The revised NHG-guideline 'The red eye' provides recommendations for the diagnosis and
therapy in patients with a red eye. In the presence of
pain, decreased visual acuity and
photophobia (alarm symptoms) should be considered as sight threatening conditions. In most instances a red eye results from
conjunctivitis. The complaint of (an) early morning glued eye(s) makes a bacterial origin of acute infectious
conjunctivitis more likely.
Itching and a history of infectious
conjunctivitis make the probability of bacterial involvement less likely. The type of discharge does not help to adequately distinguish bacterial from
viral conjunctivitis. Since an infectious
conjunctivitis is a self-limiting condition, no treatment is necessary as a rule.
Antibiotic treatment is only rational if
conjunctivitis is (most probably) caused by bacteria. It has to be considered only if a patient suffers from much discomfort, if complaints do not begin to decline after 3 days and in patients with preexisting corneal defects. Because of widespread resistance to
fusidic acid this should in principle not be prescribed for treatment of
conjunctivitis;
chloramphenicol is still the
drug of choice. During revision of the guideline discussions concentrated on 2 aspects: the position of
slit lamp biomicroscopy in general practice and giving a patient with
keratoconjunctivitis photoelectrica the remainder of a 'minim' with anaesthetic
eye drops. Regarding both topics it was decided not to change the recommendations of the former version of the guideline: the use of
slit lamp biomicroscopy remains optional for general practitioners and it remains permitted to give the remainder of a 'minim' with anaesthetic
eye drops to a patient with
keratoconjunctivitis photoelectrica.