Red eyes

=================================

Eye drops/ointment

Ofloxacin ophthalmic 0.3 % 4 times a day * 7 days (or till 1 more day after the eye heals)

Conjunctival infection:
Drops - 1 drop every 4 hrs (or 4 times a day while awake)
Ointment - 3 times a day into conjunctival sac(space between cornea and palpebral and ocular conjunctiva)

Corneal infections require more frequent instillation of drops - every 30 to 60 min.

The volume of conjunctival sac is less that that of one drop. So it is wasteful to use more than 1 drop at a time.
If two or more drops are required to be instilled, allow 5 min before giving the next drop.

Don't squeeze the eyelid closed after instillation -> drops leak out of conjunctival sac.


==================================

Danger of using steroid eye drops:

- aggrevate infection
1. unrecognized herpes simplex corneal ulceration may be aggrevated leading to corneal
perforation. - never use ocular steroids in red eye with keratitis unless slit lamp and fluorescein exam have excluded hepes simplex infection.

2. fungal or bacterial infection.

---
3. raised intraocular pressure / steroid induced glaucoma

4. cataract (with chronic use > 1yr)


CGI - cataract, glaucoma, Infection

My conclusion: stay away from ophthalmic steroid. Rather leave it to specialist.


====================================

PT WITH RED EYES

-before making Dx of conjunctivitis exclude 3 conditions: keratitis(def: inflammation of the transparent cornea - mostly infectious), iritis, glaucoma(acute angle closure). These should be referred urgently.

(It's actually 5 conditions that needs to be excluded, with the below two conditions added:
- hypopyon (def: pus in the anterior chamber of the eye)
- hyphema (def: blood in the anterior chamber of the eye)
But both seem to be quite obvious on presentation..
Let's focus on the above three)


Q's to ask pt:
---
-"Can you see well?" -decreased visual acuity is a warning sign.

-"Are you sensitive to bright light?" - photophobia can be present in keratitis, iritis, glaucoma but not in conjunctivitis.

-"Did something get into your eye?" - Hx of trauma

-"Are you wearing contact lenses?" - Contact lens wear increases suspicion of keratitis

-"Can you open your eyes spontaneously and keep it open?" - objective foreign body sensation (objective foreign body sensation - pt unable to spontaneously open the eye or keep the eye open.-> suggests corneal abrasion or foreign body.
subjective foreign body sensation - "like sand in my eyes", "grittiness" -> suggests allergy, viral conjunctivitis, dry eyes. Usually no need for referral.)

-"Do you have headache, nausea, vomitting?" - suggests angle closure glaucoma
---




Helpful examination - vision / pupil/corneal opacity / pattern of redness
---
VISION
-Measuring vision in triage setting:
 It is not important to determine exactly whether the vision is 20/30 or 20/40 at 12 or 14 inches, but rather to document visual acuity in crude categories: reading vision (small print versus large print); form vision only (hand motions or count fingers); or light perception.

The fundus examination is typically not helpful in the differential diagnosis of the red eye.
( Although the pupil is midsize in angle-closure glaucoma, the fundus examination becomes increasingly difficult to perform.)

PUPIL/CORNEA
-Keratitis: white spot on cornea. spot stains with fluorescein
-Iritis: mitotic pupil
-Glaucoma(acute angle): fixed, mid-dilated pupil

PATTERN OF REDNESS
diffuse injection suggests conjunctivitis
ciliary flush (a type of injection where redness is most prounounced in a ring around limbus. the limbus is the transitional zone between cornea and sclera) suggests keratitis, iritis or angle closure glaucoma.
---

-Keratitis is characterized by : corneal opacity, decreased vision, photophobia, extremely painful eye.

-Pts with bacterial conjunctivitis should respond to therapy in 1 to 2 days with decrease in discharge, redness, irritiation. Pts who do not respond needs to be referred to an ophthalmologist.