Red Eye Emergencies - Missouri Optometric Association · 9/27/2012 1 RED EYE EMERGENCIES: What is...

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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


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.


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


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


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


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


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


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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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



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


MeibomianitisMeibomianitisInfection andInfection and

inflammation of inflammation of

the inner eyelidthe inner eyelid

glands along theglands along the

entire lid marginentire lid margin


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


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



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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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


Signs:Signs:

1.1. MisdirectedMisdirectedeyelashes that eyelashes that grow toward eyegrow toward eye

2.2. Redness of the Redness of the eyeeye


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


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.


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)


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


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)


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


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


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



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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PingueculaPingueculaPingueculaPinguecula

LocalizedLocalizedinflammationinflammationof the conjunctivaof the conjunctivain the in the interpalpebralinterpalpebralspacespace


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


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


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


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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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.


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


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


11 Avoid offending allergenAvoid offending allergen


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


Acute Allergic Acute Allergic ConjunctivitsConjunctivits

Sudden, extremeSudden, extremeinflammationinflammationcaused by ancaused by anabrupt exposure toabrupt exposure toa specific allergena specific allergen


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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Symptoms:Symptoms:

11 SuddenSudden


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


Bacterial Bacterial ConjunctivitisConjunctivitis

Highly contagiousHighly contagious

infection of the infection of the

conjunctivaconjunctiva

caused by acaused by a

multitude ofmultitude of

bacterial strainsbacterial strains


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


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”



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


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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Symptoms:Symptoms:

1.1. Mild to moderate Mild to moderate pain especiallypain especiallywhen wearing CLswhen wearing CLs

2.2. TearingTearing

3.3. Photophobia Photophobia



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


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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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


Corneal AbrasionCorneal Abrasion

Loss of surfaceLoss of surface

cells on the front cells on the front

surface of thesurface of the

cornea cornea


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


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


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


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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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


Contact lens-associated keratitis


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


Signs:Signs:

1.1. Mild to severe Mild to severe interpalpebralinterpalpebral rednessredness

2.2. Mild to severeMild to severe

corneal stainingcorneal staining


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



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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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


Corneal InfiltrateCorneal Infiltrate

Small hazy greySmall hazy greySmall hazy greySmall hazy grey

areas of areas of

inflammationinflammation

usually near theusually near the

limbuslimbus


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


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


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


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


•• ItchinessItchiness

•• ScratchinessScratchiness

•• BurningBurning

•• IrritationIrritation

•• Frequently rubs Frequently rubs eyeseyes



BB BlepharitisBlepharitisB.B. BlepharitisBlepharitis

C.C. Foreign BodyForeign Body

D.D. MeibomianitisMeibomianitis

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•• Toddlers fingerToddlers finger

scratched eyescratched eye

•• PainPain

•• TearingTearing

•• Hard to openHard to open

•• Blurred VisionBlurred Vision


A.A. Dry EyeDry Eye

BB PingueculaPingueculaB.B. PingueculaPinguecula

C.C. Corneal AbrasionCorneal Abrasion

D.D. Corneal Foreign BodyCorneal Foreign Body


•• BurningBurning

•• ItchingItching

•• WateringWatering

•• GrittinessGrittiness

•• IrritationIrritation

•• Eye strainEye strain

•• Eye FatigueEye Fatigue


A.A. Dry EyeDry Eye

BB CLARECLAREB.B. CLARECLARE

C.C. Foreign BodyForeign Body

D.D. Seasonal AllergySeasonal Allergy


•• Red Bump on LidRed Bump on LidRed Bump on LidRed Bump on Lid

•• Moderate Moderate SorenessSoreness

•• Tender to Tender to

the touchthe touch



BB Corneal InfiltrateCorneal InfiltrateB.B. Corneal InfiltrateCorneal Infiltrate

C.C. HordeolumHordeolum

D.D. TrichiasisTrichiasis

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•• 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


A.A. Acute Allergic ConjunctivitisAcute Allergic Conjunctivitis

BB PterygiumPterygiumB.B. PterygiumPterygium

C.C. Dry EyeDry Eye

D.D. Bacterial ConjunctivitisBacterial Conjunctivitis


•• 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


A.A. SubconjunctivalSubconjunctival HemorrageHemorrage

BB PingueculaPingueculaB.B. PingueculaPinguecula

C.C. PterygiumPterygium

D.D. Bacterial ConjunctivitisBacterial Conjunctivitis


•• ItchingItching

•• Always rubbing Always rubbing ttat eyesat eyes

•• WateringWatering

•• SneezingSneezing

•• Allergies Allergies


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

Red Eye Emergencies - Missouri Optometric Association · 9/27/2012 1 RED EYE EMERGENCIES: What is...

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