This handout is for acute red eye (undifferentiated triage). Your care team identified this based on: acute ocular redness ± discharge, the undifferentiated chief complaint — the highest-yield primary-care/ed ophthalmic triage decision (johnson jama 2022 pmid 35699701; aao ppp conjunctivitis 2024).
Other reasons your team may use this plan: red eye with true ocular pain (deep ache/boring vs gritty foreign-body) — pain is the strongest single danger discriminator vs benign conjunctivitis (wills eye manual red-eye triage; aafp beaver compr ther 2001 pmid 11569323); red eye with reduced visual acuity and/or photophobia — the danger triad with pain; sight-threatening until excluded (aao ppp bacterial keratitis 2024; aao ppp anterior uveitis 2023); contact-lens wearer with an acute painful red eye — microbial keratitis until proven otherwise; never patch, never empiric steroid (stapleton ophthalmology 2008 pmid 18538404; maier dtsch arztebl int 2022 pmid 35912449).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| immediate_copious_ocular_irrigation_to_neutral_pH | — | — | — | Wills Eye Manual / AAO — alkali chemical injury is a true ocular emergency; immediate copious irrigation (≥1-2 L, e.g. saline/LR via Morgan lens) to neutral pH minimises stromal penetration and is the single highest-yield action; topical anaesthetic facilitates irrigation only. |
| topical_proparacaine_for_examination_only_not_dispensed | — | — | — | AAO PPP Bacterial Keratitis 2024 — topical anaesthetic enables exam/irrigation but is NEVER dispensed (epithelial toxicity, masking of progression); single in-clinic instillation only. |
Plan: Acute red-eye triage — immediate-harm-prevention + benign symptomatic care (definitive Rx routed by engine_id)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Benign causes: education + return precautions are the core deliverable — explicit "RED-FLAG return": new true pain, any vision drop, severe photophobia, halos, contact-lens-associated symptoms → immediate re-present. Contact-lens hygiene counselling (no overnight wear, no tap-water/showering in lenses, replace case) — the dominant preventable microbial-keratitis driver (Stapleton Ophthalmology 2008 PMID 18538404). Allergic: allergen avoidance + mast-cell stabiliser bridge. Recurrent HSV: suppression decision routed to keratitis engine (HEDS Arch Ophthalmol 2000 PMID 10922194). For routed dangerous cases, ownership transfers to the receiving engine.
Guideline: AAO Preferred Practice Pattern — Conjunctivitis (2024) + AAO PPP Bacterial Keratitis (2024) + AAO PPP Anterior Uveitis (2023) + AAO PPP Primary Angle Closure (2020) + Wills Eye Manual red-eye triage algorithm + JAMA Rational Clinical Examination (Johnson, Liu, Simel — Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection?, JAMA 2022) + Stapleton contact-lens microbial-keratitis incidence (Ophthalmology 2008 / Eye 2011) + Endophthalmitis Vitrectomy Study (Arch Ophthalmol 1995) + Herpetic Eye Disease Study (Ophthalmology 1994 / Arch Ophthalmol 2000)