Update in office managementManagement of the Red Eye for the Primary Care Physician
Section snippets
Conjunctivitis
The causes to consider in patients with suspected acute conjunctivitis are allergic; bacterial (staphylococci, pneumococci, gonococci, haemophilus); viral (adenovirus, herpes viruses); and chlamydial. The most prominent signs are generalized conjunctival injection with gritty discomfort, mild photophobia, and variable discharge but no loss of visual acuity.
Allergic conjunctivitis usually presents with itching tearing, large cobblestone papillae under the upper lid, and conjunctival swelling
Subconjunctival Hematoma (Hyposphagma)
Two types of subconjunctival hematoma can be presented: spontaneous and traumatic. In spontaneous cases with no other subjective complaints, this may arise from coughing and straining or from atherosclerotic vessels, particularly in the elderly, and can be associated with hypertension or a bleeding diathesis (Figure 2). Check the blood pressure and reassure the patient that the blood will disperse within 2 weeks. No further treatment is needed.
In traumatic cases this may be the result of a
Dry Eye
The typical sign of common dry eye is a foreign body sensation, and the feeling can be exacerbated by dry air such as air conditioning. Dry eye is found in patients with Sjögren’s syndrome.
Artificial tear eyedrops can be used without prescription. If the symptoms persist, a consultation by an ophthalmologist is recommended.
Blepharitis
Blepharitis is a frequent chronic inflammation of the eyelid margin causing red, itchy, and crusted lids. Styes and chalazions can be associated.
In chronic cases, cleaning
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Approach to Red Eye for Primary Care Practitioners
2015, Primary Care - Clinics in Office PracticeCitation Excerpt :This article provides an overview of the systematic assessment of patients presenting with a red eye in order to provide guidance for distinguishing those who must be referred immediately to an ophthalmologist versus those whose conditions can be managed in the primary care setting. The assessment of patients presenting to the primary care setting with a red eye should begin with a thorough history.1–3,5 As for any presenting complaint, the cardinal questions should be queried in terms of the timing of onset, progression over time, duration of symptoms, periodicity or chronicity, unilateral or bilateral nature, and any associated symptoms.
Acute Visual Changes in the Elderly
2013, Clinics in Geriatric MedicineCitation Excerpt :Patients with a history of contact-lens use should be covered against Pseudomonas (eg, fluoroquinolone) and instructed not to wear their contacts until complete resolution. Corneal ulcers or infiltrates should be referred within 24 hours to an ophthalmologist, as these patients often need to have the infiltrates cultured, be started on fortified antibiotic drops, and reassessed daily.40 Conjunctivitis is any inflammatory process involving the conjunctiva and often is caused by viral, bacterial, chemical, and allergic factors.
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