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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
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