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RED EYE EMERGENCIESRED EYE EMERGENCIES::What is What is YOUR Role???YOUR Role???
The role of the front office and optometric The role of the front office and optometric assistant in the detection and treatment of assistant in the detection and treatment of
REDRED EYES EYES
Front office staff and assistants Front office staff and assistants are THE first ones to begin the are THE first ones to begin the RED EYERED EYE evaluation processevaluation processwhen answering the phone…when answering the phone…
FIRST the patient calls the officeFIRST the patient calls the officeoffice…office…
What are some of the most common What are some of the most common things they say? things they say?
“My eye/eyes are “My eye/eyes are REDRED……
I’m afraid I have I’m afraid I have PINKPINK eye”eye”
“I have a “I have a REDRED bump on my eye and bump on my eye and it’s really sore to touch it”it’s really sore to touch it”
“I woke up with my eye all “I woke up with my eye all REDRED and it looks and it looks like it’s bleeding” like it’s bleeding”
““My eye/eyes are all My eye/eyes are all REDRED and goopy in and goopy in
the morning with yellow greenish pus”the morning with yellow greenish pus”
“M“M REDRED“My eyes are so “My eyes are so REDRED
and itchy…and itchy…
I can hardly stop I can hardly stop
rubbing them”rubbing them”
““My eyes are My eyes are REDRED and and
feel all grittyfeel all gritty
like I have sand like I have sand
in my eyes”in my eyes”
“I slept in my contact lenses last night “I slept in my contact lenses last night
and now my eyes are all and now my eyes are all REDRED and and irritated”irritated”
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“My two year old poked “My two year old poked me in my eye last, me in my eye last, now it’s all now it’s all REDREDand I can hardly and I can hardly keep it opened”keep it opened”
“I poked myself in the “I poked myself in the eye last night just toeye last night just toimpress my friendsimpress my friendsand now it’s and now it’s REDREDand in extreme pain” and in extreme pain”
“I was doing some work “I was doing some work under my car a few days under my car a few days
ago and now my eye is allago and now my eye is allago and now my eye is all ago and now my eye is all RED RED and feels like and feels like
something might be in it”something might be in it”
“I was cutting some drywall yesterday“I was cutting some drywall yesterdayand it feels like something got in my eyeand it feels like something got in my eye
and now it’s all and now it’s all REDRED” ”
Next, front office staff and assistantsNext, front office staff and assistantsmust know the proper questions to must know the proper questions to
ask… ask…
WHEN did the WHEN did the REDNESSREDNESS begin?begin?
Are you in any PAIN?Are you in any PAIN?
Do you have any BLURRED Do you have any BLURRED VISION?VISION?
Do your eyes ITCH, BURN, WATERDo your eyes ITCH, BURN, WATERor FEEL IRRITATED?or FEEL IRRITATED?
Do you have any MATTER in or Do you have any MATTER in or SECRETION from the eye?SECRETION from the eye?SECRETION from the eye?SECRETION from the eye?
Is the Is the REDNESSREDNESS in ONE or BOTHin ONE or BOTHeyes?eyes?
Any Other Questions we should Any Other Questions we should ask??ask??
Light Sensitivity??Light Sensitivity??
??????????
??????????
What should you do next??What should you do next??
Must determine how quickly the Must determine how quickly the patient needs to be seen…patient needs to be seen…
URGENT / IMMEDIATELY!!!URGENT / IMMEDIATELY!!!
NonNon--urgent / Later that same day urgent / Later that same day
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URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with associated with
the following…the following…
Sudden or severeSudden or severe pain and pain and discomfortdiscomfort
BleedingBleeding in or around the eye in or around the eye
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with the associated with the following…following…
Ocular TraumaOcular Trauma such as a sportssuch as a sports
injury, auto accident, blow to theinjury, auto accident, blow to the
eye, fingernail scratch, paper cut, eye, fingernail scratch, paper cut,
curling iron burn, chemical burn, etc.curling iron burn, chemical burn, etc.
