9/27/2012

RED EYE EMERGENCIES: Front office staff and assistants What is YOUR Role??? 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

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

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

“My eyes are RED and “My eye/eyes are all RED and goopy in feel all gritty the morning with yellow greenish pus” like I have sand in my eyes” “My eyes are so RED and itchy… I can hardly stop “I slept in my contact lenses last night rubbing them” and now my eyes are all RED and irritated”

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“My two year old poked me in my eye last, now it’s all RED and I can hardly “I was doing some work keep it opened” under my car a few days ago and now my eye is all “I poked myself in the RED and feels like something might be in it” eye last night just to impress my friends “I was cutting some drywall yesterday and now it’s RED and it feels like something got in my eye and in extreme pain” and now it’s all RED”

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

Do you have any MATTER in or WHEN did the REDNESS begin? SECRETION from the eye?

Are you in any PAIN? Is the REDNESS in ONE or BOTH eyes? Do you have any BLURRED VISION?

Any Other Questions we should What should you do next?? ask??

Light Sensitivity?? Must determine how quickly the patient needs to be seen… ????? URGENT / IMMEDIATELY!!! ????? NonNon--urgenturgent / Later that same day

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URGENT / Immediately!! URGENT / Immediately!! REDNESS associated with the REDNESS associated with following… the following…

Ocular Trauma such as a sports Sudden or severe pain and discomfort , auto accident, blow to the eye, fingernail scratch, paper cut, Bleeding in or around the eye curling iron burn, chemical burn, etc.

URGENT / Immediately!! URGENT / Immediately!! REDNESS associated with the REDNESS associated with the following… following…

Foreign Body or object in the eye Sudden change in vision or loss of vision

Extreme discomfort and sensitivity Copious amount of matter or discharge to light

NonNon--urgenturgent / Later the same day NonNon--urgenturgent / Later the same day

REDNESS associated with the REDNESS associated with the following… following…

Mild pain or discomfort that has been No ocular trauma present for several days to a week

No foreign body injury No bleeding in or around the eye

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Once the patient comes to the NonNon--urgent/Laterurgent/Later the same day office, what do you do?

REDNESS associated with the Case history information… following… Required by medical insurance companies

Little to no light sensitivity All current medical insurance information so that payment for the office Little to no change in vision visit will be received

Little to no matter or discharge

Specific Case history information is Specific Case history information is needed… needed… RED EYE or EYES must be the Did it occur suddenly or gradually? CHIEF COMPLIANT

How severe is the problem? Which eye has the problem? O.D./O.S./O.U. Is it worse at a specific distance?

Does it cause vision loss or blur? How long does it last?

Specific Case history information is What tests should be performed before needed… the patient sees the doctor? Visual Acuities? Always!!!! How long has it been occurring? Blood Pressure? Are there any associated symptoms? Intraocular Pressure? NO!!!! Why? Does anything help? Any others?

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Signs, Symptoms, Treatment Now...let’s take a look at some of the most common causes of RED Signs – What we clinically observe EYE in an Optometric Office… Symptoms – What the patient is feeling and experiencing

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

RED / Red EyeLID or EyeLIDS : Most Common Findings and Treatment Most Common Conditions Hordeolum ((StyeStye)) Hordeolum – Internal and External Localized or of the eyelid margin that Meibomianitis involve hair follicles of (external) or Trichiasis oil glands underneath Eyelid Trauma eyelid (internal)

Red EyeLID or EyeLIDS : Most Red EyeLID or EyeLIDS: Most Common Findings and Treatment Common Findings and Treatment

Signs: Symptoms:

1. Redness 1. SddSore and tender to 2. Swelling the touch

3. Bump on the 2. Mild, Moderate or outside or inside Extreme Pain of the eyelid

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Red EyeLID or EyeLIDS: Most Red EyeLID or EyeLIDS: Most Common Findings and Treatment Common Findings and Treatment

Treatment: Chalazion 1. “Hot Potato” Hard eyelid lump Compress caused by a single 2. Topical Antibiotics, blocked or series of usually an ointment blocked oil glands… NOT infectious 3. Oral antibiotics, if required

Red EyeLID or EyeLIDS: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Signs: Treatment: 1. Redness 2. Swelling 1. “Hot Potato” 3. Hard lump/bump on compress inside or outside of the eyelid 2. Monitor for change

Symptoms: 3. Excise if does not No pain or tenderness resolve

Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Signs: Blepharitis

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

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Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment Treatment: Symptoms:

