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Home , Cycloplegia, Red eye (medicine), Trichiasis

5/21/17

RED EYE, EYE Front office staff and assistants What do YOU See??? are THE first ones to begin the evaluation process when answering the phone… The role of the front office and optometric assistant in the detection and treatment of RED EYES

Dr. Kris Kerestan [email protected]

FIRST the patient calls the office… “I have a RED bump on my eye and it’s really sore to touch it” What are some of the most common things they say?

# 1 Comment: “I woke up with my eye all RED “My eye/eyes are RED… and it looks like it’s bleeding” I’m afraid I have PINK eye”

“My eye/eyes are all “My eyes are RED RED and goopy in and feel all gritty the morning with like I have sand yellowish pus” in my eyes”

“My eyes are so RED and itchy… “I slept in my contact I can hardly stop lenses last night and rubbing them” now my eyes are all RED and irritated”

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“My 2 yr old poked “I was doing some work me in my eye last, under my car a few days now it’s all RED ago and now my eye is all and I can hardly RED and feels like keep it opened” something might be in it”

“I purposely poked “I was cutting some drywall myself in the eye last night last week and it feels like just to impress my friends something got in my eye and now it’s RED and now it’s all RED” and in extreme ”

Next, front office staff and assistants Do your eyes ITCH, BURN, WATER must know the proper questions to ask… or FEEL IRRITATED?

Do you have any MATTER in or SECRETION from the eye? WHEN did the REDNESS begin? Is the REDNESS in ONE Are you in any PAIN? or BOTH eyes?

Light sensitivity? Do you have any ?

What should you do next?? URGENT / Immediately!!

REDNESS associated with… Must determine how quickly the patient needs to be seen… Sudden or severe pain and discomfort URGENT / IMMEDIATELY!!!

Bleeding in or around Non-urgent / Later that same day the eye

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Foreign Body or object in the eye Ocular Trauma § Sports Extreme discomfort and sensitivity § Auto accident to § Blow to the eye § Fingernail scratch Sudden change in vision or loss of vision § Paper cut § Curling iron burn § Chemical burn Copious amount of matter or discharge

Non-urgent / Later the same day No bleeding in or around the eye REDNESS associated with… Little to no light sensitivity No ocular trauma Little to no change in vision No foreign body injury Little to no matter or discharge Mild pain or discomfort that has been present for several days to a week

Once the patient comes to the office, then what? Specific Case history information is needed… Case history… Required by medical RED EYE or EYES must be the insurance companies CHIEF COMPLAINT

Which eye has the problem? O.D./O.S./O.U. All current medical insurance information… Does it cause vision loss or blur? need payment for services

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What tests should be performed before the patient sees the doctor? Did it occur suddenly or gradually?

Is the problem mild, moderate or Visual Acuities? severe? Always!!!! How long has it been occurring? Are there any associated Blood Pressure? symptoms? Intraocular Pressure? Does anything help? Why or why not?

Any others?

Signs, Symptoms, Treatment

What are some of the most common causes of RED EYE Signs – What we clinically observe in an Optometric Office… Symptoms – What the patient is feeling and experiencing

Treatment – What we do to manage Any ideas??? the condition

RED / Red EyeLID or EyeLIDS : Most Common Conditions Conditions and Treatment

Hordeolum () Hordeolum – Internal and External Localized or of the eyelid margin that involve hair Meibomianitis follicles of (external) or oil glands underneath eyelid Eyelid Trauma (internal)

4 5/21/17

Red EyeLID or EyeLIDS Red EyeLID or EyeLIDS:

Signs: Symptoms:

1. Redness 1. Sore and tender to the 2. Swelling touch 3. Bump on the outside or inside of the lid 2. Mild, Moderate or Extreme Pain 4.