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with the associated with the following…following…
Foreign BodyForeign Body or object in the eyeor object in the eye
Extreme Extreme discomfort and sensitivitydiscomfort and sensitivity
to lightto light
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with theassociated with thefollowing… following…
Sudden Sudden change in vision or loss of visionchange in vision or loss of vision
CopiousCopious amount of matter or dischargeamount of matter or discharge
REDNESSREDNESS associated with theassociated with the
following… following…
NonNon--urgent / Later the same dayurgent / Later the same day
gg
NoNo ocular trauma ocular trauma
NoNo foreign body injuryforeign body injury
NonNon--urgent / Later the same dayurgent / Later the same day
REDNESSREDNESS associated with the associated with the
following…following…
Mild pain or discomfortMild pain or discomfort that has been that has been present for several days to a weekpresent for several days to a week
NoNo bleeding in or around the eyebleeding in or around the eye
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NonNon--urgent/Later the same dayurgent/Later the same day
REDNESSREDNESS associated with theassociated with thefollowing…following…
Little to noLittle to no light sensitivitylight sensitivity
Little to noLittle to no change in visionchange in vision
Little to noLittle to no matter or dischargematter or discharge
Once the patient comes to the Once the patient comes to the office, what do you do? office, what do you do?
Case history information…Case history information…
Required by medical Required by medical insurance companiesinsurance companies
All current medical All current medical insurance information so insurance information so that payment for the office that payment for the office visit will be receivedvisit will be received
Specific Case history information is Specific Case history information is needed… needed…
RED EYE or EYESRED EYE or EYES must be the must be the CHIEF COMPLIANTCHIEF COMPLIANT
Which eye has the problem? Which eye has the problem? O.D./O.S./O.U.O.D./O.S./O.U.
Does it cause vision loss or blur?Does it cause vision loss or blur?
Specific Case history information is Specific Case history information is needed…needed…
Did it occur suddenly or gradually?Did it occur suddenly or gradually?
How severe is the problem?How severe is the problem?How severe is the problem?How severe is the problem?
Is it worse at a specific distance?Is it worse at a specific distance?
How long does it last?How long does it last?
Specific Case history information is Specific Case history information is needed…needed…
How long has it been occurring?How long has it been occurring?
Are there any associated Are there any associated symptoms?symptoms?
Does anything help?Does anything help?
What tests should be performed before What tests should be performed before the patient sees the doctor?the patient sees the doctor?
Visual Acuities? Visual Acuities?
Always!!!!Always!!!!
Blood Pressure?Blood Pressure?Blood Pressure?Blood Pressure?
Intraocular Pressure? Intraocular Pressure?
NO!!!! Why?NO!!!! Why?
Any others?Any others?
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Now...let’s take a look at some of Now...let’s take a look at some of the most common causes of the most common causes of RED RED
EYEEYE in an Optometric Office…in an Optometric Office…
Any ideas???Any ideas???
Signs, Symptoms, TreatmentSigns, Symptoms, Treatment
Signs Signs –– What we clinically observeWhat we clinically observe
SymptomsSymptoms What the patient isWhat the patient isSymptoms Symptoms –– What the patient isWhat the patient isfeeling and experiencing feeling and experiencing
Treatment Treatment –– What we do to manageWhat we do to managethe conditionthe condition
RED EYELID / EYELIDSRED EYELID / EYELIDSMost Common ConditionsMost Common Conditions
HordeolumHordeolum –– Internal and ExternalInternal and ExternalChalazionChalazionChalazionChalazionBlepharitisBlepharitis
MeibomianitisMeibomianitis
TrichiasisTrichiasis
Eyelid TraumaEyelid Trauma
Red EyeLID or EyeLIDS Red EyeLID or EyeLIDS : Most : Most Common Findings and TreatmentCommon Findings and Treatment
HordeolumHordeolum ((StyeStye))
LocalizedLocalized InfectionInfection ororLocalized Localized InfectionInfection or or inflammation of the inflammation of the eyelid margin that eyelid margin that involve hair follicles of involve hair follicles of eyelashes (external) or eyelashes (external) or oil glands underneath oil glands underneath eyelid (internal)eyelid (internal)
Red EyeLID or EyeLIDS Red EyeLID or EyeLIDS : Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. RednessRedness
2.2. SwellingSwelling