1. Hot soaks and lid 1. Itching of eyelids massage 2. Grittiness of lids 3. Burning and irritation of 2. Commercially available the eye eyelid scrubs 4. Watering of the eyes 3. Topical antibiotics usually an ointment

Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Meibomianitis Signs: 1. Redness and Infection and inflammation of inflammation of inner eyelid the inner eyelid margins 2. Toothpaste like glands along the excretion from entire lid margin inner eyelid glands

Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Treatment: Symptoms:

1. Burning of the eyes 1. Hot soaks and massage 2. General irritation of 2. LipoFlow Thermal the eyes Pulsation (NEW!) 3. Topical antibiotic 3. Watering of the eyes 4. Oral antibiotic

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Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Trichiasis Signs: Eyelid lashes 1. Misdirected that turn inward eyelashes that resulting in grow toward eye scratching of the front surface of the 2. Redness of the eye eye

Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

Symptoms: EyeLid Trauma 1. Scratchy feeling Trauma occurring 2. Foreign body from sudden sensation impact to the eye 3. Itchiness and eyelid… Treatment: car accident, 1. Removal of lashes sports injury, blow 2. Eye drops to the face, chemical 3. Bandage Contact if needed burn, etc.

Red EyeLID or EyeLIDs: Most Red EyeLID or EyeLIDs: Most Common Findings and Treatment Common Findings and Treatment

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

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

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

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Signs: Subconjunctival 1. Bloodyygy looking eye HhHemorrhage 2. Well defined area of redness and Breaking of the tiny bleeding blood vessels between 3. Flat or slightly raised the conjunctiva and hemorrhage the sclera

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Treatment: Symptoms: Usually None (Asymptomatic) 1. Check BP 2. Reassurance 1. No Pain 3. Cold compress 2. No irritation followed by hot 3. No discomfort compresses 4. Artificial tears

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

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

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions Symptoms: 1. Usually just bothersome appearance 2. May cause minor irritation Pterygium Pronounced inflammation Treatment: and fibrovascular tissue 1. Artificial Tears in the interpalbebral 2. Topical antianti--inflammatoryinflammatory space extending towards drops the 3. Sunglasses

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

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

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions Signs: Seasonal Allergic 1. Mild diffuse pinkness Conjjj unctivitis of the conjunctiva Inflammation of the 2. Hazy conjunctiva conjunctiva coinciding 3. Rubbing of the eyes known with pollen blooms, as “universal sign” 4. Watery or white stringy ragweed, animal discharge dander, dust mites, 5. Red swollen eyelids etc.

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Symptoms: Treatment:

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

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Acute Allergic Signs: Conjunctivits 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

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Symptoms: Treatment: Bacterial Conjunctivitis 1. Sudden 1. Iden tify an d remove Highly contagious intense itching offending allergen asap infection of the and tearing 2. Cold compresses for eyelid 2. Ocular burning swelling conjunctiva 3. 3. OTC oral antihistamine caused by a such as Benadryl multitude of 4. Prescription allergy and/or bacterial strains antianti--inflammatoryinflammatory drops

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Signs: Symptoms:

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

RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions Contact Lens Treatment: Associated Red Eye (CLARE) 1. TilTopical an tibititibiotic eye drops or ointment Signs: 2. Oral prescription Redness around the antibiotics limbus usually due to 3. Hot compresses over wear of CLs or solution intolerance

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RED Conjunctiva and Sclera RED Conjunctiva and Sclera Most Common Conditions Most Common Conditions

Symptoms: Treatment:

1. Mild to moderate pain especially 1. Discont inu ing CL wear when wearing CLs (Usually temporarily) 2. OTC or Rx. Eye drops 2. Tearing 3. Refit to other type of CL 4. Change CL solution 3. Photophobia

RED EYE associated with Which of the RED Eye conditions of Corneal Problems…Most the Conjunctiva are True Emergencies? Common Conditions Foreign Body Subconjuntival Hemmorrhage Abrasion Pinguecu la Recurrent Erosion Pterygium Dry Eye Seasonal Allergy Corneal Infiltrate Acute Allergy Chemical or UV Damage Bacterial Conjunctivitis Corneal Trauma CLARE

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem Corneal Foreign Symptoms: Body

1. Moderate Signs: to extreme pain 1. Foreign object in eye 2. Feels like usually metal, wood something is drywall, etc. in the eye 2. Unable to open eye 3. Discomfort 3. Light sensitive 4. Photophobia

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

Treatment: Corneal Abrasion 1. RlffibdRemoval of foreign body Loss of surface 2. Topical antibiotics cells on the front surface of the 3. Bandage CL using a cornea continuous wear CL

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

Signs: Symptoms:

