Red eye red flags: when a red eye needs an eye specialist
The short answer
Most red eyes are conjunctivitis and settle without a specialist. Refer the same day when a red eye comes with reduced vision, moderate or severe pain, sensitivity to light, an irregular or unreactive pupil, a white spot on the cornea, a chemical splash or injury, recent eye surgery, contact lens wear with pain, or a baby under four weeks old.
Refer a patientMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Who to refer
- A red eye with blurred or reduced vision that does not clear on blinking.
- A red eye with moderate or severe pain, or pain on eye movement, or a deep ache.
- Sensitivity to light, a pupil that is irregular, fixed or a different size from the other.
- A contact lens wearer with a painful red eye, which can be microbial keratitis.
- A chemical splash, a penetrating or high-speed injury, or a red eye after recent eye surgery or injections.
- A baby under four weeks old with red or sticky eyes.
- A red eye that has not improved after the expected time on treatment.
How urgently
Same day
Any red flag above. For a chemical splash, irrigate with plenty of clean water at once, then send the patient to an eye emergency service now.
Soon
Recurrent red eyes, a red eye with a lid or lash problem lasting more than a few days, or a suspected episcleritis that is not settling.
Routine
Recurring mild irritation, dry eye or allergy that is not controlled with simple treatment.
What to send with the referral
- When it started, one eye or both, and whether vision is affected.
- Pain, light sensitivity, discharge, and contact lens use.
- Visual acuity for each eye, if measured, and the pupil findings.
- Any injury, chemical exposure, recent eye surgery or injections.
- What has been tried already: drops, and for how long.
Pharmacists see red eyes first
A pharmacist is often the first clinician a person with a red eye meets. Simple conjunctivitis with normal vision and no pain can be advised on at the counter. The red flags above are the cases that should not be: they need an eye specialist's slit lamp the same day.
Avoid steroid drops in an undiagnosed red eye. They can make a herpes infection of the cornea much worse.
What you get back
- An acknowledgement email with the referral reference as soon as you submit.
- A loop-back letter from the receiving clinician once the patient has been seen: what was found, what was done and the plan.
- The patient returned to you for ongoing care, with the plan in the letter, so you keep the person you looked after.
- A named specialist and a care coordinator who calls the patient, so the referral does not sit unanswered.
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Refer a patient
No Mezo account needed. The receiving specialist and a care coordinator take it from here.
Common questions
Can I treat a painful red eye in a contact lens wearer as conjunctivitis?
No. Ask them to remove the lenses and refer the same day. Microbial keratitis can threaten sight quickly.
What will I get back?
A letter with the diagnosis and treatment, and when the patient can return to you, so you know what to look for if it comes back.
Does Mezo pay referrers?
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Guides to send your patient
Patient health guides
More referral guidance
Sources and further reading
The guidelines and patient information this page is checked against. Care in Nigeria follows the same evidence; what differs is the price and where it is done.
- Red eye. NHS. Patient information.
- Clinical Management Guidelines: Uveitis (anterior). College of Optometrists. Clinical guideline.
- Clinical Management Guidelines: Microbial keratitis (bacterial, fungal). College of Optometrists. Clinical guideline.
- Clinical Management Guidelines: Trauma (chemical). College of Optometrists. Clinical guideline.
- Clinical Management Guidelines: Scleritis. College of Optometrists. Clinical guideline.
- Conjunctivitis Preferred Practice Pattern. American Academy of Ophthalmology, 2023. Clinical guideline.
Links last checked 23 October 2026.