3.3. Bump on the Bump on the outside or insideoutside or insideof the eyelidof the eyelid
Red EyeLID or EyeLIDSRed EyeLID or EyeLIDS: Most : Most Common Findings and Treatment Common Findings and Treatment
Symptoms:Symptoms:
S d dS d d1.1. Sore and tender to Sore and tender to the touch the touch
2.2. Mild, Moderate orMild, Moderate or
Extreme PainExtreme Pain
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Red EyeLID or EyeLIDSRed EyeLID or EyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:
1. “Hot Potato” Compress
2. Topical Antibiotics, usually an ointment
3. Oral antibiotics, if required
Red EyeLID or EyeLIDSRed EyeLID or EyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
ChalazionChalazionHard eyelid lumpHard eyelid lumpHard eyelid lump Hard eyelid lump
caused by a single caused by a single
blocked or series of blocked or series of
blocked oil glands…blocked oil glands…
NOT infectiousNOT infectious
Red EyeLID or EyeLIDSRed EyeLID or EyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:1.1. RednessRedness2.2. Swelling Swelling gg3.3. Hard lump/bump on Hard lump/bump on
inside or outside of the inside or outside of the eyelideyelid
Symptoms:Symptoms:No pain or tendernessNo pain or tenderness
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:Treatment:
1.1. “Hot Potato” “Hot Potato” compresscompress
2.2. Monitor for changeMonitor for change
3.3. Excise if does notExcise if does notresolveresolve
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
BlepharitisBlepharitisInfection andInfection andInfection andInfection and
inflammation inflammation
of the outer of the outer
eyelid glands eyelid glands
along the entirealong the entire
eyelid margineyelid margin
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
11 Redness of eyelidsRedness of eyelids1.1. Redness of eyelidsRedness of eyelidsat eyelid marginsat eyelid margins
2.2. Crustiness along the Crustiness along the base of the lids andbase of the lids andlasheslashes
3.3. Tendency toTendency tofrequently rub eyesfrequently rub eyes
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Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:
11 Itching of eyelidsItching of eyelids1.1. Itching of eyelids Itching of eyelids
2.2. Grittiness of lidsGrittiness of lids
3.3. Burning and irritation of Burning and irritation of the eyethe eye
4.4. Watering of the eyesWatering of the eyes
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:Treatment:
1.1. Hot soaks and lid Hot soaks and lid massagemassage
2.2. Commercially availableCommercially availableeyelid scrubseyelid scrubs
3.3. Topical antibiotics usually Topical antibiotics usually an ointmentan ointment
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
MeibomianitisMeibomianitisInfection andInfection and
inflammation of inflammation of
the inner eyelidthe inner eyelid
glands along theglands along the
entire lid marginentire lid margin
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:1.1. Redness and Redness and
inflammation ofinflammation ofinflammation of inflammation of inner eyelid inner eyelid marginsmargins
2.2. Toothpaste like Toothpaste like excretion from excretion from inner eyelid glandsinner eyelid glands
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:
1.1. Burning of the eyesBurning of the eyes
2.2. General irritation ofGeneral irritation ofthe eyesthe eyes
3.3. Watering of the eyes Watering of the eyes
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:Treatment:
1.1. Hot soaks and Hot soaks and massage massage
2.2. LipoFlowLipoFlow ThermalThermal
Pulsation (NEW!)Pulsation (NEW!)
3.3. Topical antibioticTopical antibiotic
4.4. Oral antibiotic Oral antibiotic
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Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
TrichiasisTrichiasis
Eyelid lashesEyelid lashesEyelid lashes Eyelid lashes that turn inwardthat turn inwardresulting in resulting in scratching of thescratching of thefront surface of thefront surface of theeye eye
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. MisdirectedMisdirectedeyelashes that eyelashes that grow toward eyegrow toward eye
2.2. Redness of the Redness of the eyeeye
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:1.1. Scratchy feelingScratchy feeling2.2. Foreign body Foreign body
titisensationsensation3.3. ItchinessItchiness
Treatment:Treatment:1.1. Removal of lashesRemoval of lashes2.2. Eye dropsEye drops3.3. Bandage Contact Bandage Contact
Lens if neededLens if needed
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
EyeLidEyeLid TraumaTrauma
Trauma occurringTrauma occurring
from suddenfrom sudden
impact to the eyeimpact to the eye
and eyelid…and eyelid…
car accident,car accident,
sports injury, blowsports injury, blow
to the face, chemical to the face, chemical
burn, etc.burn, etc.
