemic symptoms
Corneal abrasion
Topical antibiotic prophylaxis
Oral analgesia
Avoid contact lenses
Suspected microbial keratitis
Ophthalmology emergent
Broad spectrum topical antibiotic per ophthalmology
Anterior uveitis
Ophthalmology urgent
Cycloplegic per ophthalmology
Steroid drops only with ophthalmology guidance
Acute angle closure glaucoma
Ophthalmology emergent
Topical beta blocker per local protocol dependent
Topical alpha agonist per local protocol dependent
Topical pilocarpine when appropriate per ophthalmology
Acetazolamide if not contraindicated per local protocol dependent
Reassessment loop
Reassessment timing and triggers
Pain reassessment within 30 to 60 minutes
Visual acuity reassessment if worsening symptoms
Escalate if new orbital signs
Escalate if new corneal opacity
Escalate if new photophobia with ciliary flush
Consultation
Specialty involvement
Ophthalmology emergent for vision loss
Ophthalmology emergent for corneal ulcer concern
Ophthalmology emergent for acute angle closure concern
ENT and ophthalmology for orbital cellulitis with sinus disease
Toxicology or poison control for chemical exposures
Disposition
ICU and inpatient criteria
Higher level of care criteria
Orbital cellulitis with systemic toxicity
Orbital abscess on imaging
Endophthalmitis concern
Observation or admission criteria
Admission or observation
Inability to administer drops reliably
Immunocompromised with suspected ocular infection
Severe pain requiring parenteral analgesia
Transfer criteria
Transfer considerations
No ophthalmology access with vision threatening features
Open globe concern needing surgical capability
Discharge criteria
Safe discharge features
Normal or baseline visual acuity
No corneal infiltrate
No hypopyon
No orbital signs
Follow up secured
Follow up timing
Follow up windows
Same day for corneal ulcer concern
Within 24 hours for contact lens related abrasion
Within 24 to 48 hours for uveitis concern
Within 48 to 72 hours for uncomplicated conjunctivitis if not improving
Discharge Instructions
Copy discharge instructions
Diagnosis summary
Eye redness evaluated today
Vision checked today
No signs of eye emergency found today
Medications
Use drops as prescribed
Do not use contact lenses until cleared
Do not use numbing eye drops at home
Activity
Avoid rubbing the eye
Avoid swimming until symptoms resolve
Follow up
Follow up with eye doctor within recommended timeframe
Return sooner if unable to obtain follow up
Return to ED now if
Any worsening vision
Severe eye pain
Increasing light sensitivity
New swelling around the eye
Fever
New double vision
New vomiting
New rash on forehead or nose
Worsening redness despite treatment
References
Guidelines and high quality sources
American Academy of Ophthalmology Preferred Practice Pattern conjunctivitis
Local protocol dependent antibiotic selection
Emphasis on contact lens risk
American Academy of Ophthalmology Preferred Practice Pattern bacterial keratitis
Corneal ulcer as vision threatening emergency
Culture considerations for severe ulcers
American Academy of Ophthalmology Preferred Practice Pattern uveitis
Steroid therapy requires diagnosis confirmation
Ophthalmology follow up urgency
American Academy of Ophthalmology Preferred Practice Pattern primary angle closure
Time critical intraocular pressure reduction
Definitive therapy planning
Infectious Diseases Society of America guideline for orbital cellulitis related infections
Imaging and admission criteria
IV antibiotics and complication monitoring
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.