This guideline last updated 06/05/2022 17:53:22

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 Fucidic 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