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
11 Moderate to severeModerate to severe1.1. Moderate to severe Moderate to severe eyelid rednesseyelid redness
2.2. Possible cut of the Possible cut of the eyelid (as seen eyelid (as seen here)here)
3.3. Total lid obliterationTotal lid obliteration(as seen in next (as seen in next slide)slide)
Red EyeLID or EyeLIDsRed EyeLID or EyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:1.1. Moderate to severe painModerate to severe pain
2.2. Light sensitiveLight sensitivegg
3.3. Blurred visionBlurred vision
Treatment:Treatment:1.1. Cold ice packsCold ice packs
2.2. Pain managementPain management
3.3. OculoplasticOculoplastic surgeonsurgeon
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Which of the Which of the RED Eyelid RED Eyelid conditions conditions are True Emergencies ?are True Emergencies ?
HordeolumHordeolum –– Internal and ExternalInternal and ExternalChalazionChalazionBlepharitisBlepharitis
MeibomianitisMeibomianitis
TrichiasisTrichiasis
Eyelid TraumaEyelid Trauma
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
SubconjunctivalSubconjunctival HemorrhageHemorrhagePingueculaPingueculaPterygiumPterygiumPterygiumPterygium
Seasonal Allergic ConjunctivitisSeasonal Allergic Conjunctivitis
Acute Allergic ConjunctivitisAcute Allergic Conjunctivitis
Bacterial ConjunctivitisBacterial Conjunctivitis
Contact Lens Associated Red Eye Contact Lens Associated Red Eye (CLARE)(CLARE)
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
SubconjunctivalSubconjunctival
H hH hHemorrhage Hemorrhage
Breaking of the tinyBreaking of the tiny
blood vessels betweenblood vessels between
the conjunctiva andthe conjunctiva and
the sclerathe sclera
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Bloody looking eyeBloody looking eyey g yy g y
2.2. Well defined area of Well defined area of redness and redness and bleedingbleeding
3.3. Flat or slightly raised Flat or slightly raised hemorrhagehemorrhage
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms: Symptoms: Usually None (Asymptomatic)Usually None (Asymptomatic)Usually None (Asymptomatic)Usually None (Asymptomatic)
1.1. No PainNo Pain
2.2. No irritationNo irritation
3.3. No discomfortNo discomfort
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Treatment:Treatment:
1.1. Check BPCheck BP
2.2. Reassurance Reassurance
3.3. Cold compressCold compress
followed by hotfollowed by hot
compressescompresses
4.4. Artificial tearsArtificial tears
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RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
PingueculaPingueculaPingueculaPinguecula
LocalizedLocalizedinflammationinflammationof the conjunctivaof the conjunctivain the in the interpalpebralinterpalpebralspacespace
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Reddish yellow inflammation with blood Reddish yellow inflammation with blood vessels running through vessels running through
2.2. Blood vessels and inflammation stops at Blood vessels and inflammation stops at the the limbuslimbus
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:1.1. Usually just bothersome Usually just bothersome
appearanceappearance
22 May cause minor irritationMay cause minor irritation2.2. May cause minor irritationMay cause minor irritation
Treatment:Treatment:1.1. Artificial TearsArtificial Tears
2.2. Topical antiTopical anti--inflammatory inflammatory dropsdrops
3.3. Sunglasses Sunglasses
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common Conditions Most Common Conditions
PterygiumPterygiumygyg
Pronounced inflammation Pronounced inflammation and and fibrovascularfibrovascular tissue tissue
in the in the interpalbebralinterpalbebral
space extending towardsspace extending towards
the cornea the cornea
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:1.1. Appearance of a raised Appearance of a raised
whitish triangle shaped whitish triangle shaped l ti “ il ti “ ivascular tissue “growing vascular tissue “growing
over the eye”over the eye”
Symptoms:Symptoms:1.1. Cosmetic concern over Cosmetic concern over
appearanceappearance
2.2. Dry irritated eyeDry irritated eye
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Treatment:Treatment:1.1. Monitor closelyMonitor closely
2.2. Use of UV Use of UV blocking blocking sunglassessunglasses
3.3. Liberal use of Liberal use of Artificial tearsArtificial tears
4.4. Surgical excisionSurgical excision
when encroachingwhen encroaching
on the pupil on the pupil
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RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Seasonal AllergicSeasonal Allergic
ConjunctivitisConjunctivitisjjInflammation of theInflammation of the
conjunctiva coincidingconjunctiva coinciding
with pollen blooms,with pollen blooms,
ragweed, animal ragweed, animal
dander, dust mites, dander, dust mites,
etc.etc.
