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This publication is available at https://www.gov.uk/government/consultations/uk-smi-s-11-red-or-painful-eye/s-11-text-descriptions-of-algorithms

This page provides accessible text descriptions of the algorithms from the UK Standards for Microbiology Investigations document ‘UK SMI S 11: red or painful eye’. For the full draft document, see the consultation page.

Red eye or painful eye is a common ophthalmic presentation in primary care. Patients can present with visual loss or no visual loss.

Visual loss can cause keratitis, anterior uveitis or acute angle closure glaucoma. Refer to section 5.6 and 5.9.

Patients can either experience pain, mild pain or no pain. If there is pain this could be caused by severe conjunctivitis, corneal trauma, keratitis or orbital cellulitis. Refer to sections 5.2, 5.5 and 5.6. Mild pain involving the cornea can result from non infectious keratitis. Refer to section 5.6. If the pain is accompanied by mucopurulent or hyperpurulent discharge, the patient can present with chlamydia or bacterial or gonococcal conjunctivitis. Refer to section 5.2. If the discharge is watery or itching the, the patient can present with allergic or viral conjunctivitis. Refer to section 5.2. Mild pain involving the eyelid can result from early dacryocysitis. If the patient presents no pain this could be caused by subconjunctival haemorrhage. Refer to section 5.2.

Patients with clinical symptoms of conjunctivitis can experience acute haemorrhagic or acute neonatal infection in under 1 month old.

An eye swab is taken from the patient and tested using molecular methods for the following pathogens: Adenovirus, Herpes simplex virus, Enterovirus, Varicella-zoster virus and Chlamydia trachomatis. An eye swab is taken from the patient and tested using culture methods for the following pathogens: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Enterobacterales, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

An eye swab is taken from the patient and tested using culture methods for the following pathogens: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Enterobacterales, Pseudomonas aeruginosa, Neisseria gonorrhoeae An eye swab is taken from the patient and tested using molecular methods for the following pathogens: Adenovirus, Herpes simplex virus, Enterovirus, Neisseria gonorrhoeae and Chlamydia trachomatis.

For blepharitis an eye swab is taken and tested by culture or molecular methods. The primary pathogens include: Staphylococcus species, Streptococcus species, Moraxella catarrhalis, Corynebacterium species, Cutibacterium acnes, Cryptococcus Malassezia species* and Trichophyton species*. Malassezia species and Trichophyton species are associated with Chronic Disease.

For Canaliculitis an eye swab or canalicular pus is taken and tested by culture methods. The primary pathogens include: Actinomyces israelii and Cutibacterium propionicum.

Patients presenting with orbital cellulitis can submit samples for culture or molecular testing. orbital tissue fluids, blood cultures or eye swabs can be tested using culture methods. The primary pathogens include: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa and Peptostreptococcus species. An eye swab is taken and tested by molecular methods for the Adenovirus.

Depending on the clinical presentations the patient presents, the Ophthalmologist can follow 4 different pathways for Keratitis.

Depending on the clinical presentations the patient presents, the Ophthalmologist can follow 4 different pathways for retinitis.

The following types of endophthalmitis infections can occur: Infectious endophthalmitis, Post-traumatic endophthalmitis, Acute post-operative endophthalmitis, Glaucoma filtering-bleb-associated endophthalmitis, Chronic endophthalmitis and Endogenous endophthalmitis.

Vitreous and aqueous fluids are tested using culture or molecular methods. The primary pathogens include: Staphylococcus species, Streptococcus species, Cutibacterium acnes, Aspergillus species, Fusarium species, Ascomycetous yeasts, Dematiaceous fungi and Scedosporium apiospermum.

Vitreous and aqueous fluids or taps are tested using culture or molecular methods. The primary pathogens include: Staphylococcus species, Bacillus cereus, Streptococcus species, Clostridium perfringens, Microsporidium species, Fusarium species, Ascomycetous yeasts and Aspergillus species.

Vitreous and aqueous fluids or taps are tested using culture or molecular methods. The primary pathogens include: Enterobacterales, Staphylococcus species, Streptococcus species, Pseudomonas aeruginosa, Cutibacterium acnes, Aspergillus species and Ascomycetous yeasts.

Vitreous and aqueous biopsy are tested using culture or molecular methods. The primary pathogens include: Cutibacterium acnes, Staphylococcus species, Corynebacterium species, Mycobacterium species, Pseudomonas aeruginosa, Aspergillus species, Ascomycetous yeasts and Fusarium species

Vitreous and aqueous fluid or taps are tested using culture or molecular methods. The primary pathogens include: Bacillus cereus, Enterobacterales, Staphylococcus species, Streptococcus species, Ascomycetous yeasts and Aspergillus species.

For Uveitis aqueous and vitreous fluids are tested using molecular and serology methods. The primary pathogens include: Toxoplasma, Cytomegalovirus, Herpes simplex virus and Varicella Zoster Virus.

Please refer to the relevant UK SMI for additional information

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