Evaluation and Management of the Red Eye
Authors: Howard A. Werman, MD, FACEP, Professor of Emergency Medicine, The Ohio State University, Medical Director, MedFlight of Ohio; and Jason Reaves, MD, Clinical Instructor House Staff, The Ohio State University Department of Emergency Medicine.
Peer Reviewer: Michael Coates, MD, MS, Professor and Chair, Department of Family and Community Medicine, Wake Forest University Health Sciences.
Introduction
The red eye is a common chief complaint among patients presenting to the emergency department (ED). There are many etiologies for eye redness that vary from minor conditions such as allergic or viral conjunctivitis to vision threatening conditions such as acute narrow angle glaucoma. Being able to identify which conditions may affect vision, initiate emergency measures, and make a timely referral to an ophthalmologist are major challenges for the emergency physician.
What Approach to Corneal Injuries is Appropriate in the ED?
Source: Aslam SA, Sheth HG, Vaughan AJ. Emergency management of corneal injuries. Injury 2007;38:594-597.
In this retrospective case review, Aslam et al surveyed the management of corneal abrasion. Of 100 cases reviewed, 94 patients were adult and 6 were pediatric. Contact lens use was associated with 12 cases.
The most common cause of injury was direct minor trauma (64% of cases). Visual acuity (VA) was recorded in 90.4% of adult patients but was not attempted in any pediatric cases. Lid examination was documented in 51% of adult cases. Chloramphenicol drops were prescribed in all cases, but there was significant variability in treatment frequency (2 to 5 times daily) and duration (3 to 7 days). An eye patch was prescribed in eight cases. Follow-up time ranged from 1 to 4 days. ED follow-up was recommended in 38 cases, while 16 cases were referred to an ophthalmologist. Most of the remaining cases were discharged from care.
The authors review several ways that the variation in the management of corneal abrasion should be reduced:
- The documentation of VA in preschool children is specialized and may be impractical in the ED, but a Snellen chart should be used to document VA in school-age children.
- VA should be correctly documented in all other cases. Patients with VA below 20/30 should undergo pinhole testing to determine whether the decrease in VA is related to a correctable refractive error. Those whose VA does not improve to at least 20/30 warrant ophthalmology consult or referral.
- All abrasions should be examined with a slit lamp to accurately document the extent of injury.
- The lid should be everted to rule out subtarsal foreign body.
- Topical NSAIDs should be considered for analgesia in non-infected, non-contact lens-related traumatic corneal abrasions.
- Routine patching is not required.
- Cases involving contact lens use should be discussed with an ophthalmologist.
- Follow-up in 48 hours is recommended for patients with persistent symptoms, children, and atypical cases.
Commentary
A slit lamp exam with fluorescein staining is crucial to differentiate a simple corneal abrasion from other conditions. Most uncomplicated corneal abrasions can be expected to heal without significant sequelae in a few days, while corneal ulcer, herpes keratitis, or foreign bodies can lead to scarring and permanent loss of vision. In this chart review, 22 of 100 patients did not report a history of trauma, which should prompt a search for an infectious etiology and, in most instances, ophthalmology referral.
This study highlights poor compliance with crucial elements of the eye examination in patients with suspected corneal abrasion. Of particular note is the lack of VA and slit lamp examination in pediatric patients.
It should be remembered that this was a retrospective review of charts and the findings may represent poor documentation rather than incomplete evaluation of patients.
How Should The Red Eye Be Managed?
Source: Wirbelauer C. Management of the red eye for the primary care physician. Am J Med 2006;119:302-306.
Acute eye redness results from inflammatory reactions due to infection or irritants, while hyperemia is associated with dilatation of the conjunctival, episcleral, or scleral vessels from trauma, chemical burns, or immunologic reactions. The differential diagnosis of the red eye is extensive. In this review article, Wirbelauer describes the clinical features and management of the most common causes of the red eye.
The causes of the red eye can be divided into three categories: painful red eye, traumatic conditions, and other common conditions (dry eye, blepharitis). Several key questions should be asked in establishing the cause of the red eye: association with pain, history of preceding trauma, seasonal or recurrent symptoms, changes in the eyelid, and current or prior use of ophthalmic drops.
Conjunctivitis is a common cause of painful red eye and presents with generalized conjunctival injection with gritty discomfort, mild photophobia, and variable discharge. A loss of visual acuity is not expected. Etiologies of conjunctivitis are allergic, bacterial, and viral.
