Scope of this summary
Children and adults presenting to ambulatory care with an acute red eye. The AAO conjunctivitis and bacterial-keratitis Preferred Practice Patterns support the two common or dangerous branches but do not replace dedicated glaucoma, uveitis, trauma, orbital cellulitis or endophthalmitis guidance.
The Bottom Line
- Measure visual acuity in each eye before treatment whenever possible and ask specifically about pain, photophobia, vision change, discharge, trauma, chemical exposure, contact lenses, recent surgery and systemic symptoms.
- Conjunctivitis is a syndrome with infectious and noninfectious causes; classify the likely cause and look for corneal or intraocular involvement rather than prescribing an antibiotic for redness alone.
- Avoid indiscriminate topical antibiotics because viral conjunctivitis does not respond and mild bacterial conjunctivitis is often self-limited; never prescribe topical corticosteroid without appropriate ophthalmic diagnosis and monitoring.
- Treat a painful contact-lens-associated red eye with corneal opacity, epithelial defect or reduced vision as possible microbial keratitis: stop lens wear and obtain same-day ophthalmic assessment.
- Hyperacute purulent conjunctivitis can be gonococcal and vision threatening, requiring immediate systemic treatment, microbiologic testing and corneal assessment rather than routine topical therapy.
Practical clinical workflow
1
Take a focused history and examine visual acuity, pupils, ocular motility, lids, pattern of injection, discharge and cornea; use fluorescein and intraocular-pressure assessment when trained, equipped and clinically appropriate.
2
Identify immediate emergencies first: chemical injury, penetrating or high-velocity trauma, acute angle closure, keratitis, uveitis, endophthalmitis, orbital disease or a new neurologic or vascular visual deficit.
3
For likely conjunctivitis, distinguish viral, routine bacterial, allergic, toxic or chlamydial patterns and assess duration, outbreak contacts and recurrence before choosing supportive, antimicrobial or allergy-directed care.
4
Provide hygiene advice for contagious conjunctivitis, including handwashing, separate towels and avoiding shared eye products; clean reusable equipment using current infection-control procedures.
5
Set an explicit review or referral point for persistent, recurrent or atypical disease, because chronic conjunctivitis can signal chlamydia, mucous-membrane pemphigoid, neoplasia or another inflammatory disorder.
Safety boundaries and escalation
- Severe pain, photophobia, reduced vision, a corneal opacity or defect, irregular or poorly reactive pupil, proptosis, restricted eye movement, recent surgery or contact-lens wear with corneal findings requires urgent or same-day ophthalmic evaluation.
- Begin copious irrigation immediately after chemical exposure and continue while arranging emergency eye care; history taking and visual testing must not delay decontamination.
- Do not patch a suspected corneal infection, allow contact-lens reuse or provide take-home topical anesthetic without a dedicated supervised protocol.
- Infants with purulent conjunctivitis, immunocompromised patients and suspected herpes, gonococcus or chlamydia need pathogen- and age-specific systemic assessment.
Localization
The AAO Preferred Practice Patterns are written for ophthalmic practice; this page uses them to define safe ambulatory triage, not to authorize office procedures beyond clinician competence. State optometry scope, after-hours eye access and local gonorrhea pathways vary.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease PanelConjunctivitis Preferred Practice PatternDOI 10.1016/j.ophtha.2023.12.037 路 published 2024-02-12 路 accessed 2026-08-20view source
- American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease PanelBacterial Keratitis Preferred Practice PatternDOI 10.1016/j.ophtha.2023.12.035 路 published 2024-02-13 路 accessed 2026-08-20view source
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