Photophobia

First actions / assessment

• Assess ABCDE first if systemically unwell. Clarify onset, unilateral or bilateral symptoms, severity, associated headache, fever, neck stiffness, eye pain, red eye, discharge, blurred vision, halos, floaters, trauma, contact lens use, chemical exposure, recent eye procedures, migraine history, sinus symptoms, rash, focal neurological symptoms, and immunosuppression. Examine visual acuity in each eye, pupils, gross visual fields, conjunctival injection pattern, corneal clarity, extraocular movements, eyelids, fluorescein staining if appropriate, and check for consensual photophobia. Measure temperature and capillary glucose if unwell. If CNS infection is possible, assess mental status, meningism, rash, and sepsis features. Eye causes are more likely when photophobia is associated with painful red eye or reduced vision
• CNS causes are more likely when associated with headache, fever, neck stiffness, vomiting, confusion, or seizures. Slit-lamp examination, intraocular pressure measurement, and fundoscopy may be needed if available and safe, but do not delay referral in obvious sight-threatening disease.