How should I approach the assessment and management of a child presenting with a red eye?

Assessment of a child presenting with a red eye:

• Begin with a thorough clinical assessment to identify any signs of serious illness or specific diseases, including neurological symptoms or systemic features.
• Ask about associated symptoms such as fever, pain, discharge, vision changes, or systemic signs like rash, lymphadenopathy, or mucosal changes.
• Consider Kawasaki disease if the child has bilateral conjunctival injection without exudate, erythema and cracking of lips, strawberry tongue, erythema of oral/pharyngeal mucosa, oedema and erythema of hands and feet, polymorphous rash, or cervical lymphadenopathy, especially if fever is present.
• Be alert to neurological signs such as new-onset squint, which may require urgent referral.
• Assess for history or signs of conjunctivitis, trauma, or other ocular conditions.

Management:

• If the child shows any red features indicating serious illness or life-threatening conditions, arrange urgent face-to-face assessment and referral to paediatric or ophthalmology specialists as appropriate.
• For suspected Kawasaki disease, urgent referral to paediatric services is required due to risk of coronary artery abnormalities.
• Provide safety-netting advice to parents about warning signs and when to seek further care.
• In the absence of serious features, manage conservatively with advice and arrange follow-up if needed.

This approach ensures timely identification of serious causes of red eye in children and appropriate referral and management in line with UK guidelines.