Toasummit.com



Unmasking the Mystery behind the Red Eye Patient – A Potpourri of Clinical CasesBeginner/Intermediate 2-hour CPOFebruary 1st?Speaker: Pat Segu, OD FAAO ABOClinical ProfessorDescription: The course will provide in depth assessment of the red eye patient including case history, patient work –up, differential diagnosis and clinical assessment.? The lecture will review key clinical features to help differentiate the red eye patient. ?Often times, red eye patients are challenging?but with a thorough case history and clinical knowledge of the signs and symptoms, the underlying etiology can be determined. ??Clinical pearls of managing red eye patients are key to appropriate treatment and quicker resolution.?? Course Objective:Understand the important steps of red eye evaluationRecognize the underlying etiology based on clinical presentationDevelop a stronger clinical knowledge of the signs and symptoms of red eyesRed Eye Evaluation (50 Minutes)IntroductionTypes of red eyesBacterial, Viral, AllergicInflammatoryTraumaCase HistoryQuestions to askLocationDischargeLateralityLengthPrevious EpisodeRecent Contact with red eyeHome remediesHx of TraumaUnderlying systemic conditions, medications (topical and oral)Pre-testingVAReduced VA associated with conditions that damage the cornea, inflammation, increase in IOPPA NodesPupilsLancet SignMid-dilated pupil associated with acute angle closure and/or inflammationEOMSPain on eye movement-inflammationRestriction – mass, muscle entrapment, inflammation IOPEvaluate the eye firstElevated IOP – angle closure steroid responder, uveitisBiomicroscopyEvaluation of the lids preseptal vs. orbital cellulitis, hordeolum, chalazion, blepharitisFollicles vs. papillary reactionConjunctiva – injection patternSectoral – episcleritis, inflamed pinguecula, pterygium, FB, ulcerDiffuse – bacterial, viral and/or allergic conjunctivitisPerilimbal – uveitisCorneaStaining Pattern – diffuse vs. sectoralSeidel’s signClinical Cases ( 50 minutes)Case 1HistoryWoke up with red eye (OD) this morning(-) Pain, Mucous (+) IrritationUsed Visine – did not help at all POH: UnremarkableSH: Construction workerDx: Subconjunctival Hemorrhage OD Tx:PFAT qid-prn (refrigerate for increased comfort)D/C VisinePlan:Educate pt on self-resolving nature of condition Further work-up if recurrent hemes for blood conditions, leukemia Case 2HistoryRedness with itch/irritationInitially OS, now OUFB sensation OU x 5 daysSerous discharge No relieving factors attemptedPOH: UnremarkablePMH: Mild cold and cough for the past week – did not go to doctorClinical Presentation:(+) PAN OS>ODSLE:(+) Grade 2+ bulbar and palpebral injection (OS > OD)(+) Diffuse SEI (OS > OD) w/SPK (+) Grade 1 inferior palpebral follicles OU Dx: Epidemic Keratoconjunctivitis (EKC) OU (OS > OD)Tx:PFAT qid-prn (refrigerate for increased comfort) and cold compressesRigorous hygieneConsider topical steroid for SEI (FML tid w/taper) Plan:Thoroughly educate on highly contagious, viral nature – no sharing pillows/towels, stay home RTC 1 week for F/U Consider chlamydia if taking >4 mo to resolveCase 331 yo HFHistoryRed eye noticed this morning (OD)Similar episode 1 mo ago Mild pain(-) Discharge(-) Relieving factors PMH: Systemic Lupus ErythematosusDx: Sectoral Episcleritis OD Tx:Mild - PFAT qid-prnModerate – FML qid, oral NSAIDS, Ibuprofen 200-600mg po tid Plan:Educate pt on recurrent nature of condition – underlying collagen vascular dz needs to be addressed Case 441 yo HMHistory:Changing car battery and got battery acid in eye (OD)Dx: Acidic Chemical Burn OD Tx:Copious irrigation STAT for at least 30 minutes Check fornices Frequent PFAT Place paper cup shield over eye Plan: Significant chemical burn to refer to cornea specialistCase 572yo CMHistoryPainful, blurred vision OD Describes colored halos around lightsFrontal HA x 2 hrs Nausea x 1 hrClinical PresentationSLE:Fixed, mid-dilated pupil “Steamy” cornea Limbal hyperemia Dx: Acute Angle Closure ODTx:Topical ?-blocker (Timolol)Topical α-adrenergic agonist (Brimonidine 2%)Oral CAI (Diamox 500mg – NOT sequels)Pilocarpine 1-2% Consider oral hyperosmotic agentPlan:Schedule LPI RTC for glaucoma F/U (baseline testing) and educate risk to fellow eyeCase 7History 59 yo CF“My eyes look old and I can’t wear make-up, even the expensive stuff!”POH: Rxed AT in the past with little successPMH: Unremarkable and no medsClinical Presentation: SLE: (-) MGD(+) Low tear prismDx: Aqueous Deficient Dry Eye OU Tx:PFAT throughout the day Restasis 1 gtt bid OU with a concurrent loading steroid dose (FML 1 gtt bid x 3 weeks OU)Xiidra 1 gtt bid OU Plan:Educate pt on chronic nature of OSD Caution that clinical effects can take as long as 6-8 weeks for Restasis and 2-3 weeks for Xiidra Case 8History27 yo AMCL wearer presenting for occasional redness and irritationAvg WT: 18hrs; WT today: 6hrs lenses with generic brand solution replacing lenses every 1-2 months(+) ItchDx: Giant Papillary Conjunctivitis (GPC)Tx:D/C CL wear – refit into dailies at a future date Topical steroid (FML qid OU)Topical mast cell stabilizer/anti-histamine Plan:Educate pt on potential for continued CL intolerance without proper wear/care schedule Case 9History 24 yo CF Red, painful OS x 3 days with tearing and decreased visionPOH: UnremarkablePMH: Hx of cold soresDx: Herpes Simplex Keratitis Tx:Ganciclovir gel 0.15% (Zirgan) 5xday until re-epithelialization, then tid x 3 daysVanciclovir (Viroptic) 9xday, but increased toxicity Plan:Educate pt on recurrent nature Case 10History 20 yo CM(+) yellowish-green dischargeStarted in OD and spread to the OS within 3 daysNo relieving factors attemptedPOH: Similar episode 1 year agoPMH: Asthma and Crohns diseaseClinical PresentationSLE: (+) Diffuse Injection of Conj, (+) 2+ papillary response, (-) SEIDx: Bacterial conjunctivitis Tx: Topical Antibiotic Drop – Polytrim, PFAT PRN, HygienePlan:Educate pt on contagious nature of the condition and self-limiting ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download