A Primary Care Approach to Treating the Red Eye

Transcription

A Primary Care Approach
to Treating the Red Eye
30th Annual Family Medicine Review
April 12, 2014
Rachel Cook, MD
Scott & White Ophthalmology Resident
We’re all doctors, so why discuss this?
• “Red eye” is a common complaint
• It’s intimidating because I might miss something
serious!
• I feel comfortable with conjunctivitis but am not
familiar with many other ocular diagnoses.
• How do I know when to refer to ophthalmology?
Discussion Topics
• History (How to get a useful ophthalmic history!)
• Anatomy Review
• Exam (What am I looking for?)
• Common causes of “red eye” and what to do!
Taking a Useful Ophthalmic History: 101
• Still the basics: onset, timing, quality, severity,
duration, modifying factors, context
• When taking a history, think: Does this sound
like something that could:
▫ - kill my patient?!?
▫ - blind my patient or cause significant vision loss?
▫ - be merely uncomfortable and/or self-limited?
• Consider systemic context!
• Decreased Vision?
▫ Acute or chronic?
▫ While wearing refractive correction?
• Laterality of complaints?
• History of Trauma?
▫
▫
▫
▫
Blunt or sharp? What object? Vegetable matter?
How severe? Possible ocular laceration?
Possible foreign body?
Chemical injury?
• Contact Lens Wearer?
▫ Still wearing lenses?
▫ Sleep in lenses?
• Itching? Seasonal pattern?
• Recent sick contacts? Recent respiratory illness?
• Discharge? Tearing? Crusting on eyelids?
• Photophobia?
• Foreign body sensation?
• Medications
▫
▫
▫
▫
On oral antihistamines? Diuretics? TCAs?
Require nasal corticosteroids for allergies?
Using topical glaucoma medications?
Using OTC topical vasoconstrictors/ “gets the red
out” drops?
Ocular/Orbital Anatomy Review
Encyclopaedia Iranica. FĀRESĪ,
KAMĀL-AL-DĪN ABU’L-ḤASAN
MOḤAMMAD.
http://www.iranicaonline.org/artic
les/faresi-2
© 2013 American Academy of Ophthalmology
JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318
Elements of a Complete Eye Exam
•
•
•
•
•
•
•
•
Visual acuity (near and distance)
Pupils
Motility/alignment
Visual fields
Tonometry (intraocular pressure)
External exam (orbits, eyelids, lashes)
Anterior segment exam
Posterior segment exam
http://www.opsweb.org/?page=Externaleye
Anterior Segment Exam
• Penlight / Diffuse Beam
▫ Conjunctival injection? How
deep does the redness
appear?
▫ Chemosis? (Edematous, puffy
or ballooning conjunctiva)
▫ Where is the injection? Ciliary
flush (deep purple hue at
limbus) or limbal sparing?
▫ Cornea clear or hazy? Corneal
light reflex sharp or scattered?
http://www.med.uottawa.ca/procedures/slamp/seg_exam.htm
Anterior Segment Exam
• Slit Beam Exam
▫ Scan corneal surface to
look for opacities, changing
angle of beam.
▫ Look between the two
beams at the anterior
chamber – should be black
space with no cloudiness
(cell/flare), hyphema,
hypopyon.
▫ Beams should be fairly far
apart.
http://emedicine.medscape.com/article/1228681-overview#aw2aab6b3
Eyelid Eversion Technique
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19662.htm
Eye Exam Toolkit Essentials
http://www.eyesite4u.net
https://lombartinstrument.com
http:/emedicine.medscape.com/
Proparacaine
or
Tetracaine
http://www.scrubshopper.com
http://www.optometrial.com
Eye Exam Toolkit Essentials
Don’t forget that smartphone
or tablet resources can fill in
the gaps!