Red EyeLID or EyeLIDS Red EyeLID or EyeLIDS

Treatment:

Chalazion 1. Warm/Hot Moist heat Bruder Mask “Hot Potato” Hard eyelid lump 2. Topical Antibiotics, caused by a single usually an ointment blocked or series of 3. Oral antibiotics, if blocked oil glands… required NOT infectious

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDS

Signs: Treatment: 1. Redness 2. Swelling 1. Bruder Mask/ “Hot 3. Hard lump/bump on inside Potato” compress or outside of the eyelid 2. Monitor for change Symptoms: 1. No pain or tenderness 3. Excise if does not 2. Cosmesis resolve

5 5/21/17

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Signs: Blepharitis 1. Redness of eyelids Infection and inflammation at eyelid margins of the outer eyelid glands 2. Crustiness along the base of the lids and along the entire eyelid lashes margin 3. Tendency to frequently rub eyes

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Symptoms: Treatment:

1. Itching of eyelids 1. Hot soaks and lid 2. Grittines s of lids massage 3. Burning and ocular irritation 2. Commercially available eyelid scrubs 4. Watering of the eyes (w and w/o antibiotic) 3. Topical antibiotics usually an ointment

Red EyeLID or EyeLIDs

Meibomianitis

Infection and inflammation of the inner oil eyelid glands along the entire lid margin

6 5/21/17

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Signs: Symptoms:

1. Redness and 1. Burning of the eyes inflammation of inner eyelid margins 2. General irritation of 2. Toothpaste like the eyes excretion from inner eyelid glands 3. Watering of the eyes

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Treatment:

Trichiasis 1. Hot moist soaks and massage 2. Bruder Mask Eyelid lashes 3. MiBo that turn inward 4. LipoFlow Thermal resulting in Pulsation (NEW!) scratching of the 3. Topical antibiotic and conjuctiva 4. Oral antibiotic

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Signs: Symptoms: 1. Scratchy feeling 1. Misdirected 2. Foreign body sensation eyelashes that 3. Itchiness grow toward eye Treatment: 2. Redness of the 1. Removal of lashes eye 2. Eye drops 3. Bandage Contact if needed

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Red EyeLID or EyeLIDs Seriously? WHY??

EyeLid Trauma

Trauma occurring from sudden impact to the eye and eyelid…car accident, sports injury, blow to the face, chemical burn, etc.

Red EyeLID or EyeLIDs Red EyeLID or EyeLIDs

Symptoms: Signs: 1. Moderate to severe pain 2. Light sensitive 1. Moderate to severe eyelid redness 3. Blurred vision 2. Possible cut of the eyelid (as seen here) Treatment: 3. Total lid obliteration 1. Cold ice packs (as seen in next slide) 2. Pain management 3. Oc uloplas tic

RED and Which of the RED Eyelid conditions Common Conditions and Treatment are True Emergencies ?

Subconjunctival Hemorrhage Hordeolum – Internal and External Chalazion Blepharitis Seasonal Allergic Meibomianitis Acute Trichiasis Bacterial Conjunctivitis Eyelid Trauma Associated Red Eye (CLARE)

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Signs:

Subconjunctival 1. Bloody looking eye Hemorrhage

2. Well defined area of Breaking of the tiny redness and bleeding blood vessels between the conjunctiva and 3. Flat or slightly raised the sclera hemorrhage

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Symptoms…Usually None! Treatment:

1. No Pain 1. Check BP 2. Reassurance 2. No irritation 3. Cold compresses followed by hot 3. No discomfort compresses 4. Artificial tears

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Signs:

Pinguecula 1. Reddish yellow inflammation with blood vessels Localized inflammation running through of the conjunctiva in the interpalpebral space 2. Blood vessels and inflammation stops at the limbus

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Symptoms: 1. Usually just bothersome Pterygium appearance 2. May cause minor irritation Pronounced inflammation and fibrovascular tissue Treatment: in the interpalbebral 1. Artificial Tears space extending past the 2. Topical anti-inflammatory drops limbus and into the cornea 3. Sunglasses

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Signs: Treatment: 1. Appearance of a raised whitish triangle shaped 1. Monitor closely vascular tissue “growing 2. Use of UV blocking over the eye” sunglasses 3. Liberal use of Symptoms: Artificial tears 1. Cosmetic concern over 4. Surgical excision appearance when encroaching 2. Dry irritated eye on the

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Signs: Seasonal Allergic Conjunctivitis 1. Mild diffuse pinkness of the conjunctiva Inflammation of the 2. Hazy conjunctiva conjunctiva coinciding 3. Rubbing of the eyes… “universal sign” with pollen blooms, 4. Watery or white stringy ragweed, animal discharge dander, dust mites… 5. Red swollen eyelids

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Symptoms: Treatment:

1. Itching of the eyes 1. Avoid offending allergen (pollen blooms, which gets worse animal dander, dust mites) with rubbing 2. OTC allergy eye drops 2. Tearing of the eyes 3. Prescription allergy drops 3. Mucus in corners 4. Cool compresses 4. Sneezing 5. Oral allergy meds -Zyrtec, Claritin, Benadryl

