RED EYE EMERGENCIES RED EYE EMERGENCIES : : What do YOU What do YOU do??? do??? The role of the front office and The role of the front office and optometric assistant in the optometric assistant in the detection and treatment of detection and treatment of RED RED EYES EYES Front office staff and assistants Front office staff and assistants are THE first ones to begin the are THE first ones to begin the RED EYE RED EYE evaluation process evaluation process when answering the phone when answering the phone … … FIRST the patient calls the office FIRST the patient calls the office office office … … What are some of the most common What are some of the most common things they say? things they say? “ “ My eye/eyes are My eye/eyes are RED RED … … I I ’ ’ m m afraid I have afraid I have PINK PINK eye eye ” ” Other common things Other common things they say they say … … “ “ I have a I have a RED RED bump on my eye and bump on my eye and it it ’ ’ s really sore to touch it s really sore to touch it ” ” “ “ I woke up with my eye all I woke up with my eye all RED RED and it and it looks like it looks like it ’ ’ s bleeding s bleeding ” ”
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RED EYE EMERGENCIESRED EYE EMERGENCIES::What do YOUWhat do YOU
do???do???
The role of the front office and The role of the front office and optometric assistant in the optometric assistant in the detection and treatment of detection and treatment of
REDRED EYES EYES
Front office staff and assistants Front office staff and assistants are THE first ones to begin the are THE first ones to begin the RED EYERED EYE evaluation processevaluation processwhen answering the phonewhen answering the phone……
FIRST the patient calls the officeFIRST the patient calls the officeofficeoffice……
What are some of the most common What are some of the most common things they say? things they say?
““My eye/eyes are My eye/eyes are REDRED……II’’mmafraid I have afraid I have PINKPINK eyeeye””
Other common things Other common things they saythey say……
““I have a I have a REDRED bump on my eye and bump on my eye and itit’’s really sore to touch its really sore to touch it””
““I woke up with my eye all I woke up with my eye all REDRED and it and it looks like itlooks like it’’s bleedings bleeding””
Other common things Other common things they saythey say……
““My eye/eyes are all My eye/eyes are all REDRED and goopy in and goopy in the morning with yellow greenish pusthe morning with yellow greenish pus””
““My eyes are so My eyes are so REDRED and itchyand itchy……I can hardly stop rubbing themI can hardly stop rubbing them””
Other common things Other common things they saythey say……
““My eyes are My eyes are REDRED and feel all grittyand feel all grittylike I have sand in my eyeslike I have sand in my eyes””
““I slept in my contact lenses last night I slept in my contact lenses last night and now my eyes are all and now my eyes are all REDRED and and
irritatedirritated””
Other common things Other common things they saythey say……
““My two year old was having a temperMy two year old was having a tempertantrum and her fingernail scratched mytantrum and her fingernail scratched myeye, now iteye, now it’’s all s all REDRED and I can hardly and I can hardly
keep it openedkeep it opened””
Other common things Other common things they saythey say……
““I was doing some work under my car I was doing some work under my car a few days ago and now my eye is all a few days ago and now my eye is all REDRED
and feels like something might be in itand feels like something might be in it””
““I was cutting some drywall yesterdayI was cutting some drywall yesterdayand it feels like something got in my eyeand it feels like something got in my eye
and now itand now it’’s all s all REDRED””
Next, front office staff and assistantsNext, front office staff and assistantsmust know the proper questions to must know the proper questions to
askask……
WHEN did the WHEN did the REDNESSREDNESS begin?begin?
Are you in any PAIN?Are you in any PAIN?
Do you have any BLURRED Do you have any BLURRED VISION?VISION?
Do your eyes ITCH, BURN, WATERDo your eyes ITCH, BURN, WATERor FEEL IRRITATED?or FEEL IRRITATED?
Do you have any MATTER in or Do you have any MATTER in or SECRETION from the eye?SECRETION from the eye?
Is the Is the REDNESSREDNESS in ONE or BOTHin ONE or BOTHeyes?eyes?
Any Other Questions we should Any Other Questions we should ask??ask??
Light Sensitivity??Light Sensitivity??
??????????
??????????
What should you do next??What should you do next??
Must determine how quickly the Must determine how quickly the patient needs to be seenpatient needs to be seen……
URGENT / IMMEDIATELY!!!URGENT / IMMEDIATELY!!!
NonNon--urgent / Later that same day urgent / Later that same day
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with associated with the followingthe following……
Sudden or severe pain and discomfortSudden or severe pain and discomfort
Bleeding in or around the eye Bleeding in or around the eye
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with the associated with the followingfollowing……
Ocular Trauma such as a SportsOcular Trauma such as a SportsInjury, Blow to the Eye, FingernailInjury, Blow to the Eye, Fingernailscratch, Paper cut, Curling Iron burn,scratch, Paper cut, Curling Iron burn,Chemical burn, etc.Chemical burn, etc.
