Red EyeAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

500 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/hx54

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

02Alarm Features/alarm26

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

03Medications/meds18

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

04Diet/diet8

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

05Review of Systems/ros20

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

06Collateral History and Family History/chafh8

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

07Risk Factors/rf21

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

08Differential Diagnosis/ddx89

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

09Past Medical History/pmh18

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

10Physical Exam/exam53

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

11Lab Studies/labs10

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

12Imaging/img23

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 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

13Special Tests/spec13

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

14ECG/ecg6

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

15Assessment/ax18

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)

16Plan/plan54

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

17Disposition/dispo22

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

18Discharge Instructions/di24

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

19References/r15

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

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.

Red EyeAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

500 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/hx54

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

02Alarm Features/alarm26

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

03Medications/meds18

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

04Diet/diet8

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

05Review of Systems/ros20

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

06Collateral History and Family History/chafh8

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

07Risk Factors/rf21

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

08Differential Diagnosis/ddx89

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

09Past Medical History/pmh18

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

10Physical Exam/exam53

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

11Lab Studies/labs10

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

12Imaging/img23

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 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

13Special Tests/spec13

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

14ECG/ecg6

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

15Assessment/ax18

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)

16Plan/plan54

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

17Disposition/dispo22

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

18Discharge Instructions/di24

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

19References/r15

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

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.