Herpes zoster conjunctivitis (a potentially devastating cause of viral conjunctivitis) usually presents with uniocular involvement. A vesicular rash in the ophthalmic distribution of the trigeminal nerve may be present. The rash may be preceded by a prodrome of pain and paresthesias. Hutchinson sign, where the rash involves the tip of the nose, suggests involvement of the cornea (keratitis). Oral and topical acyclovir should be started and the patient referred to an ophthalmologist to minimize the risk of sight-threatening complications.
Other causes of painful red eye include episcleritis and scleritis, keratitis and corneal ulcer, iritis and intraocular infections (endophthalmitis), and glaucoma. All etiologies of painful red eye warrant ophthalmology follow-up; suspected endophthalmitis and acute glaucoma require emergent consultation. Therapy for acute narrow angle glaucoma includes pilocarpine, acetazolamide, anti-emetic agents, and osmotic agents (mannitol).
Traumatic causes of red eye include subconjunctival hematoma, corneal and conjunctival foreign body, corneal abrasion, corneal flash burn, chemical burns, and blunt or penetrating trauma to the eye. Uncomplicated, spontaneous subconjunctival hematoma requires only patient reassurance; traumatic cases should prompt a search for conjunctival foreign body or penetrating injury.
Fluorescein staining facilitates the diagnosis of corneal abrasion and corneal or conjunctival foreign body. Eversion of the upper eyelid may be required to identify and remove a foreign body. Deep foreign bodies and those associated with extensive rust rings should be removed by an ophthalmologist.
Chemical burns require immediate, copious, prolonged irrigation with normal saline, facilitated by local anesthetic drops. Alkali burns cause a liquefaction necrosis and are particularly damaging. Among the traumatic causes of red eye, chemical burns and penetrating eye injury should be immediately referred to an ophthalmologist.
Commentary
Emergency physicians are generally well-versed in the diagnosis and management of the more common presentations of red eye, such as acute infectious conjunctivitis and simple corneal abrasion. This review by Wirbelauer provides an overview of these conditions, but also describes other entities that should be considered. In particular, organizing one's differential into traumatic, non-traumatic, and other non-painful conditions is useful. Additionally, the authors provide an important list of relevant questions to ask any patient presenting with eye redness. Familiarity with the differential diagnosis of red eye, supported by a thorough exam including use of the slit lamp and fluorescein staining, can help the emergency physician avoid missing presentations.
Which Diagnoses Require Emergency Ophthalmologic Consultation?
Source: Magauran B. Conditions requiring emergency ophthalmologic consultation. Emerg Med Clin North Am 2008;26:233-238, viii.
Eye complaints account for 3% of all ED visits. Corneal abrasions, conjunctivitis, and conjunctival or corneal foreign bodies comprise most ophthalmologic complaints in the ED. Emergency physicians are equipped to diagnose and manage most cases; one of the challenges is to recognize situations requiring ophthalmologic consultation.
In this article, Magauran reviews emergency diagnoses that generally require ophthalmology consultation, many of which may present with a red eye. These include:
- Trauma: Ruptured globe or lid laceration through margin, nasolacrimal system, or canaliculus;
- Endophthalmitis: Inflammation of the aqueous or vitreous humor that may result from infection, trauma, or as a postoperative complication;
- Angle closure glaucoma;
- Severe uveitis: Anterior uveitis (inflammation of the iritis and ciliary body) accounts for most cases of uveitis in Western countries. Inflammatory cells and flare in the anterior chamber associated with conjunctival injection primarily involving the limbus suggest the diagnosis;
- Corneal ulceration: Degradation of the corneal stroma with a variety of possible etiologies. Management by an ophthalmologist is indicated to minimize scarring, corneal opacification, and permanent vision loss;
- Acute vision loss (central retinal artery occlusion, temporal arteritis, retinal detachment, optic neuritis); and
- Orbital cellulitis.
The author briefly discusses the evaluation and management of these conditions. Emergency ophthalmologic consultation also is warranted in patients with one "good eye" who experience vision changes, patients with a complicated ocular history, and cases in which the ED practitioner is unsure of a diagnosis and is concerned about vision loss. The authors emphasize direct communication between the consulting ophthalmologist and emergency physician when any questions exist regarding the timing of follow-up.
