Transcript Not All Red Eye is Conjunctivitis

Not All Red Eye is
Conjunctivitis
NP Virtual Rounds
January 13, 2009
Cortes Health Centre
Eight Steps of Assessment of
Red Eye
 Visual Acuity
 Conjunctiva
 Discharge
 Corneal opacities
 Epithelial disruption
 Anterior chamber
 Pupils
 Other Symptoms
Case Study # 1 – Red Eye
 21 y/o man presenting w/ acute onset of R
eye pain w/ tearing ++, photophobia
 History:
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onset of sore R eye previous day w/ increased
redness, & sensitivity to light through day
Today increased pain especially if needing to
focus vision quickly
Working previous day w/ wood chips, yet denies
FB
No itch, no change in vision,
No pain, no redness L eye
Case # 1 continued
 No significant PMH aside for treatment of sore
throat 1 mo previously, no meds, or allergies
 Potential differentials: FB, conjunctivitis, other
serious causes? - sudden & progressive pain w/
severe photosensitivity very worrisome
 Examination:
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Visual acuity 20/20 both eyes R 20/25
Periorbital swelling, redness R eye
R conjunctiva diffusely red, clear discharge
EMOIs – R eye pain w/ movement laterally
Fluorescein – no FB
PERRLA, fundascopic satisfactory
Case # 1 continued
 Diagnosis: severe conjunctivitis R/O other
causes eye pain w/ periorbital swelling
 Plan
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Urgent referral to opthalmology for next day
Gentamycin eye gtts – 2 gtts tid to be re-assessed
by specialist
Final diagnosis: Unilateral iritis
Systemic cause?
Case Study # 2 – Red Eye
 52 y/o woman presenting w/ c/o
irritation L eye
 Feels
she has something in her eye
 Flushed at home but unable to remove
 No change in vision
 No pain – more scratchy discomfort on
surface of eye
 Slightly itchy
Case # 2 - continued
 PMH: L eye herpetic lesion treated w/ optic
antiretrovirals 10 years ago
 Meds: currently treating L eye w/
erythromycin gtts
 No allergies
 Examination
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R eye N
PERRLA
L eye conjunctiva red, gel-like clear discharge lateral mid
section of conjunctiva, surface vessels dilated
Fluorescein – no branching lesion, no FB
Fundascopic N
Case # 2 - continued
 Differential diagnoses:
 Allergic conjunctivitis
 Blepharitis
 R/O recurrent herpetic lesion
 Plan
 Discontinue all eye gtts/ung
 Warm compresses to L eye qid
 If no resolution Sx RTC
 Referral to opthalmology to r/o herpetic lesion
 Consultation letter
Case Study # 3 - Red Eye
 57 y/o man presenting c/o L eye pain x
1 wk
 Gritty
feeling L eye w/ ++ light sensitive &
eye muscle discomfort
 No itching, no discharge, no change in
vision
 Somewhat similar to previous herpes
infection in eye
Case # 3 - continued
 PMH: 1st herpes infection L eye 1979, w/ last
outbreak 2007 treated w/ gtts & po acyclovir – has
seen many specialists in past, not keen to see
anymore; no meds, no allergies
 Examination
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L eye conjunctiva red, difficulty opening eye wide
No discharge
Fluorescein – no FB, opaque lesion w. small area
of clearing at 6 o’clock mid conjunctiva & iris L eye
PERRLA
Case # 3 - continued
 Differential diagnoses:
 Atypical herpetic lesion (no branching)?
 Corneal lesion
 Iritis
 Plan
 p/c to opthalmologist re: Sx & hx
 Started Homatropine 5% eye gtts qid per opthal.
recommendations
 Arranged visit for next day
 Consultation Letter