Diagnostic Approach to Bilateral Eye Redness

Initial Assessment and Risk Stratification

The American Academy of Ophthalmology recommends determining urgency by assessing for red flag features, including severe ocular pain, photophobia, decreased visual acuity, history of trauma, and unilateral versus bilateral presentation, to guide immediate referral to ophthalmology within 24 hours 1, 2
A thorough history should include onset and duration of symptoms, diurnal variation, associated symptoms such as discharge, itching, and halos around lights, and exacerbating factors like computer use or contact lens wear, as suggested by the American Academy of Ophthalmology 2, 3, 4
The American Academy of Ophthalmology advises assessing medication and systemic history, including topical or systemic medications, atopic dermatitis, autoimmune disorders, and recent viral illness, to identify potential contributing factors 1, 2, 4, 5

The American Academy of Ophthalmology recommends visual acuity testing, including best-corrected visual acuity in each eye separately, and external examination, including eyelid assessment, conjunctival injection pattern, and discharge character, to evaluate the severity of symptoms 2, 3, 6
Pupil examination, including size, shape, symmetry, and reactivity, and corneal assessment, including clarity and luster, should be performed to identify potential abnormalities, as suggested by the American Academy of Ophthalmology 4, 6, 8, 9
Intraocular pressure measurement should be considered if equipment is available, as elevated IOP may indicate acute angle closure glaucoma, according to the American Academy of Ophthalmology 4, 6

For a 21-year-old patient, the American Academy of Ophthalmology notes a lower risk for acute angle closure glaucoma and ischemic optic neuropathy, but a higher likelihood of contact lens-related complications, allergic conjunctivitis, digital eye strain, and viral conjunctivitis 2, 4, 6, 9, 10
If atopic dermatitis is present, the British Journal of Dermatology suggests considering dupilumab-related ocular surface disorder if the patient is on this medication 1, 5