Clinical research studyBedside Diagnosis of the ‘Red Eye’: A Systematic Review
Section snippets
Materials and Methods
We searched PubMed to identify all English-language studies that evaluated the diagnostic accuracy of the patient interview and physical examination in adult patients presenting with a red eye. The specific search strategy is shown in Appendix E1, (available online).
We included all studies meeting the following 3 criteria: (1) The study enrolled either consecutive unselected adults with red eye, all of whom eventually underwent the diagnostic standard of slit-lamp examination to distinguish
Distinguishing Serious From Benign Eye Disease
Five studies enrolling 957 consecutive patients were included in this review. Four studies recruited patients with red eye,4, 5, 6, 7 and 1 study enrolled patients with “miscellaneous eye complaints.”8 All patients underwent slit-lamp biomicroscopy: Serious disease was found in 4% to 59% (mean, 27%), mostly anterior uveitis (iritis) and corneal disorders (herpes simplex infection, corneal abrasion, and miscellaneous causes of keratitis).
Two findings—anisocoria and the presence of pain during
Discussion
Most ophthalmologic diagnosis depends on empiric observation by specialists using slit-lamp biomicroscopy. However, our results demonstrate that some clinical variables easily observed by primary providers without a slit lamp also accurately diagnose serious eye disease and bacterial conjunctivitis.
Simple observation of the pupil and the patient's response to pupillary constriction provide important clues suggesting serious eye disease. Inflammation of the iris and spasm of the ciliary body are
Conclusions
In patients with the red eye, simple examination of the pupils and response to pupillary constriction accurately identify patients who require immediate referral to an ophthalmologist. All patients with visual blurring and significant eye pain also require immediate referral, although these findings have not been evaluated systematically. In patients with conjunctivitis, a bacterial cause is more likely if there is bilateral matting of the eyes, conjunctival redness obscuring tarsal vessels,
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Cited by (0)
Funding: None.
Conflict of Interest: SM receives royalties from Elsevier for his textbook Evidence-based Physical Diagnosis, 3rd Edition.
Authorship: Both authors had access to the data and played a role in writing this manuscript.