Commentary
Most cases of red eye can be diagnosed and managed safely by the emergency physician. Magauran's article lists conditions that require ophthalmology consultation. The emergency physician should maintain a high index of suspicion for these diagnoses (see list, above) to minimize patients' risk for permanent vision loss. In cases in which the diagnosis is unclear (e.g., anterior uveitis versus conjunctivitis, periorbital versus orbital cellulitis), consultation or referral should be obtained.
Additionally, the article comments on the use of CT scans; in patients with penetrating trauma, CT is only 75% sensitive for acute injury. Therefore, a complete examination by an ophthalmologist should be performed in any confirmed or suspected penetrating injury to the globe, despite a negative radiological examination.
Can Guidelines Improve Corneal Abrasion Management?
Source: Thyagarajan SK, Sharma V, Austin S, et al. An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department. Emerg Med J 2006;23:526-529.
Corneal abrasion is a common problem encountered in the ED. Thyagarajan et al developed at set of clinical guidelines for the management of a corneal abrasion based on a literature search and collaboration with ophthalmologists at their hospital. Case audits were performed before and after implementation of the guidelines. Key elements of the guidelines included:
- Documentation of visual acuity (VA);
- Inquiry into contact lens wear;
- Examination of both eyes with either a slit lamp or direct ophthalmoscope with high magnification, and fluorescein exam with cobalt blue lamp;
- Prescription of a five-day course of chloramphenicol ointment twice-daily for infection prophylaxis and lubrication;
- Use of eye patches only for very painful abrasions (for 4-6 hours) and mydriatic drops (cyclopentolate) only for severe photophobia; and
- Avoidance of the use of topical anesthetics for home use.
The guidelines recommended ophthalmology referral for patients at higher risk for poor prognosis, such as those with signs of infection, abrasion of their only functioning eye, recurrent corneal erosion, or a history of contact lens wear. Patients were instructed to return to the ED if symptoms persisted after 72 hours or if symptoms of infection developed.
The guidelines were displayed in the ED and introduced in several teaching sessions. A case audit after implementation of the guidelines showed an increase in documentation of VA and inquiry regarding contact lens use. Staff also stopped prescribing topical anesthetic drops. The follow-up profile improved for every parameter measured, with an increase in appropriate discharges and a decrease in inappropriate ophthalmology referrals. Only the use of fluorescein staining did not improve after the guidelines were implemented. The authors concluded that the implementation of clinical guidelines improved the care of patients with a corneal abrasion.
Commentary
This study demonstrated improvements in the management of corneal abrasion following the introduction of clinical guidelines, as has been demonstrated with other clinical conditions. While this study was conducted in a setting in which many physicians did not have formal training in ophthalmologic emergencies, there are elements of the guidelines that may be very useful for current ED practice. Documentation of a clear history of trauma is important; the physician may miss other important conditions if the history is not thoroughly investigated. Also, one must ask about other confounding diseases such as arthritis. The authors emphasize an examination of both eyes with fluorescein.
Is Patching Indicated in Corneal Abrasion Treatment ?
Source: Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev 2006 Apr 19;(2):CD004764.
Corneal abrasion, a superficial defect in the corneal epithelium, typically is due to mechanical injury to the cornea. Topical antibiotics and an occlusive patch are the conventional therapies; however, several trials have questioned the benefit of patching as a way to reduce pain or promote healing.
The objective of this meta-analysis by Turner and Rabiu was to examine the hypothesis that patching improves healing or provides pain relief for corneal abrasion. Trials that compared patching the eye with no patching to treat simple corneal abrasions were selected, and the analysis included 11 trials that randomized a total of 1014 participants.
Meta-analyses of the studies that assessed healing favored no patching on the first day and showed no significant difference in healing on days two and three. Of the 9 studies that evaluated pain scores, two favored no patching and none favored patching. Although complication rates were low, there were no differences between the two groups. The authors concluded that patching slowed healing on the first day after the injury and made no difference in pain control. The authors pointed out that these results apply to simple, small (10 mm2) corneal abrasions, and they suggest the need for further research regarding larger abrasions.
Commentary
The results of this meta-analysis by Turner and Rabiu suggest that patching should not be a routine part of the management of simple, small corneal abrasions in the ED. Patching results in a loss of binocular vision. In addition, inadvertent loosening of the patch may exacerbate pain as the eye is able to move and rub against the patch. Patching is contraindicated in cases in which contamination or infection is likely.