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Mild diffuse pinkness Mild diffuse pinkness of the conjunctivaof the conjunctivaof the conjunctiva of the conjunctiva
2.2. Hazy conjunctivaHazy conjunctiva3.3. Rubbing of the eyes known Rubbing of the eyes known
as “universal sign”as “universal sign”4.4. Watery or white stringyWatery or white stringy
discharge discharge 5.5. Red swollen eyelidsRed swollen eyelids
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
11 Itching of the eyesItching of the eyes1.1. Itching of the eyesItching of the eyeswhich gets worse withwhich gets worse withrubbingrubbing
2.2. Tearing of the eyesTearing of the eyes3.3. Mucus in cornersMucus in corners4.4. SneezingSneezing
Treatment:Treatment:
11 Avoid offending allergenAvoid offending allergen
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
1.1. Avoid offending allergen Avoid offending allergen (pollen blooms, animal (pollen blooms, animal dander, dust mites)dander, dust mites)
2.2. OTC allergy eye dropsOTC allergy eye drops3.3. Prescription allergy Prescription allergy
dropsdrops4.4. Cool compressesCool compresses5.5. Oral allergy medsOral allergy meds
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Acute Allergic Acute Allergic ConjunctivitsConjunctivits
Sudden, extremeSudden, extremeinflammationinflammationcaused by ancaused by anabrupt exposure toabrupt exposure toa specific allergena specific allergen
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Extreme redness of the Extreme redness of the conjunctivaconjunctiva
2.2. Profound Profound conjunctivalconjunctivalchemosischemosis (glassy (glassy appearance) appearance)
3.3. Red, swollen and Red, swollen and edematous eyelids edematous eyelids
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RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
11 SuddenSudden
Treatment:Treatment:
11 Id tif dId tif d1.1. Sudden Sudden intense itching intense itching and tearingand tearing
2.2. Ocular burningOcular burning3.3. PhotophobiaPhotophobia
1.1. Identify and removeIdentify and removeoffending allergen offending allergen asapasap
2.2. Cold compresses for eyelid Cold compresses for eyelid swellingswelling
3.3. OTC oral antihistamine OTC oral antihistamine such as Benadryl such as Benadryl
4.4. Prescription allergy and/or Prescription allergy and/or antianti--inflammatory dropsinflammatory drops
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Bacterial Bacterial ConjunctivitisConjunctivitis
Highly contagiousHighly contagious
infection of the infection of the
conjunctivaconjunctiva
caused by acaused by a
multitude ofmultitude of
bacterial strainsbacterial strains
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Reddish “Pink” eye that Reddish “Pink” eye that usually starts in one eye, usually starts in one eye, but often moves to the but often moves to the other (Highly contagious)other (Highly contagious)
2.2. YellowishYellowish--green green
dischargedischarge
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
1.1. Eyelids feel “glued shut” Eyelids feel “glued shut” in the morningin the morning
2.2. Buildup of yellowish green Buildup of yellowish green discharge through the daydischarge through the day
3.3. Mild to moderate irritationMild to moderate irritation
4.4. Patient is usually “sick”Patient is usually “sick”
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Treatment:Treatment:
T i l tibi tiT i l tibi ti1.1. Topical antibiotic eye Topical antibiotic eye
drops or ointmentdrops or ointment
2.2. Oral prescription Oral prescription antibioticsantibiotics
3.3. Hot compressesHot compresses
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Contact Lens Contact Lens Associated Red Eye Associated Red Eye (CLARE)(CLARE)
Signs:Signs:Redness around theRedness around the
limbuslimbus usually due tousually due to
over wear of CLs orover wear of CLs or
solution intolerancesolution intolerance
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RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
1.1. Mild to moderate Mild to moderate pain especiallypain especiallywhen wearing CLswhen wearing CLs
2.2. TearingTearing
3.3. Photophobia Photophobia
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Treatment:Treatment:
Di i i CLDi i i CL1.1. Discontinuing CL wear Discontinuing CL wear (Usually temporarily)(Usually temporarily)
2.2. OTC or Rx. Eye dropsOTC or Rx. Eye drops
3.3. Refit to other type of CLRefit to other type of CL
4.4. Change CL solutionChange CL solution
Which of the Which of the RED Eye RED Eye conditions of conditions of the Conjunctiva are True the Conjunctiva are True
Emergencies?Emergencies?
