Photophobia — common causes and red flags
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Photophobia usually points toward corneal disease, anterior uveitis, or significant ocular surface disturbance rather than simple conjunctivitis alone.
- Pain, reduced vision, ciliary injection, or focal corneal staining increase urgency.
- Check the cornea, anterior chamber, pupils, and contact lens history early.
- Refer urgently when photophobia is accompanied by reduced acuity, corneal involvement, or anterior chamber inflammation.
Common causes
- Corneal abrasion or keratitis.
- Anterior uveitis.
- Severe dry eye or surface toxicity.
- Corneal foreign body or recurrent erosion.
- Migraine-related light sensitivity when ocular findings are otherwise quiet.
Red flags (must not miss)
- Photophobia with reduced visual acuity.
- Ciliary flush, cells and flare, or irregular pupil.
- Focal staining, infiltrate, or corneal opacity.
- Contact lens wear with pain and redness.
- Unilateral marked symptoms without a benign surface explanation.
Use OptoGuide™ to guide this decision during consult.
What to check
- Visual acuity and pain severity.
- Corneal staining pattern and lid eversion where relevant.
- Anterior chamber reaction and pupil shape.
- Pattern of redness and tear film quality.
- Contact lens history, trauma, or chemical exposure.
When to refer
- Same day for keratitis, anterior uveitis, or unexplained photophobia with vision change.
- Urgent review when corneal or anterior chamber signs are present.
- Routine care only when the cause is clearly superficial and stable.
Initial management
- Treat photophobia as a sign of corneal or intraocular inflammation until proven otherwise.
- Document acuity, staining, and chamber findings carefully.
- Escalate early when the symptom profile is stronger than the apparent surface findings.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.