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with the associated with the followingfollowing……
Foreign Body or object in the eyeForeign Body or object in the eye
Extreme discomfort and sensitivityExtreme discomfort and sensitivityto lightto light
Sudden Sudden change in vision or loss of visionchange in vision or loss of vision
Copious amount of matter or dischargeCopious amount of matter or discharge
URGENT / Immediately!!URGENT / Immediately!!
REDNESSREDNESS associated with theassociated with thefollowingfollowing……
REDNESSREDNESS associated with theassociated with thefollowingfollowing……
No ocular trauma No ocular trauma
No foreign body injuryNo foreign body injury
NonNon--urgent / Later the same dayurgent / Later the same day NonNon--urgent / Later the same dayurgent / Later the same day
REDNESSREDNESS associated with the associated with the followingfollowing……
Mild pain or discomfort that has been Mild pain or discomfort that has been present for several days to a weekpresent for several days to a week
No bleeding in or around the eyeNo bleeding in or around the eye
NonNon--urgent/Later the same dayurgent/Later the same day
REDNESSREDNESS associated with theassociated with thefollowingfollowing……
Little to no light sensitivityLittle to no light sensitivity
Little to no change in visionLittle to no change in vision
Little to no matter or dischargeLittle to no matter or discharge
Once the patient comes to the Once the patient comes to the office, what do you do? office, what do you do?
Have them fill out Have them fill out appropriate case history appropriate case history informationinformation……medical medical insurance companiesinsurance companies
Obtain all current medical Obtain all current medical insurance information so insurance information so that payment for the that payment for the office visit will be receivedoffice visit will be received
Specific Case history information is Specific Case history information is neededneeded……
RED EYE or EYESRED EYE or EYES must be the must be the CHIEF COMPLIANTCHIEF COMPLIANT
Which eye has the problem? Which eye has the problem? O.D./O.S./O.UO.D./O.S./O.U
Does it cause vision loss or blur?Does it cause vision loss or blur?
Specific Case history information is Specific Case history information is neededneeded……
Did it occur suddenly or gradually?Did it occur suddenly or gradually?
How severe is the problem?How severe is the problem?
Is it worse at a specific distance?Is it worse at a specific distance?
How long does it last?How long does it last?
Specific Case history information is Specific Case history information is neededneeded……
How long has it been occurring?How long has it been occurring?
Are there any associated symptoms?Are there any associated symptoms?
Does anything help?Does anything help?
What tests should be performed before What tests should be performed before the patient sees the doctor?the patient sees the doctor?
Signs Signs –– What we clinically observeWhat we clinically observe
Symptoms Symptoms –– What the patient isWhat the patient isfeeling and experiencing feeling and experiencing
Treatment Treatment –– What we do to manageWhat we do to managethe conditionthe condition
RED EYELID / EYELIDSRED EYELID / EYELIDSMost Common ConditionsMost Common Conditions
HordeolumHordeolum –– Internal and ExternalInternal and ExternalChalazionChalazionBlepharitisBlepharitisMeibomianitisMeibomianitisTrichiasisTrichiasisEyelid TraumaEyelid Trauma
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS : Most : Most Common Findings and TreatmentCommon Findings and Treatment
HordeolumHordeolum ((StyeStye))
Localized Localized InfectionInfection or or inflammation of the inflammation of the eyelid margin that eyelid margin that involve hair follicles of involve hair follicles of eyelashes (external) or eyelashes (external) or oil glands underneath oil glands underneath eyelid (internal)eyelid (internal)
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS : Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. RednessRedness
2.2. SwellingSwelling
3.3. Bump on the Bump on the outside or insideoutside or insideof the eyelidof the eyelid
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS: Most : Most Common Findings and Treatment Common Findings and Treatment
Symptoms:Symptoms:
1.1. Sore and tender to Sore and tender to the touch the touch
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:
1. “Hot Potato”Compress
2. Topical Antibiotics, usually an ointment
3. Oral antibiotics, if required
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
ChalazionChalazionHard eyelid lump Hard eyelid lump caused by a single caused by a single blocked or series of blocked or series of blocked oil glandsblocked oil glands……NOT infectiousNOT infectious
Red Red EyeLIDEyeLID or or EyeLIDSEyeLIDS: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:1.1. RednessRedness2.2. Swelling Swelling 3.3. Hard lump/bump on Hard lump/bump on
inside or outside of the inside or outside of the eyelideyelid
Symptoms:Symptoms:No pain or tendernessNo pain or tenderness
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Treatment:Treatment:
1.1. ““Hot PotatoHot Potato””compresscompress
2.2. Monitor for changeMonitor for change
3.3. Excise if does notExcise if does notresolveresolve
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
BlepharitisBlepharitisInfection andInfection andinflammation inflammation of the outer of the outer eyelid glands eyelid glands along the entirealong the entireeyelid margineyelid margin
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. Redness of eyelidsRedness of eyelidsat eyelid marginsat eyelid margins
2.2. Crustiness along the Crustiness along the base of the lids andbase of the lids andlasheslashes
3.3. Topical antibiotics usually Topical antibiotics usually an ointmentan ointment
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
MeibomianitisMeibomianitisInfection andInfection andinflammation of inflammation of the inner eyelidthe inner eyelidglands along theglands along theentire lid marginentire lid margin
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:1.1. Redness and Redness and
inflammation of inflammation of inner eyelid inner eyelid marginsmargins
2.2. Toothpaste like Toothpaste like excretion from excretion from inner eyelid glandsinner eyelid glands
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:
1.1. Burning of the eyesBurning of the eyes
2.2. General irritation ofGeneral irritation ofthe eyesthe eyes
3.3. Watering of the eyes Watering of the eyes
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
TrichiasisTrichiasis
Eyelid lashes Eyelid lashes that turn inwardthat turn inwardresulting in resulting in scratching of thescratching of thefront surface of thefront surface of theeye eye
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. MisdirectedMisdirectedeyelashes that eyelashes that grow toward eyegrow toward eye
2.2. Redness of the Redness of the eyeeye
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:1.1. Scratchy feelingScratchy feeling2.2. Foreign body Foreign body
sensationsensation3.3. ItchinessItchiness
Treatment:Treatment:1.1. Removal of lashesRemoval of lashes2.2. Eye dropsEye drops3.3. Bandage Contact Bandage Contact
Lens if neededLens if needed
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
EyeLidEyeLid TraumaTraumaTrauma occurringTrauma occurringfrom suddenfrom suddenimpact to the eyeimpact to the eyeand eyelidand eyelid……car accident,car accident,sports injury, blowsports injury, blowto the face, chemical to the face, chemical burn, etc.burn, etc.
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Signs:Signs:
1.1. Moderate to severe Moderate to severe eyelid rednesseyelid redness
2.2. Possible cut of the Possible cut of the eyelid (as seen eyelid (as seen here)here)
3.3. Total lid obliterationTotal lid obliteration(as seen in next (as seen in next slide)slide)
Red Red EyeLIDEyeLID or or EyeLIDsEyeLIDs: Most : Most Common Findings and TreatmentCommon Findings and Treatment
Symptoms:Symptoms:1.1. Moderate to severe painModerate to severe pain2.2. Light sensitiveLight sensitive3.3. Blurred visionBlurred vision
Which of the Which of the RED Eyelid RED Eyelid conditions conditions are True Emergencies ?are True Emergencies ?
HordeolumHordeolum –– Internal and ExternalInternal and ExternalChalazionChalazionBlepharitisBlepharitisMeibomianitisMeibomianitisTrichiasisTrichiasisEyelid TraumaEyelid Trauma
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common Conditions Most Common Conditions
PterygiumPterygiumPronounced inflammation Pronounced inflammation and and fibrovascularfibrovascular tissue tissue in the in the interpalbebralinterpalbebralspace extending towardsspace extending towardsthe cornea the cornea
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:1.1. Appearance of a raised Appearance of a raised
whitish triangle shaped whitish triangle shaped vascular tissue vascular tissue ““growing growing over the eyeover the eye””
Symptoms:Symptoms:1.1. Cosmetic concern over Cosmetic concern over
Sudden, extremeSudden, extremeinflammationinflammationcaused by ancaused by anabrupt exposure toabrupt exposure toa specific allergena specific allergen
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Extreme redness of the Extreme redness of the conjunctivaconjunctiva
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Bacterial Bacterial ConjunctivitisConjunctivitisHighly contagiousHighly contagiousinfection of the infection of the conjunctivaconjunctivacaused by acaused by amultitude ofmultitude ofbacterial strainsbacterial strains
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Signs:Signs:
1.1. Reddish Reddish ““PinkPink”” eye that eye that usually starts in one eye, usually starts in one eye, but often moves to the but often moves to the other (Highly contagious)other (Highly contagious)
2.2. YellowishYellowish--green green dischargedischarge
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
1.1. Eyelids feel Eyelids feel ““glued shutglued shut””in the morningin the morning
2.2. Buildup of yellowish green Buildup of yellowish green discharge through the daydischarge through the day
3.3. Mild to moderate irritationMild to moderate irritation4.4. Patient is usually Patient is usually ““sicksick””