SubconjuntivalSubconjuntival HemmorrhageHemmorrhage
Pi lPi lPingueculaPinguecula
PterygiumPterygium
Seasonal AllergySeasonal Allergy
Acute AllergyAcute Allergy
Bacterial ConjunctivitisBacterial Conjunctivitis
CLARECLARE
RED EYERED EYE associated with associated with Corneal Problems…Most Corneal Problems…Most
Common ConditionsCommon Conditions
Foreign BodyForeign Body
AbrasionAbrasion
Recurrent ErosionRecurrent Erosion
Dry EyeDry Eye
Corneal InfiltrateCorneal Infiltrate
Chemical or UV DamageChemical or UV Damage
Corneal TraumaCorneal Trauma
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal Foreign Corneal Foreign BodyBody
Signs:Signs:1.1. Foreign object in eyeForeign object in eye
usually metal, woodusually metal, wooddrywall, etc.drywall, etc.
2.2. Unable to open eyeUnable to open eye3.3. Light sensitiveLight sensitive
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Symptoms:Symptoms:
11 ModerateModerate1.1. ModerateModerateto extreme painto extreme pain
2.2. Feels like Feels like something issomething isin the eyein the eye
3.3. DiscomfortDiscomfort4.4. PhotophobiaPhotophobia
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RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Treatment: Treatment:
R l f f i b dR l f f i b d1.1. Removal of foreign bodyRemoval of foreign body
2.2. Topical antibioticsTopical antibiotics
3.3. Bandage CL using a Bandage CL using a
continuous wear CLcontinuous wear CL
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal AbrasionCorneal Abrasion
Loss of surfaceLoss of surface
cells on the front cells on the front
surface of thesurface of the
cornea cornea
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:
11 Unable to open eyeUnable to open eye1.1. Unable to open eyeUnable to open eye2.2. Extremely light Extremely light
sensitivesensitive3.3. Appearance of scratchAppearance of scratch
or section of cornea or section of cornea removedremoved
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Symptoms:Symptoms:
M dM d1.1. Moderate to extremeModerate to extreme
pain pain
2.2. Feels like something Feels like something
is in the eyeis in the eye
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Treatment:Treatment:1.1. Topical antibiotic Topical antibiotic
eye dropseye dropseye dropseye drops
2.2. Fitting of a bandage Fitting of a bandage CL until resolvesCL until resolves
3.3. Prophylactic nightly Prophylactic nightly use of lubricating use of lubricating eye ointmentseye ointments
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Recurrent Corneal Recurrent Corneal ErosionErosion
Recurrence of the removal of Recurrence of the removal of the front surface cells of thethe front surface cells of thecornea after previous cornealcornea after previous cornealabrasion (Basically rippingabrasion (Basically rippingoff of the previously off of the previously damaged cells)damaged cells)
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RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:1.1. Redness upon awakeningRedness upon awakening2.2. Watering and tearing of the eyeWatering and tearing of the eye
Symptoms:Symptoms:Symptoms:Symptoms:1.1. Pain and irritation upon awakening Pain and irritation upon awakening 2.2. Feels like something is in the eyeFeels like something is in the eye3.3. Light sensitiveLight sensitive
Treatment:Treatment:Prophylactic use of lubricating eye gels or ointments at Prophylactic use of lubricating eye gels or ointments at bedtime to minimize future erosionsbedtime to minimize future erosions
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Contact lens-associated keratitis
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Dry Eye SyndromeDry Eye Syndrome
Chronic lack of Chronic lack of l b i ti dl b i ti dlubrication and lubrication and moisture of the eye moisture of the eye due to many factors due to many factors including low tear including low tear production, poor tear production, poor tear quality and other quality and other eyelid issueseyelid issues
