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Urgent Care Evaluation and treatment of the Red Eye LTC(ret) Ronald D Oldfield MPAS,PA-C Emergency and Aviation Medicine

Learning Objectives 1. Review of clinically significant anatomy and physiology of the eye 2. Review of pathological and clinically notable conditions associated with red eye 3. Review of those conditions which warrant urgent/emergent ophthalmologist intervention.

INTRODUCTION Despite being a very common presenting compliant there is very little epidemiologic or evidence based data to guide clinicians in the management of these patients. While simple conjunctivitis is the most common cause a number of more serious conditions can occur knowing when to refer is essential Strong history taking and examination skills are what remove all intimidation from caring for this condition

“RED EYE”DIFFERENTIAL DIAGNOSIS Acute hemorrhagic conjunctivitis Adult blepharitis Bacterial conjunctivitis Allergic conjunctivitis Bacterial endopthalmitis Chalazion Chemical burns Contact lens complications Corneal foreign Body Corneal graft rejection Corneal Ulcer Dacryocystitis Distichiassis DES-Dry eye syndrome Ectropian Emergent care of corneal abrasion Entropian Entropian Episcleritis Fungal endophthalmitis Giant papilary conjunctivitis Glaucoma Acute angle closure Herpes Zoster Hordeolum Neonatal conjunctivitis Karposi sarcoma opthomalogic manifestations Orbital cellulitis Post operative endophthalmitis Preseptal cellulitis Pterygium Recurrent corneal erosion Viral conjunctivitis Stevens Johnson syndrome

PATIENT EVALUATION HISTORY EXAMINATION Vision affected Foreign body sensation Photophobia Trauma Contact lens wear Discharge Onset of symptoms EXAMINATION General observation Visual acuity Penlight examination Fundal examination Slit lamp examination

Exam devices

Exam -intraocularpressure

Diagnostic work up Examination is generally the most revealing especially with slit lamp Point of care adenovirus is now available (adenoplus@RPS) Gram stain Culture and sensitivity HSV PCR

TREATMENT Antibiotics Antivirals Nsaids Miotics Antiglaucoma,carbonic anhydrase inhibitors Diuretics,osmotic agents Antihistamines,opthalmic

EYE ANATOMY

ALLERGIC CONJUCTIVITIS

VIRAL CONJUCTIVITIS

Bacterial conjuctivitis

GC BACTERIAL CONJUCTIVIS

HORDEOLUM

BLEPHARITIS

CONJUNCTIVAL HEMORRHAGE

EPISCLERITIS

EPISCLERITIS VS SCLERITIS

Conditions warranting referral EMERGENT Angle closeure glaucoma Hyphema Hypopyon Bacteral keratitis Penetrated globe URGENT Iritis (uveitis) Retained foreign body Corneal ulcer HSV Un-improving abrasion

CORNEAL ABRASION

RETAINED FOREIGN BODY

PENETRATED GLOBE

BACTERIAL KERATITIS

Hyphema

HSV

Acute angle glaucoma

IRITIS

HYPOPYON

Myaisis

QUESTIONS