1. Unable to open eye 1. MdModerate to extreme 2. Extremely light pain sensitive 2. Feels like something 3. Appearance of scratch is in the eye or section of cornea removed

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem Recurrent Corneal Treatment: Erosion 1. Topical antibiotic eye drops Recurrence of the removal of the front surface cells of the 2. Fitting of a bandage cornea after previous corneal CL until resolves abrasion (Basically ripping 3. Prophylactic nightly off of the previously damaged cells) 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 Contact lens- 2. Watering and tearing of the eye associated Symptoms: 1. Pain and irritation upon awakening 2. Feels like something is in the eye 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

Signs: Chronic lack of lbilubrica tion an d moisture of the eye 1. Mild to severe due to many factors interpalpebral redness including low tear production, poor tear 2. Mild to severe quality and other corneal staining eyelid issues

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

Treatment: Symptoms: 1. OTC artificial tears 1. Burning & stinging (Refresh Optive, 2. Grittiness & Scratchiness Systane Ultra or Balance, Soothe XP) 3. Foreign Body sensation 4. Photophobia 2. Rx. anti-anti-inflammatoryinflammatory 5. Intermittent blurred vision eye drops ((RestasisRestasis)) 6. Watering and tearing 3. Rx. anti-anti-inflammatoryinflammatory eye drops (Steroid)

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

Other Treatment: Corneal Infiltrate 1. Omega --33 Small hazy grey Salmon, Tuna, mackerel, herring, areas of trout, sardines or inflammation halibut usually near the 2. Ocular Supplements limbus 10001000--20002000 mg/Day

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem Signs: Chemical /UV Damage 1. Redness Damage of the 2. Tearing cornea caused by Symptoms: chemical solution or 1. Foreign body sensation UV exposure 2. Mild to severe irritation 3. Light sensitive Signs: Treatment: 1. Redness 1. Topical antibioticantibiotic--steroidsteroid 2. Chemosis of Conjunctiva drops 3. Corneal Staining

RED EYE associated with RED EYE associated with Corneal Problem Corneal Problem Chemical Solution / UV Damage Corneal Trauma Symptoms: 1. Pain and discomfort 2. Tearing, burning and stinging 3. Foreign body sensation Treatment: 1. Artificial tears 2. Antibiotic / steroid drops 3. Change of CL solution 4. Advise against tanning bed use 5. Sun protection when outside

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Which of the RED EYE conditions of the Cornea are True Once the doctor examines the Red Emergencies?? Eye Patient…how do YOU come back in the picture? Foreign Body Abrasion Recurrent Erosion Exam room Dry Eye assistance Corneal Infiltrate Patient education Chemical or UV damage FollowFollow--upup care Cornea Trauma

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

A. Chalazion • Woke up with it B. Allergic Conjunctivitis • No pain • No discomfort C. Subconjunctival Hemmorhage • No blurred vision D. Blepharitis

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

• Itchiness A. Chalazion • Scratchiness B. Blepharitis • Burning • Irritation C. Foreign Body • Frequently rubs eyes D. Meibomianitis

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

• Toddlers finger A. Dry Eye scratched eye B. Pinguecula • Pain • Tearing C. Corneal Abrasion • Hard to open • Blurred Vision D. Corneal Foreign Body

Can you identify Is that your Final Answer? THIS Red EYE ? • Burning • Itching A. Dry Eye • Watering B. CLARE • Grittiness • Irritation C. Foreign Body • • Eye Fatigue D. Seasonal Allergy

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

A. Chalazion

• RedBumponLidRed Bump on Lid B. Corneal Infiltrate • Moderate Soreness C. Hordeolum • Tender to the touch D. Trichiasis

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

• Woke up with eyes A. Acute Allergic Conjunctivitis “glued” shut • YllYellow ihish ma tter B. Pterygium through the day • Mild irritation C. Dry Eye • Had a cold last week D. Bacterial Conjunctivitis

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

• Yellow raised A. Subconjunctival Hemorrage bump on white part of the eye B. Pinguecula • Seems to look worse after being C. Pterygium outside in sun and wind D. Bacterial Conjunctivitis • Mild occasional irritation

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

• Itching A. Foreign Body • Always rubbing at eyes B. CLARE • Watering • Sneezing C. Acute Allergic Conjunctivitis • Allergies D. Seasonal Allergic Conjunctivitis

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Thank you…it has been a pleasure Questions on RED EYE?? spending the past few hours with you! I hope you feel that you have learned more about your RED EYE patients.

Have a fantastic conference …

Dr. Kris Kerestan Garbig [email protected]

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