Screenshot of my phone – EyeHandbook app
“Red eye” Glossary of Terms
• Blepharitis – inflammation of eyelid margins
• Conjunctivitis – inflammation of conjunctiva
(no matter what the etiology)
• Episcleritis/Scleritis – inflammation of
episclera/sclera (deeper than conjunctiva), often
associated with autoimmune disease
“Red eye” Glossary of Terms
• Corneal abrasion – area of denuded corneal
epithelium due to mechanical injury
• Keratitis – corneal inflammation, often due to
infection
• Corneal ulcer – ulcerative keratitis: epithelial
defect with stromal inflammatory infiltrate and
often thinning, typically infectious
Dry Eye Syndrome
dry
• Symptoms:
▫ Burning, foreign body
sensation, redness of lids
and conjunctiva, dry
sensation, filmy vision that
may improve with blinking
http://en.wikipedia.org/wiki/Naked_eye
• Signs
▫ Conjunctival hyperemia,
decreased tear meniscus,
punctate epithelial erosions
(punctate fluorescein
staining), tearing (epiphora)
normal
Dry Eye Syndrome
http://www.willseye.org/health-library/dry-eye-syndrome
Dry Eye Syndrome
• Tear film – 3 layers
▫ Oil (surface) – Meibomian
and Zeis glands in eyelid
▫ Aqueous (middle) – main
and accessory lacrimal
glands
▫ Mucin (juxtacorneal) –
conjunctival goblet cells
• Deficiency in any layer 
dry eye symptoms
http://www.emedicinehealth.com/dry_eye_syndrome/page17_em.htm
Dry Eye Syndrome
• Aqueous Tear Deficiency / Keratoconjunctivitis Sicca
▫ Sjögren – Primary or Secondary
▫ Non-Sjögren – many causes but consider medications;
elderly, women (low androgen state) at risk
http://www.optometricmanagement.com/articleviewer.aspx?articleid=102506
• Evaporative Dry Eye
▫ Blepharitis / Meibomian
Gland Dysfunction
▫ Environmental
▫ Accutane
▫ Ectropion/Exposure
Dry Eye Syndrome
• Initial Management
▫ Artificial tears – frequent use; if >5x/day consider
recommending preservative free
▫ Avoid aggravating factors – turn fans off, modify
medications
▫ Treat blepharitis – warm compresses, lid hygiene
• If unresponsive  refer
• Severe dry eye can cause corneal decompensation,
increased risk of infection, scarring, perforation!
http://www.improveeyesighthq.com/blepharitis.html
Blepharitis
• Chronic eyelid inflammation,
typically bilateral
• Symptoms:
▫ Burning, eyelid irritation and redness, tearing, foreign
body sensation, gritty sensation, blurry vision
• Signs:
▫ Eyelid margin redness, swelling, scaling, crusting on
lashes
▫ Hordeola (styes) or chalazia
▫ Chronic conjunctivitis  red, irritated-looking eye
Blepharitis
• Seborrheic and Staphylococcal varieties (most
common)
• Seborrheic associated with rosacea and chalazia
• Staphylococcal (typically S. aureus) can be
associated with blepharoconjunctivitis = blepharitis
presentation + conjunctivitis appearance with scant
discharge; also associated with hordeolum (“stye”)
formation
• Different than acute bacterial conjunctivitis!
Blepharitis (Seborrheic)
Chalazion
Blepharitis (Staphylococcal)
External Hordeolum
Chronic Blepharokeratoconjunctivitis
Refer for
corneal
infiltrates or
a cloudy
appearance!
Blepharitis Conservative Management
• warm compresses (several times daily)
• lid hygiene (dilute baby shampoo or OTC preps)
• topical ophthalmic antibiotic ointment (bacitracin,
erythromycin, azithromycin)
Both images: http://patienteducationcenter.org/articles/blepharitis/
Sebaceous Carcinoma
This can
kill your
patient!
Images courtesy of Evan Silverstein, MD and Louise Mawn, MD
http://eyewiki.aao.org/Sebaceous_carcinoma
Refer after 3 months
of conservative
“chalazion” or
“chronic unilateral
blepharitis”
management!
From: Conjunctivitis: A Systematic Review of Diagnosis and Treatment
JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318
Figure Legend:
Suggested Algorithm for Clinical Approach to Suspected Acute Conjunctivitis
Date of download: 3/25/2014
Copyright © 2014 American Medical
Association. All rights reserved.
Allergic / Hay Fever Conjunctivitis
• Associated with seasonal allergy symptoms
• Often in patients with other atopic conditions
• Typically Type I hypersensitivity (IgE mediated)
▫ Mast cell degranulation  histamine / other
inflammatory mediators  conjunctivitis
• Contact lenses and dry eye can exacerbate
symptoms!
• Signs and Symptoms: intense itching, burning
eyelid swelling, chemosis, conjunctival hyperemia,
mucoid or watery discharge, papillary reaction
• Management
▫ Avoidance of allergens
▫ Supportive: cold compresses, artificial tears (try cold!)
▫ Topical antihistamines/mast cell stabilizers (ketotifen,
olopatadine)
Digital Reference of Ophthalmology. http://dro.hs.columbia.edu/
Contact Blepharoconjunctivitis
• Type I Hypersensitivity - Acute Contact
Dermatoblepharitis (immediate)
• Type IV Hypersensitivity (T-cell mediated)
▫ Typically begins 24-72 hours after starting a topical
medication (diagnostic clues in history are critical)
• Clinical appearance and management are the
same as allergic/hay fever conjunctivitis + remove
offending agent!
