Patients presenting with an acute red eye are common in the emergency department. Megan Boysen Osborn, MD, FACEP, has worked up a checklist that tells emergency physicians what they need to look for—no pun intended.

The following queries will be presented at her session, “Discharge or Disaster? Differentiating Between Harmless and Dangerous Causes of the Acute Red Eye.” They are:

• Does the patient have pain in his or her eye, and is that pain more than mild?
• Is there fluorescein uptake on the fluorescein exam?
• Do they have cells and flare in the anterior chamber?
• Do they have elevated intraocular pressure?
• Is there any decreased visual acuity?

“If the answer to all of those questions is no, then you are pretty safe to discharge that patient home to follow up as needed,” said Dr. Osborn, vice chair of education and residency program director for emergency medicine at University of California Irvine Health in Orange. “If a patient has pain associated with their acute red eye, they definitely need a more detailed ophthalmologic examination, including fluorescein.”

One issue is emergency physicians assuming an acute red eye is “probably just conjunctivitis,” Dr. Osborn said.

“Patients with benign eye conditions shouldn’t have more than a mild irritation,” she said. “I had a patient one time who appeared to have conjunctivitis, but he endorsed a moderate level of pain. So, sure enough on fluorescein exam, he had a viral keratitis from a herpes virus. That is something we would not have wanted to miss in the emergency department.”

“When you are evaluating a patient with an acute red eye,” Dr. Osborn said, “the presence or absence of pain is a very important feature.”