Date of last review: Due to be updated

Differential diagnosis

  • Other causes of acute red eye
  • Pre-septal cellulitis

Possible management by Optometrist

Treatment

  • Cold compress to ease lid oedema
  • Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)
  • Topical antibiotic and ocular lubrication for any corneal abrasion
    • Ask if allergic to Chloramphenicol
    • If not, supply Chloramphenicol 1% eye ointment 3 times daily for 5 days
    • If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for 5 days

Advice

  • Dependent on clinical findings
  • Advise patient to return/seek further help if symptoms persist

Management Category

  • Ocular management depends on mechanism and severity of injury
  • Initial referral to A&E may be more appropriate if there has been a period of unconsciousness or if there is suspicion of skull or orbital fracture
  • Severe cases (usually with some loss of visual function) should be referred same day if:
    • Enophthalmos
    • Nasal bleeding
    • Relative afferent pupillary defect
    • Traumatic mydriasis
    • Disturbance of ocular motility
    • Infraorbital nerve anaesthesia
    • Corneal oedema or laceration
    • Hyphaema
    • Iridodialysis
    • Lens subluxation
    • Raised IOP
    • Vitreous haemorrhage
    • Commotio retinae
    • Retinal detachment
    • Retinal dialysis
    • Traumatic macular hole
    • Globe rupture
  • Mild cases (usually with good corrected vision) not normally referred
    • Eyelid oedema
    • Eyelid ecchymosis
    • Conjunctival chemosis
    • Subconjunctival haemorrhage
    • Corneal abrasion

Possible management by Ophthalmologist

  • Assessment and investigation
  • Treatment of globe rupture where present
  • May require hospital admission