Common Eye Complaints

Chad E. Richmond, D.O. Urgent care physician, Inspira Health Network, Southern New Jersey Objectives

▪ To review common eye conditions from a primary care or emergency situation ▪ Initial treatment and management ▪ Know when to refer Conflicts of Interest

▪ None. Main Reasons patients present for eye complaints:

Redness Pain Trauma Discharge Foreign bodies swelling Systematic evaluation of the eye

▪ Inspect ▪ Lie the pt down-- 45 degree angle if hyphema possibility) ▪ Topical anesthetic (proparacaine/tetracaine) ▪ Visual acuity when pain decreased will help ▪ Look at the sclera/cornea/conjunctiva/lids (incl.under the upper lid) ▪ Fluroscene ▪ Tono pen/(shiatz tonometer) ▪ Remove foreign bodies ▪ Slit lamp. (very important) ▪ Bedside ultrasound (if available) Tonometer Pen Slit Lamp machine Bedside ultrasound

▪ Retinal detachment ▪ Foreign Bodies ▪ Intraocular hemorrhage ▪ Globe rupture Anatomy of the eye Redness

▪ Infection ▪ Trauma ▪ Allergies ▪ Foreign bodies ▪ Chemical exposure (MSD sheet--poison control) ▪ Elevated ocular pressure ▪ Non-traumatic/non-infection (subconj. Hematoma) Infection

▪ Conjunctivitis ▪ Blepharitis ▪ Keratitis ▪ Secondary to another condition: ▪ Foreign body ▪ Corneal ulcer/abrasion ▪ Herpes/GC Conjunctivitis Bacterial vs. Viral vs. Allergic conjunctivitis

▪ Bacterial ▪ Viral ▪ Viral syndrome ▪ Mucoprurulent ▪ Watery discharge ▪ Less adenopathy ▪ B/l--but can be unilateral with ▪ Less viral symptoms herpes ▪ Unilateral--but will spread ▪ Allergic b/l ▪ Bilateral ▪ Cobblestoning of the lid ▪ Watery discharge ▪ Itching ▪ Sudden onset Localized allergic/sting

▪ Sudden onset ▪ Significant swelling ▪ Topical and oral/ systemic antihistamines Tx of conjunctivitis:

▪ Bacterial: antibiotic eye drops x 7-10 days ▪ Viral: steroids (optho) ▪ Allergic: antihistamines/mast cell stabilizers Herpes conjunctivitis/keratitis Herpes opthalmicus

▪ Immediate optho consult ▪ Hutchinson’s sign (tip of the nose and the nasociliary brach of the trigeminal nerve to the cornea) ▪ Oral and topical antivirals. Blepharitis Keratitis Corneal Abrasion/ulcers Corneal foreign bodies Welders flash

▪ Intense corneal inflammation ▪ Retinal edema ▪ Severe photophobia ▪ Intense watery discharge ▪ Inspect for foreign body (not wearing a mask) ▪ Topical antibiotics/+/-patching ▪ Optho consult w/in 24 hrs. dacrocystitis Acid vs. alkali chemical burns

▪ Acid: ▪ alkali: ▪ Less severe ▪ More severe ▪ More painful ▪ Less painful ▪ Quicker erosion ▪ Slower erosion ▪ Ph< 7.0 ▪ pH >8.0 ▪ Irrigate to normal pH ▪ Immediate optho eval! ▪ Optho f/u in 24 hrs (except ▪ Poison control hydroflouric acid) ▪ Transfer to higher center of ▪ Poison control care ▪ Irrigate until the pt leaves the ER/office Orbital vs periorbital cellulitis

(posterior vs. anterior to the orbital septum/ membrane) ▪ Orbital (post-septal) ▪ Periorbital (preseptal)

CT scanning will help!!! Orbital/periorbital cellulitis (con’t) trauma

▪ Foreign bodies (already done) ▪ Direct blow/fall/punch ▪ Lacerations-corneal or surrounding (ruptured globe) ▪ Hyphema/microhyphema ▪ Orbital fractures--ct scanning. ▪ Check for ocular muscle mvmt and document!!! (protects in a lawsuit) Direct Blow/punch etc.

▪ Eyelid lac, orbital fx Ruptured globe

▪ Eye sheild--No patch!! Hyphema/microhyphema Severe injury

▪ Lens dislocation ▪ Vitreous hemorrhag

▪ Retinal detachment ▪ NON-trauma add-ons Acute angle closure glaucoma

▪ Need to shield, send to an acute eye surgical center, start drops to lower pressure. Ie. Beta blockers/carb.anhydrase inhib. Subconjunctival hematomas Styes/hordeolum/meiobian gland cysts/chalazion Systemic inflammatory diseases

▪ Sjogrens--chronic dry eyes!

▪ Reiters syndrome (uveitis) Central retinal artery/vein occlusion

▪ artery ▪ vein ▪ The end. ▪ Thank you. REFERENCES

Wikimediacommons.com ▪ Medrounds.org cdc.gov ▪ Justinbazan.wordpress.com Riversideonline.com ▪ Nlm.nih.gov Aafp.org ▪ Irishhealth.com Bausch.com ▪ Afv.org.hk Cehjournal.org ▪ Baddawi-camp.com Med.miami.com ▪ Bloggersbase.com Nature.com ▪ Retinamd.com Elinewberger.com ▪ Opt.indiana.edu Mdconsult.com ▪ Retinavitreouscenter.com Worldortho.com ▪ Retinaexperts.com Gentili.net ▪ mayoClinic.com Reuophth.com Radswiki.net Snof.org Molvis.org Retinaphysician.com Timothyjackson.net Biomed.brown.edu