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Red eyes in children: red flags and a case to learn from.

An acute red eye is a common presentation to primary care. The majority of these can be safely managed with expectant waiting or topical antibiotics. Children with red eyes are more challenging to assess, as the history may be unclear and examination is often difficult. This article presents an example of a serious ocular condition in a child with a red eye and considers the learning points from this case.

A 4-year-old boy presented to primary care with a sticky red left eye, new-onset squint, and possible abnormal red reflex. He was difficult to examine and so was managed initially with chloramphenicol drops and referred routinely to ophthalmology. While awaiting his eye appointment he continued to be reviewed in primary care, although the presenting condition remained largely unchanged.

He was seen in ophthalmology outpatients 3 months after the onset of symptoms. On examination he was found to have a vision of 6/60 in the affected eye, blepharospasm (difficulty opening the eyelids), photophobia, pain, ptosis, and lid swelling. Further observation revealed a poor red reflex with scarring of the cornea. The superior cornea had localised green fluorescein staining, indicating an epithelial defect in a location frequently associated with a subtarsal foreign body (Figure 1). An examination under anaesthetic was performed and a subtarsal foreign body was found and removed. Postoperatively, the vision gradually improved to 6/18 with glasses wear to correct astigmatism, and …