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Acute Allergic Signs: Conjunctivitis 1. Extreme redness of the Sudden, extreme conjunctiva inflammation 2. Profound conjunctival caused by an chemosis (glassy abrupt exposure to appearance) a specific allergen 3. Red, swollen and edematous eyelids

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Symptoms: Treatment: Bacterial Conjunctivitis

1. Sudden intense 1. Identify and remove Highly contagious itching and offending allergen asap tearing infection of the 2. Cold compresses for eyelid 2. Oc ular burning conjunctiva swelling 3. 3. OTC oral antihistamine such as caused by a Benadryl multitude of 4. Prescription allergy and/or anti- bacterial strains inflammatory drops

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Signs: Symptoms:

1. Reddish “Pink” eye that 1. Eyelids feel “glued shut” in the usually starts in one eye… often moves to the other morning (Highly contagious) 2. Buildup of yellowish green discharge through the day 2. Yellowish discharge 3. Mild to moderate irritation 4. Patient is usually “sick”

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Contact Lens Associated Treatment: Red Eye (CLARE)

1. Topical antibiotic eye Signs: drops or ointment

Redness around the 2. Oral pres c ription antibiotics limbus usually due to over wear of CLs or 3. Hot compresses solution intolerance

RED Conjunctiva and Sclera RED Conjunctiva and Sclera

Symptoms: Treatment: 1. Mild to moderate pain especially 1. Discontinuing CL wear when wearing CLs (Usually temporarily) 2. OTC or Rx . Ey e drops 2. Tearing 3. Refit to other type of CL 3. Photophobia 4. Change CL solution

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Carotid Cavernous Fistula

4. Progressive pulsatile proptosis which may cause a Sudden vascular engorgement and ocular redness humming sound in skull secondary to poor circulation of blood in cavernous sinus 5. Decrease in VA 6. Increase in IOP due to increased venous pressure Signs: 7. Intolerable pain 1. Diffuse injection 8. Young adults – Head trauma 2. Engorged “corkscrew” blood vessels 9. Older adults – Progressive atherosclerosis 3. Unilateral 10. May lead to neurological deficits or a fatal brain hemorrhage

Which of the RED Eye conditions of the Conjunctiva are True Emergencies?

Subconjuntival Hemmorrhage Pinguecula Treatment: Pterygium Seasonal Allergy 1. Order CT scan and MRI to look for an enlarged Acute Allergy superior ophthalmic vein Bacterial Conjunctivitis 2. Refer to Neurologist/ Vascular surgeon CLARE Carotid Cavernous Fistula

RED EYE associated with RED EYE associated with Corneal Corneal Problem Conditions and Treatment

Corneal Foreign Body Foreign Body Abrasion Signs: Recurrent Erosion 1. Foreign object in eye Dry Eye usually metal, wood Corneal Infiltrate drywall, etc. Chemical or UV Damage 2. Unable to open eye 3. Light sensitive Corneal Trauma

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RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Treatment: Symptoms:

1. Moderate 1. Removal of foreign body to extreme pain 2. Feels like 2. Topical antibiotics something is in the eye 3. Bandage CL using a 3. Discomfort continuous wear CL 4. Photophobia

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Signs:

1. Unable to open eye Loss of surface cells on 2. Extremely light sensitive the front surface of the cornea 3. Appearance of scratch or section of cornea removed

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Symptoms: Treatment:

1. Moderate to extreme 1. Topical antibiotic eye pain drops 2. Feels like something 2. Fitting of a bandage CL is in the eye until resolves 3. Prophylactic nightly use of lubricating eye ointments

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RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Signs: 1. Redness upon awakening Recurrent Corneal Erosion 2. Watering and tearing of the eye

Sporadic and spontaneous Symptoms: removal of the front surface 1. Pain and irritation upon awakening cells of the cornea after 2. Feels like something is in the eye previous corneal abrasion 3. Light sensitive

Treatment: Prophylactic use of lubricating eye gels or ointments at bedtime to minimize future erosions

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Contact Lens Associated Corneal inflammation resulting from various CL related issues that can Chronic lack of lubrication and moisture of the eventually result in eye due to many factors • Ov erwear including low tear • Poor hygiene production, poor tear • Solution (ReNu Moisture-Loc) quality and other eyelid issues