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Treatment:Treatment:
1.1. Topical antibiotic eye Topical antibiotic eye drops or ointmentdrops or ointment
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Contact Lens Contact Lens Associated Red Eye Associated Red Eye (CLARE)(CLARE)
Signs:Signs:Redness around theRedness around thelimbuslimbus usually due tousually due toover wear of over wear of CLsCLs ororsolution intolerancesolution intolerance
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Symptoms:Symptoms:
1.1. Mild to moderate Mild to moderate pain especiallypain especiallywhen wearing when wearing CLsCLs
2.2. TearingTearing
3.3. Photophobia Photophobia
RED Conjunctiva and ScleraRED Conjunctiva and ScleraMost Common ConditionsMost Common Conditions
Recurrence of the removal of Recurrence of the removal of the front surface cells of thethe front surface cells of thecornea after previous cornealcornea after previous cornealabrasion (Basically rippingabrasion (Basically rippingoff of the previously off of the previously damaged cells)damaged cells)
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:1.1. Redness upon awakeningRedness upon awakening2.2. Watering and tearing of the eyeWatering and tearing of the eye
Symptoms:Symptoms:1.1. Pain and irritation upon awakening Pain and irritation upon awakening 2.2. Feels like something is in the eyeFeels like something is in the eye3.3. Light sensitiveLight sensitive
Treatment:Treatment:Prophylactic use of lubricating eye gels or ointments at Prophylactic use of lubricating eye gels or ointments at bedtime to minimize future erosionsbedtime to minimize future erosions
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Dry Eye SyndromeDry Eye Syndrome
Chronic lack of Chronic lack of lubrication and lubrication and moisture of the eye moisture of the eye due to many factors due to many factors including low tear including low tear production, poor tear production, poor tear quality and other quality and other eyelid issueseyelid issues
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:
1.1. Mild to severe Mild to severe interpalpebralinterpalpebral rednessredness
2.2. Mild to severeMild to severecorneal stainingcorneal staining
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Symptoms:Symptoms:
1.1. Burning & stingingBurning & stinging2.2. Grittiness & ScratchinessGrittiness & Scratchiness3.3. Foreign Body sensationForeign Body sensation4.4. PhotophobiaPhotophobia5.5. Intermittent blurred visionIntermittent blurred vision6.6. Watering and tearing Watering and tearing
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Treatment:Treatment:
1.1. OTC artificial tearsOTC artificial tears(Refresh (Refresh OptiveOptive, , SystaneSystane Ultra or Balance, Ultra or Balance, Soothe XP)Soothe XP)
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal InfiltrateCorneal InfiltrateSmall hazy greySmall hazy greyareas of areas of inflammationinflammationusually near theusually near thelimbuslimbus
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Signs:Signs:1.1. Redness Redness 2.2. TearingTearingSymptoms:Symptoms:1.1. Foreign body sensationForeign body sensation2.2. Mild to severe irritationMild to severe irritation3.3. Light sensitiveLight sensitiveTreatment:Treatment:1.1. Topical antibioticTopical antibiotic--steroid steroid
dropsdrops
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Chemical /UV DamageChemical /UV DamageDamage of theDamage of thecornea caused bycornea caused bychemical solution orchemical solution orUV exposureUV exposure
Signs:Signs:1.1. RednessRedness2.2. ChemosisChemosis of Conjunctivaof Conjunctiva3.3. Corneal StainingCorneal Staining
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Chemical Solution / UV DamageChemical Solution / UV Damage
Symptoms:Symptoms:1.1. Pain and discomfort Pain and discomfort 2.2. Tearing, burning and stingingTearing, burning and stinging3.3. Foreign body sensationForeign body sensation
Treatment:Treatment:1.1. Artificial tearsArtificial tears2.2. Antibiotic / steroid dropsAntibiotic / steroid drops3.3. Change of CL solutionChange of CL solution4.4. Advise against tanning bed useAdvise against tanning bed use5.5. Sun protection when outsideSun protection when outside
RED EYERED EYE associated with associated with Corneal ProblemCorneal Problem
Corneal TraumaCorneal Trauma
Which of the Which of the RED EYERED EYE conditions conditions of the Cornea are True of the Cornea are True
Emergencies??Emergencies??
Foreign BodyForeign BodyAbrasionAbrasionRecurrent ErosionRecurrent ErosionDry EyeDry EyeCorneal Infiltrate Corneal Infiltrate Chemical or UV damageChemical or UV damageCornea TraumaCornea Trauma
Once the doctor examines the Once the doctor examines the Red Red EyeEye PatientPatient……how do YOU come how do YOU come
back in the picture?back in the picture?
Exam room Exam room assistanceassistancePatient educationPatient educationFollowFollow--up careup care
Can you identify Can you identify THIS THIS Red EYE Red EYE ??
•• Woke up with itWoke up with it•• No painNo pain•• No discomfortNo discomfort•• No blurred visionNo blurred vision
Is that your Final Answer?Is that your Final Answer?