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Tim Fetherston, Ophthalmologist
Topic: Assessment of the Red Eye
The session focused on the assessment of "red eyes", potentially through remote consultations. Tim Fetherston discussed the significance of gathering an accurate patient history and recognizing eye problems, even when a clinical presentation might not be typical.
Key Points:
Patient Consultation:
- Patients generally present with symptoms/signs rather than a diagnosis.
- Vital questions include discerning if the condition is acute or chronic, if the patient is a contact lens wearer, the type of discomfort felt, and if there's any history of allergies. It's essential to identify if the vision is affected and if there's any family history.
Remote Consultation Tool: The use of a 'selfie' photo can be invaluable for remote consultations to provide a clearer picture of the issue.
Main 'Red Eye' Conditions Covered:
- Conjunctivitis
- Iritis (Uveitis)
- Corneal issues (abrasion, trauma, ulcer, etc.)
- Acute (angle closure) Glaucoma
Recognizing Types of Conjunctivitis:
- Bacterial Conjunctivitis: Sticky, purulent discharge. Might be caused by Gonococcus, especially in severe cases or in neonates. Other possible organisms include Chlamydia.
- Viral Conjunctivitis: Usually associated with the Adenovirus and is often bilateral. It’s highly contagious, and eyelid swelling is typical.
- Allergic Conjunctivitis
Trauma or Foreign Bodies (FB):
- Traumas can have numerous causes ranging from assault to accidents with power tools. Notably, metal FBs can leave rust rings.
- Chemical exposures and traditional medicines can also play a role.
Pattern of Redness:
- The distribution of redness is crucial in diagnosis. For instance, Conjunctivitis involves the entire ocular surface, while conditions like Iritis and Glaucoma might only cause redness in particular areas.
- It's essential to discern if the redness is most intense around the corneal edge.
Red Eye Conditions:
- Iritis/Uveitis: Causes photophobia, pain, and potential loss of vision.
- Acute Glaucoma: A rare condition with a 'rock-hard' eye and hazy cornea. Symptoms might include severe pain, headache, and possible vomiting.
- Corneal Lesions: Typically, they cause redness around the cornea and some vision impairment.
Conclusion:
For a proper assessment of the red eye, one should ask the right questions, ensuring the consistency of history with findings. Knowing the symptoms, recognizing any discharge, identifying the pattern of redness, checking the vision, and assessing the pupil's state are essential steps. Depending on these assessments, the patient can then be treated or referred for specialized care.