Interestingly, the "no-patch" groups received more complete adjuvant treatment including antibiotics and/or cycloplegics than the patch group, an important confounding factor. As a practical matter, this provides another reason to avoid routine patching.
Clinical judgement is required to assess the potential benefit of patching in some situations. The analysis did not draw conclusions with respect to patching for larger (> 10 mm2) corneal abrasions. Further study is needed to determine the benefit, if any, of patching in this group.
The analysis included only one trial that enrolled children. There is a practical reason to consider an eye patch in this age group. Some children might benefit from patching to prevent rubbing the eye.
One final point should be made about the use of a meta-analysis as a basis for clinical decisions. Because of the strict criteria used to evaluate studies for inclusion, other potentially valuable studies (e.g. non-randomized trials) are usually excluded from meta-analyses. This may limit the value of a meta-analysis.
Are Antibiotics Indicated for Acute Bacterial Conjunctivitis Treatment?
Source: Sheikh A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev 2006 Apr 19;(2):CD001211.
Infectious conjunctivitis is a common presentation in the ED and primary care settings. Symptoms include red eyes, discharge, and discomfort. The etiology is usually viral or bacterial. Adenovirus accounts for most cases of viral conjunctivitis. Bacterial conjunctivitis is usually caused by Haemophilus influenzae, Streptococcus pneumoniae, or Staphylococcus aureus.
Both bacterial and viral conjunctivitis are considered self-limited; however, antibiotics have traditionally been considered desirable for bacterial conjunctivitis to prevent complications such as orbital cellulitis, keratitis, panophthalmitis, and conjunctivitis-otitis syndrome. Because bacterial and viral conjunctivitis may be difficult to distinguish clinically, and culture may not be practical, many practitioners treat all cases of infectious conjunctivitis with a broad-spectrum antibiotic. However, several recent investigations have cast doubt on the effectiveness of antibiotic therapy.
This meta-analysis by Sheikh and Hurwitz assessed the effectiveness of antibiotic therapy in the management of acute bacterial conjunctivitis. Trials that compared any form of antibiotic treatment to placebo in the management of acute bacterial conjunctivitis were identified by searches of common medical databases. The review included five trials that randomized a total of 1034 participants. These trials differed in inclusion criteria, interventions, and outcome measures.
Meta-analyses of data on clinical and microbiological remission rates revealed that topical antibiotics improved early (days 2 to 5) clinical and microbiological remission rates. Later (days 6 to 10) data showed that these early advantages over placebo are reduced, but persist. Even in the placebo group, remission was achieved in 65% by days 2 to 5, confirming the idea that infective conjunctivitis is a self-limited condition. No serious outcomes were reported in either the placebo or treatment arms, suggesting that significant sight-threatening complications are rare.
Commentary
The results of this meta-analysis show that the use of topical antibiotics speeds recovery from acute bacterial conjunctivitis. The benefits are marginal, however, as the condition is usually self-limited and serious complications are rare. Only one-third of patients with culture-proven bacterial conjunctivitis will achieve any benefit from antibiotics. Emergency physicians should probably continue to prescribe topical antibiotics for most cases of infectious conjunctivitis, especially in those patients whose follow-up is limited. However, withholding antibiotics for presentations that are strongly suggestive of a viral etiology (viral prodrome, rapid spread to the contralateral eye, similar symptoms in close contacts) also is probably reasonable because sight-threatening complications are unlikely even if the etiology is in fact bacterial. A cost-benefit analysis of the practice of prescribing antibiotics in all cases of conjunctivitis is needed.
What Are the Characteristics of RPS Adeno Detector for Point-of-Care Diagnosis of Adenoviral Conjunctivitis?
Source: Sambursky R, Tauber S, Schirra F, et al. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology 2006;113:1758-1764.
Adenovirus is the most frequent pathogenic cause for red eye worldwide. Conjunctivitis is usually diagnosed on the basis of history, signs, and symptoms, but studies have shown that there is no evidence that signs and symptoms alone definitively differentiate adenovirus or other viral causes from bacterial etiologies. Several laboratory tests for adenoviral infections are available. Cell culture in combination with immunofluorescence staining is the historical gold standard, and polymerase chain reaction (PCR) also has been used in clinical ophthalmology. However, these laboratory tests are not performed routinely because of the time delay associated with the test and the self-limited nature of the disease.
