Mild or Pricking Pain

Small foreign body

Herpes Simplex Keratitis
Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure

Trauma?

Herpes Simplex Keratitis

Bacterial Conjunctivitis
Dry Eye
Episcleritis
H202 solution exposure

Small foreign body

Unilateral
Fl- staining track
Evert upper lid and check

Anaesthetiseandliftoff
withmoiststerilecottonbud
ifsuperficial
Urgent referral to hospital
eye casualty department

Dry Eye
H202 solution exposure

H202 solution exposure

Bilateral
Diffuse corneal punctate
fl- staining
C/L removal

Severe conjunctival
injection?

Bacterial Conjunctivitis
Dry Eye
H202 solution exposure

C/L
wearer
?

Herpes Simplex Keratitis

Bacterial Conjunctivitis
Dry Eye
Episcleritis

Mucopurulent
discharge?

Bacterial Conjunctivitis
Bilateral
Papillae in palpebral conj
Conjinjectionmostat
fornix

Refer urgently to GP for Tx

due to the potential for
serious infections

C/L removal
Cold compresses
Prophylactic antiinfective if staining is
severe
Resolves in 48 hours

Dry Eye
Small tear prism
Low TBUT
Low tear quality
Punctate fl- staining
Diffuse RB staining
Artificial tears
Refer to GP for Tx if severe

Mucopurulent
discharge?

Herpes Simplex
Keratitis
Unilateral
Dendritic ulcer

N
Herpes Simplex
Keratitis
Dry Eye
Episcleritis

Marginal lid
skin lesions?

Refer urgently to GP

for Tx due to the

potential for visual
loss

Episcleritis
Unilateral
Pain on palpation
Refer to GP for Tx and
systemic diagnosis

Dry Eye
Episcleritis

Localised redness
beneath
conjunctiva?
N

Itching or Discomfort
Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis
C/L solution sensitivity
Canaliculitis
Blepharitis
Mild Anterior Uveitis

Discharge?

C/L solution sensitivity

Canaliculitis
Blepharitis
Mild Anterior Uveitis

Viral Conjunctivitis
Chlamydial Conjunctivitis
Allergic Conjunctivitis

Watery

Discharge?

Viral Conjunctivitis
Allergic Conjunctivitis

Chlamydial Conjunctivitis
Allergic Conjunctivitis

Upper lid
eversion

Papillae

Follicles
Viral Conjunctivitis
Bilateral
Preauricular node
tenderness
Superficial punctate
fl- staining
Highly contagious

Counsel and clean

Refer to GP for sick note

Mucous

Allergic Conjunctivitis
Bilateral
Superficial punctate flstain

Conjunctival
chemosis

Localised
swelling?

Canaliculitis
Unilateral
Mucopurulent discharge
expressable from punctum

Cold compresses
Refer to GP for Tx

Chlamydial Conjunctivitis
Bilateral
Young adult
Follicles and papillae
Corneal infiltrates
Superior Pannus
History of new sexual
partner
Refer to GP for Tx and
further investigation

C/L solution sensitivity

Mild Anterior Uveitis

Lid margin
swollen/red?

Canaliculitis
Blepharitis

Refer to GP if causing
irritation or bacterial
conjunctival infections

Blepharitis
Bilateral
Self-limiting

Flare and
cells in AC?

Reassure and advise on

use of lid scrubs

Y
Mild Anterior
Uveitis
Unilateral
Check IOP
Refer to GP for Tx
and investigation

C/L solution sensitivity

Bilateral
Uses a preserved C/L
cleaning or soaking
solution
Reassure patient
Cease C/L wear
Refer to C/L
practitioner

No Pain or No Discomfort

ModerateorSevereAnteriorUveitis
Scleritis
Acanthamoeba keratitis
Angle-closure glaucoma
Penetrating trauma
Chemical burn
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

Subconjunctival haemorrhage
Pinguecula
Pterygium

Solid red

Y
Subconjunctival
haemorrhage
Unilateral
Resolves in 7-10 days

ModerateorSevere
AnteriorUveitis
Penetrating trauma
Counsel
patient
Chemical burn

Refer to GP if recurrent

blunt
Moderate
orsevere
anterior
uveitis
CheckIOP

sharp
Penetrating
trauma
Hyphaema
Seidels
test

trauma?

Shape and
colour of lesion
Photokeratitis
Bilateral
6-12 hours from exposure
superficial punctate fl- stain
No other abnormality

ModerateorSevere
AnteriorUveitis
Refer to GP for Tx Angle-closure
with
glaucoma

Type of
trauma?

artifical tears if staining

extends to cornea

Txoralanalgesia
Ocular lubricant
Self-resolving in
24-48 hours

chemical
Chemicalburn
Irrigatewith
water
Removesolid
debris

Urgent referral to hospital eye casualty department

Moderate to Severe Deep Pain

Pinguecula
Pterygium

Round or oval,
History ofwhite/yellow
Pinguecula
Bilateral
Asymmetrical
May cause local fl- stain

Sectoral
redness?

Reduced Visual
Acuity?

Y
N

ModerateorSevereAnteriorUveitis
beneath glaucoma
Angle-closure
Penetrating trauma
conjunctiva
Chemical burn

Subconjunctival haemorrhage
Chronic Anterior Uveitis
Pinguecula
Pterygium

Raised IOP >

40mmHg?

Angle-closure glaucoma
mid-dilated fixed pupil
corneal oedema
diffuse circumlimbal flush
narrow/closed AC angles

N
Moderate or Severe
Anterior Uveitis
Miotic reactive pupil
Deep circumlimbal
flush

Urgent referral to hospital eye casualty department

N
Chronic Anterior Uveitis
Bilateral
Associated systemic condition
Low level AC flare and cells
Check IOP

Scleritis
Acanthamoeba keratitis
Photokeratitis
Herpes Zoster keratitis
Orbital Cellulitis

Refer to GP for diagnosis and

Tx if not previously detected

Triangular with apex

UV exposure?
at cornea

Pterygium
Bilateral
Asymmetrical
Present in individuals
exposed to sun and dry,
dusty environments
May cause local flstaining

N
Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis
Orbital Cellulitis

Pain on eye
movement?

Orbital cellulites

Refer to Unilateral
hospital via GP
for Tx
if
lesion
extends
Severely
swollen
lids
to pupil
margin
Proptosisor VA is
reduced
Urgent referral to hospital eye
casualty department as brain can
be affected

Seeflowchart1
continuationsheet

Scleritis
Acanthamoeba keratitis
Herpes Zoster keratitis

Visible skin lesions

on same side?

Y
Herpes Zoster keratitis
Unilateral
Superficial or deep fl- stain
Associated anterior uveitis

N
Scleritis
Acanthamoeba keratitis

UrgentreferraltoGP
forantiviraltreatment

Y
Scleritis
Bilateral/Unilateral
Associated with
rheumatoid arthritis and
herpes zoster

UrgentreferraltoGP
forantiinflammatory
treatment.Thinning
maycauseperforation

Diffuse or localised
deep bluish injection
Immobile on palpation?

N
Acanthamoeba keratitis
Moderate signs
Severe symptoms
C/L wearer
Uses tap water for
cleaning or storage

Urgentreferraltohospital
eyecasualtyfor
treatment.Completeloss
ofsightpossiblein48
hours