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:
1.1. Mild to severe Mild to severe interpalpebralinterpalpebral rednessredness
2.2. Mild to severeMild to severe
corneal stainingcorneal staining
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Symptoms:Symptoms:
11 Burning & stingingBurning & stinging1.1. Burning & stingingBurning & stinging2.2. Grittiness & ScratchinessGrittiness & Scratchiness3.3. Foreign Body sensationForeign Body sensation4.4. PhotophobiaPhotophobia5.5. Intermittent blurred visionIntermittent blurred vision6.6. Watering and tearing Watering and tearing
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Treatment:Treatment:
1.1. OTC artificial tearsOTC artificial tears(Refresh(Refresh OptiveOptive(Refresh (Refresh OptiveOptive, , SystaneSystane Ultra or Balance, Ultra or Balance, Soothe XP)Soothe XP)
2.2. Rx. antiRx. anti--inflammatory inflammatory eye drops (eye drops (RestasisRestasis))
3.3. Rx. antiRx. anti--inflammatory inflammatory eye drops (Steroid)eye drops (Steroid)
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RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Other Treatment:Other Treatment:1.1. Omega Omega --33
Salmon, TSalmon, Tuna,una,
mackerel, herring,mackerel, herring,
trout, sardines ortrout, sardines or
halibuthalibut
2.2. Ocular SupplementsOcular Supplements
10001000--2000 mg/Day2000 mg/Day
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal InfiltrateCorneal Infiltrate
Small hazy greySmall hazy greySmall hazy greySmall hazy grey
areas of areas of
inflammationinflammation
usually near theusually near the
limbuslimbus
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:1.1. Redness Redness 2.2. TearingTearing
Symptoms:Symptoms:Symptoms:Symptoms:1.1. Foreign body sensationForeign body sensation2.2. Mild to severe irritationMild to severe irritation3.3. Light sensitiveLight sensitive
Treatment:Treatment:1.1. Topical antibioticTopical antibiotic--steroid steroid
dropsdrops
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Chemical /UV DamageChemical /UV DamageDamage of theDamage of the
cornea caused bycornea caused by
chemical solution orchemical solution orchemical solution orchemical solution or
UV exposureUV exposure
Signs:Signs:1.1. RednessRedness
2.2. ChemosisChemosis of Conjunctivaof Conjunctiva
3.3. Corneal StainingCorneal Staining
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Chemical Solution / UV DamageChemical Solution / UV Damage
Symptoms:Symptoms:1.1. Pain and discomfort Pain and discomfort 2.2. Tearing, burning and stingingTearing, burning and stinging3.3. Foreign body sensationForeign body sensation
Treatment:Treatment:1.1. Artificial tearsArtificial tears2.2. Antibiotic / steroid dropsAntibiotic / steroid drops3.3. Change of CL solutionChange of CL solution4.4. Advise against tanning bed useAdvise against tanning bed use5.5. Sun protection when outsideSun protection when outside
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal TraumaCorneal Trauma
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Which of the Which of the RED EYERED EYE conditions conditions of the Cornea are True of the Cornea are True
Emergencies??Emergencies??
Foreign BodyForeign Body
AbrasionAbrasion
Recurrent ErosionRecurrent Erosion
Dry EyeDry Eye
Corneal Infiltrate Corneal Infiltrate
Chemical or UV damageChemical or UV damage
Cornea TraumaCornea Trauma
Once the doctor examines the Once the doctor examines the Red Red EyeEye Patient…how do YOU come Patient…how do YOU come
back in the picture?back in the picture?
Exam room Exam room
assistanceassistance
Patient educationPatient education
FollowFollow--up careup care
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Woke up with itWoke up with it
•• No painNo pain
•• No discomfortNo discomfort
•• No blurred visionNo blurred vision
Is that your Final Answer?Is that your Final Answer?