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Signs: Symptoms:

1. Burning & stinging 1. Mild to severe 2. Grittiness & Scratchiness interpalpebral 3. Foreign Body sensation redness 4. Photophobia 5. Intermittent blurred vision 2. Mild to severe 6. Watering and tearing corneal staining

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RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Treatment: 1. Omega -3 1. OTC lubric ants Salmon, Tuna, • Refresh Optiv e/Advanced mackerel, herring, • Systane Ultra/Balance • Soothe XP trout, sardines or halibut 2. Rx. eye drops 2. Oc ular Supplements • Restasis 1000-2000 mg/Day • Xiidra

3. Rx. anti-inflammatory eye drops (Steroid)

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Corneal Infiltrate Symptoms: Small hazy grey areas of 1. Foreign body sensation inflammation usually near 2. Mild to severe irritation the limbus 3. Light sensitive

Signs: Treatment: 1. Redness 1. Topical antibiotic-steroid 2. Tearing drops

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem

Chemical Solution/UV Damage Chemical Solution / UV Damage

Damage of the Symptoms: cornea caused by 1. Pain and discomfort chemical solution 2. Tearing, burning and stinging or UV exposure 3. Foreign body sensation Treatment: 1. Artificial tears Signs: 2. Antibiotic / steroid drops 1. Redness 3. Change of CL solution 2. Chemosis of Conjunctiva 4. Advise against tanning bed use 3. Corneal Staining 5. Sun protection when outside

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RED EYE associated with Which of the RED EYE conditions of Corneal Problem the Cornea are True Emergencies??

Corneal Trauma Foreign Body Abrasion Recurrent Erosion Dry Eye Corneal Infiltrate Chemical or UV damage Cornea Trauma

RED EYE associated with RED EYE associated with Uveal Tract Uveal Tract

Anterior Inflammation of the Treatment: middle layer of the eye 1. Signs/Symptoms: 1. Red, sore, inflamed eye 2. Topical steroids 2. Blurred vision 3. Light sensitivity 4. Small pupil

Once the doctor examines the Red Eye Can you identify THIS Red EYE ? Patient…how do YOU come back in the picture?

• Woke up with it • No pain Exam room • No discomfort assistance • No blurred vision Patient education Follow-up care

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Is that your Final Answer? Can you identify THIS Red EYE ?

A. Allergic Conjunctivitis • Itchiness • Scratchiness B. Pinguecula • Burning • Irritation C. Subconjunctival Hemmorhage • Frequently rubs eyes

D. Pterygium

Is that your Final Answer? Can you identify THIS Red EYE ?

A. Hordeolum • Toddlers finger scratched eye B. Blepharitis • Pain • Tearing C. Foreign Body • Hard to open • Blurred Vision D. Meibomianitis

Is that your Final Answer? Can you identify THIS Red EYE ?

• Burning A. Dry Eye • Itching • Watering B. Recurrent Corneal Erosion • Grittiness C. Corneal Abrasion • Irritation • • Eye Fatigue D. Corneal Foreign Body

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Is that your Final Answer? Can you identify THIS Red EYE ?

A. Digital Eye Strain

• Red Bump on Lid B. CLARE

• Moderate Soreness C. Dry Eye

• Tender to the touch D. Seasonal Allergy

Can you identify THIS Red EYE ? Is that your Final Answer?

A. Chalazion • Woke up with eyes “glued” shut B. • Yellowish matter through the day • Mild irritation C. Hordeolum • Had a cold last week D. Trichiasis

Is that your Final Answer? Can you identify THIS Red EYE ?

A. Acute Allergic Conjunctivitis • Yellow raised bump on white part of the eye B. Seasonal Allergic Conjunctivitis • Worse after being outside in sun and C. Dry Eye wind • Mild occasional D. Bacterial Conjunctivitis irritation

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Is that your Final Answer? Can you identify THIS Red EYE ?

A. Subconjunctival Hemorrage • Itching • Always rubbing eyes B. Pinguecula • Watering • Sneezing C. Pterygium • Allergies

D. Bacterial Conjunctivitis

Is that your Final Answer? RED EYE??

THANK YOU!

A. CLARE

B. Acute Allergic Conjunctivitis

C. Seasonal Allergic Conjunctivitis

D. SubconjunctivalHemorrhage Dr. Kris Kerestan [email protected]

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