Assessing the painful, uninflamed eye in primary care

#### The bottom line Eye pain is common. Around 2-5% of general practice patients have an eye complaint featuring pain in and around the eye (ocular, periocular, and periorbital pain, described here collectively as eye pain).1 Among patients attending an ophthalmic emergency department in New Zealand, more than 50% of new referrals were from general practices,2 with eye pain being the most common symptom. The authors suggested that referrals could be reduced with better initial diagnosis. Eye pain with an inflamed, red eye is common and can be readily triaged for a management plan, in most cases by simple examination with a direct ophthalmoscope3 or pen torch. This is discussed elsewhere in relation to the differential diagnosis and treatment of conjunctivitis4 and when to refer for slit-lamp examination for sight threatening ocular surface inflammation or uveitis.5 Eye pain in an uninflamed (white) eye is less common.6 Guidelines for the diagnosis of conjunctivitis have been produced by the Dutch College of General Practitioners,7 and evidence based summaries on management of the red eye are available (http://cks.nice.org.uk/red-eye), but no validated guidelines for the painful, inflamed or uninflamed, eye have been developed. The present advice is based on …