How to Diagnose the Red Eye – Episode 14

A commonly encountered condition that we see in our practices is the red eye. Unfortunately, the red eyes that we encounter can be caused by a variety of etiologies and they can present with significant variability. There are a number of questions that we need to investigate. Is it monocular or binocular? Is it an acute flare up or is it something that’s chronic? Is there pain associated with it? Is there any discharge? Is there light sensitivity? Is there a reduction in vision? Based on what we discover, we start narrowing the possibilities. Although not a complete differential of conditions that may cause a red eye, some of the more common reasons are seen here. Dry eye and blepharitis tend to be more chronic conditions and also tend to be bilateral, although the redness that they cause can be asymmetric in nature. Ocular rosacea is another chronic condition that’s bilateral but may be asymmetric in its presentation as well. Contact lens related eyes, or contact lens related red eyes, usually have an acute onset and are usually associated with some level of contact lens abuse. Adult occlusion conjunctivitis will often initially be treated as a standard bacterial conjunctivitis. It will often times resolve with topical antibiotic therapy, but then will likely return because of the fact that this condition usually stems from a systemic chlamydial infection. This will require either oral doxycycline or erythromycin to resolve the condition. Medicamentosa is often times diagnosed through a thorough patient history. This can either be for patients abusing over the counter products containing vasoconstrictors or medications such as glaucoma meds utilized to treat chronic conditions. Allergic eye disease is usually a bilateral condition and is accompanied with a severe knuckle rub towards the inner canthus, which is where the allergens typically accumulate in the highest concentrations. But the two that are the most difficult to distinguish between are bacterial and viral conjunctivitis, with the reason being there’s a number of overlapping signs and symptoms. In fact, recent studies have shown a 50% misdiagnosis of viral conjunctivitis because of this fact. Fortunately, point of care tests offers us
the ability to improve the accuracy of our point of care tests offers us the ability to improve the accuracy of our diagnosis. With AdenoPlus a tear sample is collected from the lower palpebral conjunctiva. Then the sample collectors snapped into the test cassette, which is dipped in a buffer vial. If an adequate sample has been collected, a blue control line would be visible. If there is adenovirus present, there will be a red line that appears next to the blue line. Ultimately, this helps you distinguish between adenovirus, the most common form of viral conjunctivitis and other forms of infectious conjunctivitis. It is important to understand the differential diagnosis for red eye and it’s also critical to rule out unlikely possibilities of the red eye. Additionally, you may want to consider putting a protocol in place that includes point of care testing. This will help improve patient care and clinical outcomes when diagnosing the red eye, which is ultimately why we do what we do. We hope that this has been clinically insightful.

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