This prospective, non-randomized, masked, multicenter clinical trial by Sambursky et al compared the sensitivity, specificity, and accuracy of the RPS Adeno Detector to both viral cell culture with confirmatory immunofluorescence staining (CC-IFA) and the PCR. The RPS Adeno Detector is a visual, qualitative, point-of-care diagnostic test for the detection of adenoviral antigen in eye fluid. The study enrolled 186 consecutive patients with a presumptive diagnosis of acute conjunctivitis. Patients with signs and symptoms suggestive of herpes infection or trauma were excluded. Samples of eye fluid were collected from each patient for each of the three diagnostic tests and the test results were compared. Using CC-IFA as a gold standard, the RPS Adeno Detector was 88% sensitive and 91% specific. Similar results were obtained when the results of the point-of-care test were compared to PCR. The authors conclude that the RPS Adeno Detector demonstrated sensitivity and specificity sufficient for use in the physician's office.
The authors suggest that the use of point-of-care tests such as the RPS Adeno Detector could change the practice of using empiric antibiotic treatment for acute conjunctivitis in patients who test positive for adenovirus, thereby reducing adverse drug events and antibiotic resistance. The authors present a primary-care red-eye management algorithm incorporating the test. In this algorithm, patients with signs and symptoms suggestive of acute conjunctivitis but without high-risk features such as contact lens use or trauma would undergo the point-of-care test. Topical antibiotics would be considered for patients who test negative for adenovirus, while those who test positive would receive education, supportive care, and ophthalmology referral if symptoms worsen or fail to improve in 7 days.
Commentary
This clinical trial by Sambursky et al found that the sensitivity and specificity of the RPS Adeno Detector test are sufficient for use in clinical practice. The test takes about 10 minutes to perform and, from the operator's perspective, is similar to other point-of-care tests performed in the ED, such as those commonly used for influenza and Streptococcal pharyngitis. The authors suggest that use of the test could decrease health care costs by reducing unnecessary antibiotic use and limiting the spread of disease, as patients who test positive for adenovirus would be considered contagious and advised to stay home from work or school. The authors did not provide information regarding the cost of the test itself, which would be imperative for conducting a cost-benefit analysis for use in the ED. This information, along with trials in an acute care setting, would be required prior to widespread adoption in the ED.
How Does Acute Angle Closure Glaucoma Present in Elderly Patients?
Source: Gandhewar RR, Kamath GG. Acute glaucoma presentations in the elderly. Emerg Med J 2005;22:306-307.
Acute angle closure glaucoma (AACG) results from sudden increase in intraocular pressure. Contact between the iris of a semi-dilated pupil and the lens causes a pupillary block in which aqueous humor does not flow from its site of production in the ciliary body, through the pupil, and into the anterior chamber. The resulting increase in intraocular pressure may lead to severe pain, eye redness, decreased visual acuity (VA), a hazy cornea, and a fixed, partially dilated pupil on exam. Systemic symptoms such as headache, nausea, and vomiting may occur. Elderly patients, however, may not present with these classic symptoms, making diagnosis difficult. In addition, the prominence of systemic symptoms may obscure the diagnosis in this population.
Gandhewar and Kamath discuss three elderly patients who did not exhibit the classic ocular symptoms of glaucoma, resulting in delay or misdiagnosis. The first case was that of a 77-year-old woman with past medical history that included Parkinson's disease and recent weight loss who presented with 2 days of vomiting and a general deterioration in her condition. The only significant eye-related findings on initial presentation were swollen lids and conjunctival injection, and she was started on chloramphenicol eye ointment. After six days, the patient was referred to an ophthalmologist for persistent red eye. Ophthalmic examination revealed conjunctival injection and a semi-dilated, fixed pupil in both eyes. Intraocular pressure (IOP) was 50 mmHg in the right eye and 38 mmHg in the left, suggesting AACG. The patient's medications, including dopaminergic medications for Parkinson's disease and a muscle relaxant with antimuscarinic properties, may have contributed.
In the second case, a 71-year-old female presented with sudden onset, right-sided temporal headache, vomiting, and a sore red eye. Examination showed scalp tenderness, and the right eye was red with an advanced cataract. Erythrocyte sedimentation rate was 24 mm. The patient was initially diagnosed with temporal arteritis and referred to ophthalmology for temporal artery biopsy. On ophthalmic examination, VA was poor, and ocular exam revealed several physical findings suggestive of acute glaucoma, including markedly elevated IOP.
