Seeing Red: A Practical Guide to Red Eye for Optometrists in Pre-Reg Preparation

When faced with a red-eye patient, a structured history is your best starting point. Indy recommends the “LOFTS” approach:

• Location – Where is the redness? Localised or diffuse? One eye or both?
• Onset – When did it start? Was it sudden or gradual?
• Frequency – Is this a first episode, recurrent, or persistent?
• Type – What kind of redness — generalised, sectoral, or lid margin?
• Severity – How red is the eye, and how much is it impacting comfort or vision?

During pre-reg preparation, practice taking a detailed history, including systemic health, medications, allergies, trauma, and contact lens use. This structured method not only prepares you for real clinics but also mirrors OSCE assessment expectations.

Common Red Eye Conditions

Conjunctivitis

• Presentation: Bilateral, mild discomfort, discharge (watery, sticky, or mucopurulent depending on type), vision typically unaffected.
• Types: Bacterial, viral, allergic, or toxic.
• Management: Often self-limiting. Emphasise hygiene, artificial tears, and cold compresses. Antibiotics may help in bacterial cases; mast-cell stabilisers or antihistamines for allergic cases.

Blepharitis

• Presentation: Lid margin inflammation, often chronic. Symptoms include burning, itching, grittiness, and crusting on waking.
• Signs: Thickened lids, blocked meibomian glands, corneal staining.
• Management: Lid hygiene, warm compresses, preservative-free lubricants, omega-3 supplements. Severe cases may require antibiotics.

Dry Eye

• Presentation: Chronic, bilateral irritation with fluctuating vision. Often worsens with environment or screen use.
• Signs: Reduced tear meniscus, shortened break-up time, corneal staining.
• Management: Preservative-free artificial tears, hot compresses, omega-3 supplements, and lifestyle advice. Severe cases may require punctal plugs.

Episcleritis

• Presentation: Gradual onset, unilateral, mild discomfort, redness (sectoral or diffuse). Vision unaffected, no discharge.
• Diagnosis tip: Vessels blanch with 2.5% phenylephrine, helping differentiate from scleritis.
• Management: Usually self-limiting. Reassure, use lubricants, and refer if recurrent or atypical.

Subconjunctival Haemorrhage

• Presentation: Sudden, bright-red scleral patch, usually painless and unilateral. Vision unaffected.
• Causes: Often idiopathic, but may be linked to trauma, hypertension, or clotting disorders.
• Management: Reassure, use lubricants for comfort. Refer to GP if recurrent.

Key Takeaways for Pre-Reg Preparation

• Structured history taking (like LOFTS) is essential for accurate red-eye assessment.
• Many red-eye conditions are self-limiting but require clear patient communication and reassurance.
• Understanding the differences between common presentations will improve your OSCE performance and clinical decision-making.
• Knowing when to refer or escalate ensures patient safety — a key skill in both exams and practice.

For trainees, incorporating red-eye scenarios into your pre-reg preparation helps build confidence in both clinical competence and patient interaction.