Contact Blepharoconjunctivitis
• Can also get an acute excematous dermatitis on
eyelid skin (leathery, scaly, erythematous)
• Common culprits for delayed reaction:
▫ Preservatives in OTC and prescription (often
generic) eye drops
▫ Topical aminoglycosides: neomycin, gentamicin,
tobramycin
▫ Topical antivirals (trifluridine) and cycloplegics
(atropine)
Viral Conjunctivitis
• Typically bilateral (or unilateral  quickly bilateral)
• Symptoms:
▫ Diffuse hyperemia, watery/serous discharge, sudden
onset especially following recent contact with others with
“pink eye” or recent respiratory viral illness, mild itching,
foreign body sensation, if severe may have photophobia
• Signs:
▫ Diffuse conjunctival injection, normal vision, normally
reactive pupils, preauricular lymphadenopathy, follicular
reaction, severe cases may develop pseudomembranes
and/or subepithelial corneal infiltrates
 This is not purulent discharge,
it is a pseudomembrane!
http://www.hindawi.com/journals/joph/2010/423672/fig4/
• Common viruses:
▫ Adenovirus – very common, can be very severe
(epidemic keratoconjunctivitis)
 Very contagious! It’s critical to advise hand hygiene,
washing linens, etc. Clean your office thoroughly to
avoid epidemic!
 Typically self-limited, worsens over first 4-7 days,
lasts 2-3 weeks, contagious while eyes are red
▫ Enterovirus & coxsackievirus (acute hemorrhagic
conjunctivitis), molluscum, EBV
• Treatment for typical viral conjunctivitis:
▫ Counseling about careful hygiene while contagious
▫ Frequent (every 2-4 hours) preservative-free
artificial tears
▫ Cool compresses
▫ Topical antibiotics discouraged unless you notice
corneal involvement
▫ If corneal involvement or vision decreases  refer!
• Common viruses:
▫ Herpes Simplex Virus
 Primary ocular – HSV blepharoconjunctivitis can
present with typical viral conjunctivitis picture with
vesicles on skin or eyelids, can be bilateral, can have
epithelial dendritic keratitis
 Recurrent HSV – typically unilateral, presentation more
often involves dendritic and stromal keratitis and iritis
HSV Epithelial (Dendritic) Keratitis
Digital Reference of Ophthalmology. http://dro.hs.columbia.edu/
• Common viruses:
▫ Herpes Simplex Virus
 Treatment is supportive + referral.
 Course is self-limited but you may initiate oral
antivirals (can shorten duration of symptoms)
 Treat for 10 days with one antiviral: Acyclovir
400mg 5x/day, famciclovir 250mg TID, valacyclovir
1000mg BID
• Common viruses:
▫ Varicella Zoster Virus
• Common viruses:
 Virus reactivates in 20% of infected individuals
 15% of all reactivations occur in CN V1 distribution
(Herpes zoster ophthalmicus)
 Of those, 70% have ocular involvement
 Hutchinson’s sign (nasociliary branch of CN V1)
 Vesicular eruption on face, scalp eyelids + typical
viral conjunctivitis features + pseudodendrite lesions
on cornea (look very similar to HSV dendrites)
• Common viruses:
 Treatment with oral antivirals within 72 hours reduces
viral shedding, decreases incidence and severity of
ocular complications and reduces risk of post-herpetic
neuralgia
 Treat for 7-10 days with one antiviral: Acyclovir
800mg 5x/day, famciclovir 500mg TID, valacyclovir
1000mg TID (essentially double the dose for HSV)
 Refer to ophthalmology!
Acute Bacterial Conjunctivitis
• Typically unilateral (can become bilateral)
• Far less common than viral conjunctivitis in adults
• Acute = <4 weeks duration
• Symptoms:
▫ Diffuse hyperemia, sticky white, green, or yellow
discharge, eyelids/lashes stuck together on
awakening, mild eye pain and foreign body sensation,
intermittent blurry vision
• Signs:
▫ Diffuse conjunctival injection, normal vision, normally
reactive pupils, mucopurulent discharge, eyelid
edema, papillary reaction
http://www.optometry.co.uk/clinical/details?aid=718
• Common pathogens: S.aureus, S. pneumoniae,
H. influenzae, Moraxella
• Gonococcal Conjunctivitis (Hyperacute)
▫ If hyperacute onset (12-24 hrs) and severe
mucopurulent discharge  consider Gonococcal
conjunctivitis
▫ GC is often more painful, with more chemosis, can
have decreased vision
▫ GC can invade and perforate the cornea very
quickly!  need immediate referral to
ophthalmology if GC conjunctivitis is suspected!
▫ Culture the discharge! If positive, will require
systemic antibiotic treatment & chlamydia coverage.
• Gonococcal Conjunctivitis (Hyperacute)
• Treatment of Non-Gonococcal Conjunctivitis
▫ Most uncomplicated acute bacterial conjunctivitis is
self-limited (most improve by 1 week)
▫ Supportive Measures: eye irrigation, artificial tears; NO
patching!