A.A. ChalazionChalazion
BB Allergic ConjunctivitisAllergic ConjunctivitisB.B. Allergic ConjunctivitisAllergic Conjunctivitis
C.C. SubconjunctivalSubconjunctival HemmorhageHemmorhage
D.D. BlepharitisBlepharitis
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• ItchinessItchiness
•• ScratchinessScratchiness
•• BurningBurning
•• IrritationIrritation
•• Frequently rubs Frequently rubs eyeseyes
Is that your Final Answer?Is that your Final Answer?
A.A. ChalazionChalazion
BB BlepharitisBlepharitisB.B. BlepharitisBlepharitis
C.C. Foreign BodyForeign Body
D.D. MeibomianitisMeibomianitis
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Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Toddlers fingerToddlers finger
scratched eyescratched eye
•• PainPain
•• TearingTearing
•• Hard to openHard to open
•• Blurred VisionBlurred Vision
Is that your Final Answer?Is that your Final Answer?
A.A. Dry EyeDry Eye
BB PingueculaPingueculaB.B. PingueculaPinguecula
C.C. Corneal AbrasionCorneal Abrasion
D.D. Corneal Foreign BodyCorneal Foreign Body
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• BurningBurning
•• ItchingItching
•• WateringWatering
•• GrittinessGrittiness
•• IrritationIrritation
•• Eye strainEye strain
•• Eye FatigueEye Fatigue
Is that your Final Answer?Is that your Final Answer?
A.A. Dry EyeDry Eye
BB CLARECLAREB.B. CLARECLARE
C.C. Foreign BodyForeign Body
D.D. Seasonal AllergySeasonal Allergy
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Red Bump on LidRed Bump on LidRed Bump on LidRed Bump on Lid
•• Moderate Moderate SorenessSoreness
•• Tender to Tender to
the touchthe touch
Is that your Final Answer?Is that your Final Answer?
A.A. ChalazionChalazion
BB Corneal InfiltrateCorneal InfiltrateB.B. Corneal InfiltrateCorneal Infiltrate
C.C. HordeolumHordeolum
D.D. TrichiasisTrichiasis
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Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Woke up with eyes Woke up with eyes “glued” shut“glued” shut
Y ll i h ttY ll i h tt•• Yellowish matter Yellowish matter through the daythrough the day
•• Mild irritationMild irritation
•• Had a cold last Had a cold last weekweek
Is that your Final Answer?Is that your Final Answer?
A.A. Acute Allergic ConjunctivitisAcute Allergic Conjunctivitis
BB PterygiumPterygiumB.B. PterygiumPterygium
C.C. Dry EyeDry Eye
D.D. Bacterial ConjunctivitisBacterial Conjunctivitis
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Yellow raised Yellow raised bump on white part bump on white part of the eyeof the eyeof the eyeof the eye
•• Seems to look Seems to look worse after being worse after being outside in sun and outside in sun and windwind
•• Mild occasional Mild occasional irritationirritation
Is that your Final Answer?Is that your Final Answer?
A.A. SubconjunctivalSubconjunctival HemorrageHemorrage
BB PingueculaPingueculaB.B. PingueculaPinguecula
C.C. PterygiumPterygium
D.D. Bacterial ConjunctivitisBacterial Conjunctivitis
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• ItchingItching
•• Always rubbing Always rubbing ttat eyesat eyes
•• WateringWatering
•• SneezingSneezing
•• Allergies Allergies
Is that your Final Answer?Is that your Final Answer?
A.A. Foreign BodyForeign Body
B.B. CLARECLARE
C.C. Acute Allergic ConjunctivitisAcute Allergic Conjunctivitis
D.D. Seasonal Allergic ConjunctivitisSeasonal Allergic Conjunctivitis
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Questions on Questions on RED EYE??RED EYE??Thank youThank you…it has been a pleasure …it has been a pleasure
spending the past few hours with you!spending the past few hours with you!
I hope you feel that you have learned I hope you feel that you have learned more about your more about your RED EYE RED EYE patients. patients. yy pp
Have a fantastic conference … Have a fantastic conference …
Dr. Kris Dr. Kris KerestanKerestan [email protected]@fuse.net
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