Examqo › Examqo library › Family medicine › Eye, ENT and neurology · IMLE
The red eye in primary care
Most red eyes are benign conjunctivitis; reduced vision, severe pain, photophobia, an abnormal pupil or contact lenses mark a sight-threatening condition that needs an ophthalmologist the same day.
Why it matters in the exam
The exam presents: an eye with purulent discharge that glues the lids in the morning, a week-old baby with conjunctivitis, severe pain and blurred vision after pupil-dilating drops, a foreign body after grinding metal, and a burn from a cleaning product. It asks for the first step.
The first step in a chemical burn is immediate, prolonged irrigation — even before examination. In angle-closure glaucoma — pressure-lowering treatment and urgent referral.
The family doctor sees red eyes almost every day, usually without a slit lamp. So the decision rests on a few simple questions — is vision reduced, is there pain, does light bother, how does the pupil look and are contact lenses worn — and they separate what is treated in the clinic from what is sent today. Questions on blunt eye trauma also appear: double vision on looking up and numbness of the cheek suggest an orbital floor fracture, and blood in the anterior chamber requires referral.
Key points
- Most red eyes — benign conjunctivitis.
- Reduced vision, pain, photophobia, abnormal pupil or contact lenses — ophthalmologist today.
- Chemical burn — immediate, prolonged irrigation.
- Acute glaucoma — pain, halos and a fixed mid-dilated pupil; treat and refer immediately.
- Newborn: gonococcus on days 2–5, chlamydia on days 5–14.
Summary table
| Condition | Clues | Urgency | Treatment |
|---|---|---|---|
| Viral conjunctivitis | Watery discharge, preauricular node, starts in one eye and spreads to the other | Not urgent | Cold compresses, hygiene; contagious |
| Bacterial conjunctivitis | Purulent discharge, lids stuck in the morning | Not urgent; contact lenses — urgent | Antibiotic drops; with contact lenses — cover Pseudomonas and refer |
| Allergic conjunctivitis | Itch, bilateral, seasonal | Not urgent | Antihistamine or mast-cell stabiliser drops |
| Acute angle-closure glaucoma | Severe pain, halos around lights, fixed mid-dilated pupil, nausea; after pupil dilation or in the dark | Emergency | Acetazolamide, pressure-lowering drops, immediate referral for laser |
| Chemical burn | Exposure to a cleaning product (alkali) or acid | Emergency | Immediate, prolonged irrigation until the pH is normal, then an ophthalmologist |
| Neonatal conjunctivitis | Gonococcus on days 2–5, chlamydia on days 5–14 | Urgent | Gonococcus — ceftriaxone; chlamydia — oral erythromycin |
A free exam question
מנותח חוזר לביקורת שבוע אחרי resection rectus .medial בבדיקה יש כמוזיס של הלחמית הנזלית והידקקות קלה של הקרנית הקדמית הגובלת באיזור זה. בבדיקה עם סטריפ פלורצאין נראה איגום ( של צבע באיזור ההידקקות pooling). מה הטיפול הראשוני? (the question as examined, in Hebrew)
- א. טיפול מקומי בלובריקציה
- ב. טיפול מקומי בסטרואידים
- ג. טיפול מקומי באנטיביוטיקה
- ד. כריתת הלחמית הסמוכה
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Family medicine, Medical licensing exam (IMLE), Ophthalmology, Emergency medicine, Pediatrics.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- American Academy of Ophthalmology Preferred Practice Pattern, 2023 — Conjunctivitis; Primary angle-closure disease
- Goroll AH, Mulley AG. Primary Care Medicine, 8th edition (2020) — Evaluation of the red eye
- American Academy of Pediatrics, Red Book, 2024 — Gonococcal and chlamydial ophthalmia neonatorum
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.