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Bedside diagnosis of the "Red Eye": A Systematic Review.
Am J Med. 2015 Jul 10;
Authors: Narayana S, McGee S
Abstract
BACKGROUND: In patients with red eye, traditional teachings suggest that photophobia, visual blurring, and eye pain indicate serious eye disease; in patients with presumed conjunctivitis, the finding of purulent drainage traditionally indicates a bacterial cause. The accuracy of these teachings is unknown.
METHODS: A MEDLINE search was performed to retrieve articles published between 1966 and April 2014 relevant to the bedside diagnosis of serious eye disease and of bacterial conjunctivitis.
RESULTS: In patients with red eye, the most useful findings indicating serious eye disease are anisocoria (with the smaller pupil in the red eye and difference between pupil diameters > 1 mm; LR, 6.5; 95% CI 2.6-16.3) and photophobia, elicited either by direct illumination (LR, 8.3; 95% confidence interval, 2.7-25.9), indirect illumination (LR, 28.8; 95% CI, 1.8-459), or near synkinesis test ("finger-to-nose convergence test", LR, 21.4; 95% CI 12-38.2). In patients with presumed conjunctivitis, complete redness of the conjunctival membrane obscuring tarsal vessels (LR 4.6; 95% CI 1.2-17.1), observed purulent discharge (LR 3.9; 95% CI 1.7-9.1), and matting of both eyes in the morning (LR 3.6; 95% CI 1.9-6.5) increase probability of a bacterial cause; failure to observe a red eye at 20 feet (LR 0.2; 95% CI 0-0.8) and absence of morning gluing of either eye (LR 0.3; 95% CI 0.1-0.8) decrease probability of a bacterial cause.
CONCLUSIONS: Several bedside findings accurately distinguish serious from benign eye disease in patients with red eye and, in patients with presumed conjunctivitis, distinguish bacterial from viral or allergic causes.
PMID: 26169885 [PubMed - as supplied by publisher]