The third case involved an 84-year-old female with a past medical history of Alzheimer's disease who presented with a laceration near her left eye after a fall at home. Over the next several days, the patient became increasingly confused and complained of a progressive headache. The diagnosis of angle closure glaucoma was made after subsequent evaluation by an ophthalmologist.
Commentary
The diagnosis of AACG is not likely to be missed in the patient who presents with classic symptoms. The cases by Gandhewar and Kamath emphasize that the diagnosis is not always straightforward, particularly in elderly patients, who may present with vague systemic symptoms or confounding complaints. The authors conclude that the diagnosis should be considered in any patient who presents with headache, malaise, or gastrointestinal disturbance, particularly with clinical findings of an acute red eye or reduced vision.
Although some non-ophthalmologists may not be adept at detecting corneal edema or the funduscopic changes associated with increased IOP, simple physical findings such as a sluggish pupil or a globe that is firm to palpation raise the possibility AACG.
In each of the cases presented, intraocular pressure was significantly elevated by the time of exam by an ophthalmologist. A high index of suspicion for acute glaucoma and measurement of IOP at the time of initial presentation might have prevented delays in diagnosis. Interestingly, despite the delay in treatment in these cases each patient had a good functional outcome.
What is Appropriate Management of Warfarin-Associated Subconjunctival Hemorrhage?
Source: Bodack MI. A warfarin-induced subconjunctival hemorrhage. Optometry 2007;78:113-118.
Warfarin is the most commonly prescribed anticoagulant in the United States. The most frequent side effect is bleeding, which is related to the intensity of anticoagulation. The severity of warfarin-associated bleeding ranges from minor (nosebleed, bruising, mild hemorrhoid bleeding) to life-threatening (intracerebral hemorrhage, hemothorax). Ocular bleeding also is commonly associated with warfarin therapy and is associated with both minor and potentially sight-threatening conditions.
Subconjunctival hemorrhage is a common ocular complication of warfarin therapy. The author cites a small study conducted at a warfarin clinic that suggests a prevalence of warfarin-associated ocular hemorrhage of 4.76%. Most cases of warfarin-associated subconjunctival hemorrhage are managed with a dose adjustment; however, the author cites a case report in which a patient presented with subconjunctival hemorrhage and bloody tears that required reversal of anticoagulation with vitamin-K and fresh frozen plasma.
In addition to subconjunctival hemorrhage, warfarin-associated ocular complications can include hyphema, bloody tears, and subconjunctival, vitreal, retinal, and choroidal hemorrhages. Glaucoma has been noted to occur in association with warfarin-associated hyphema, subretinal hemorrhage, and retinal detachment.
Commentary
Subconjunctival hemorrhage is a common ocular finding and usually has a benign etiology. Subconjunctival hemorrhage occurring in association with warfarin use necessitates a careful evaluation, including a thorough eye exam, coagulation studies, and consideration of other sites of both ocular and systemic bleeding. Subconjunctival hemorrhage causing significant bulging of the conjunctiva can cause corneal damage and necessitates prompt ophthalmology referral and warfarin dose adjustment.
Conclusions
Patients with a chief complaint of "red eye" need to be approached in a systematic manner with an organized differential diagnosis in mind. A thorough history must be obtained, including VA, previous episodes of similar complaints, contact lens use, and any systemic inflammatory diseases.
The articles cited emphasize a complete examination including baseline visual acuities, examination of both eyes, and surrounding structures as well as a good slit lamp examination with fluorescein staining. The emergency physician must have facility in the use of tonometry. Finally, the emergency physician must be familiar with those conditions that have the potential to have long-term effects on vision as outlined by Magauran. These patients should have close follow-up by an ophthalmologist.
More specifically, current literature does not support patching to reduce pain or improve healing in corneal abrasions. Although antibiotics are still suggested in cases of infectious conjunctivitis, new developments may allow us to target specific patients who are at risk for bacterial etiologies. The acute care physician must be aware of potentially dangerous eye conditions that can have misleading presentations: namely, acute narrow angle glaucoma in the elderly and "benign" subconjuctival hemorrhages in the patient on warfarin.
There are many etiologies for eye redness that vary from minor conditions such as allergic or viral conjunctivitis to vision threatening conditions such as acute narrow angle glaucoma. Being able to identify which conditions may affect vision, initiate emergency measures, and make a timely referral to an ophthalmologist are major challenges for the emergency physician.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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