Background: Red eye is a frequent presentation in primary eye care, with causes ranging from mild, self-limiting conditions to potentially serious ocular emergencies. Despite its high prevalence, limited data exists on the patterns, causes, and outcomes of red eye cases seen in primary care settings, particularly in resource-limited environments.

Objective: To evaluate the clinical patterns, underlying causes, and short-term outcomes of patients presenting with red eye to a primary eye care facility, aiming to improve early diagnosis and management at the primary level.

Methods: A descriptive observational study was conducted at the department of Ophthalmology, Bolan Medical College / Helpers Eye Hospital Quetta, over six months (from January 2020 to June 2020). A total of 612 patients with red eye were included. Comprehensive clinical assessments were performed, and diagnoses were categorized into major groups such as infective conjunctivitis, allergic conjunctivitis, episcleritis, keratitis, anterior uveitis, and acute angle-closure glaucoma. Management was provided based on standardized protocols. Follow-up within 7–10 days assessed outcomes as complete resolution, partial improvement, or no improvement. Data were analyzed using descriptive statistics and Chi-square tests.

Results: Of the 612 patients, 52.6% were male and 47.4% female, with a mean age of 28.4 ± 13.6 years. The most common diagnosis was infective conjunctivitis (43.8%), followed by allergic conjunctivitis (20.3%) and nonspecific conjunctivitis (10.5%). Serious conditions like keratitis (6.2%), anterior uveitis (4.2%), and acute angle-closure glaucoma (2.9%) were less frequent but clinically significant. At follow-up, 67.6% of patients showed complete resolution, 23.2% had partial improvement, and 9.2% showed no improvement and required referral.

Conclusion: Red eye is a common and varied presentation in primary care, most often due to infective or allergic conjunctivitis. While most cases can be effectively managed at the primary level, a subset requires specialist care. This highlights the importance of accurate clinical assessment, structured triage, and efficient referral systems to ensure timely and appropriate treatment.

Keywords: Red eye, conjunctivitis, primary eye care, keratitis, uveitis, ocular emergencies, diagnosis patterns.