Not all red eye is conjunctivitis
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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.

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Not all red eye is conjunctivitis

Not All Red Eye is Conjunctivitis

NP Virtual Rounds

January 13, 2009

Cortes Health Centre


Eight steps of assessment of red eye
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
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
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 continued1
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
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
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 continued1
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
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
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 continued1
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


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