Clinical Evaluation of Red Eyes in Pediatric Patients

Casey Beal, MD; Beverly Giordano, MS, RN, CPNP, PMHS


J Pediatr Health Care. 2016;30(5):506-514. 

In This Article

Abstract and Introduction


Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.


Patients with the primary symptom of a red eye are often seen in the pediatric primary care setting, and because the differential diagnoses are broad, the diagnosis can sometimes be elusive. However, with use of a focused history and simple clinical examination techniques, the provider can be more confident in the diagnosis and management of red eyes in children. Clinic visits for red eyes are common; approximately 1% of all primary care office visits are due to conjunctivitis (Azari & Barney, 2013). The eye becomes red as a nonspecific reaction to any type of insult, including infection, allergy, trauma, dryness, or systemic inflammation. The redness stems from engorgement of the conjunctival vessels. In trauma and some types of infection, the redness can be caused by subconjunctival hemorrhages. The red eye has a broad differential diagnosis, but very often, a simple history and physical examination can help elucidate the diagnosis (Table).