not all red eye is conjunctivitis
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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. - PowerPoint PPT PresentationTRANSCRIPT
Not All Red Eye is Conjunctivitis
NP Virtual RoundsJanuary 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:
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: 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 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
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 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