▫ Many options for empiric treatment, prefer drops vs
ointments
▫ Suggested Antibiotics: 4-6x daily for 5-7 days
 Polymixin B/ trimethoprim – topical hypersensitivity
uncommon, great coverage (even H. influenzae), cheap!
 Fluoroquinolones: Ciprofloxaxin, Ofloxacin, Moxifloxacin –
excellent coverage, well tolerated, more expensive
• Treatment of Non-Gonococcal Conjunctivitis
▫ Consider immediate vs delayed antibiotics
 Quicker recovery vs increasing resistance
 Regardless of strategy, need follow-up in 2-3 days
 If not improving by day 4 of symptoms, start antibiotics
▫ These patients need immediate coverage:




Healthcare workers
Immunocompromised, hospitalized
Contact lens wearers
Unlikely to follow up or unreliable
▫ May consider delayed coverage in low-risk patients with
expected reliable follow-up
General Tips: Treating Conjunctivitis
• If patient is a contact lens wearer  no use of contact lenses
▫ Trap allergens to ocular surface if allergic conjunctivitis
▫ Increase risk of keratitis /corneal ulcers in microbial conjunctivitis
which may be CL-related…discontinue use for at least 2 weeks
• Follow-up for bacterial conjunctivitis should be frequent until
patient is definitely improving
• Immediate referral for: HSV or VZV conjunctivitis, suspected
Gonococcal or hyperpurulent conjunctivitis, severely
immunocompromised patients, neonates, any corneal
involvement
• If patient is not improving in expected amount of time with
appropriate therapy  refer!
Subconjunctival Hemorrhage
• Symptoms/History:
▫ Red eye, otherwise usually asymptomatic, normal vision
▫ Ask about history of minor trauma, Valsalva or straining,
uncontrolled HTN, antiplatelet or anticoagulant use
• Signs:
▫ Frank blood under the
conjunctiva, often sectoral,
occasional elevation of
the conjunctiva
Subconjunctival Hemorrhage
• Like a bruise, will resolve in 2-3 weeks
• If on anticoagulants, check INR
• If recurrent un-provoked hemorrhages, workup
for bleeding disorder
• If no view of the sclera,
decrease in vision,
or history of significant
trauma, refer to
ophthalmology
immediately!
Corneal Abrasion
• History
▫ Mechanism of Injury? Vegetable matter? Fingernail?
▫ Contact lens wearer?
Corneal Abrasion
• Symptoms:
▫ Sharp pain, foreign body sensation, discomfort with
blinking, photophobia, tearing, history of minor trauma
• Signs:
▫ Epithelial defect that stains with fluorescein, clear
underlying corneal stroma, conjunctival injection, mild
eyelid edema
• Exam:
▫
▫
▫
▫
Topical anesthetic helpful for exam (do not prescribe!)
Must examine with fluorescein
Evert eyelids to look for foreign body
Note size of abrasion & location (central vs peripheral)
Corneal Abrasion
• Treatment:
▫ Topical antibiotic
 Ointments provide more lubrication (erythromycin,
bacitracin, polymixin B/bacitracin), use q2-4 hours
 Drops are associated with less blurry vision
(trimethoprim/polymixin B), use QID
▫ If contact lens wearer:
 no CL use until 1 week after eye feels comfortable
 Must cover for Pseudomonas with a topical fluoroquinolone
at least QID
▫ If fingernail or vegetable matter caused abrasion:
 Cover with a fluoroquinolone at least QID
Corneal Abrasion
• Treatment:
▫ Follow up in 2-3 days to ensure abrasion is healed,
consider sooner if the abrasion is large or central
▫ If contact lens wearer, continue antibiotic for 2 days
after epithelial defect is healed
▫ Patching is not recommended!
▫ If abrasion is not healed in 3 days, refer!
▫ Counsel patient about protective eyewear!
Corneal Foreign Body
• Symptoms: same as for corneal abrasion
• Signs: visible foreign body on corneal surface,
no distortion of pupil, no
vision loss, no visible FB
in the anterior chamber,
no hyphema
• History: determine type of
FB, velocity of injury,
contact lens use?
• Exam:
▫ Must check vision!
▫ Complete anterior segment exam
▫ Ensure no pupillary distortion or hyphema – could
indicate penetrating, intraocular foreign body
▫ Give topical anesthetic
▫ Use fluorescein to help visualize
▫ If no penetrating injury, and not a high-velocity
injury, can attempt to remove FB
▫ Evert eyelids to inspect for trapped FB
• Methods of Removal
▫ Saline irrigation
▫ Under magnified visualization (loupes), gently roll FB
off of corneal surface with anesthetic-moistened cotton
tip applicator (Don’t push it in!)
▫ Corneal foreign body spud is an excellent tool!
▫ If you are comfortable and patient reliable, with
magnification, attempt to use small-gauge (20-25G)
short needle on a syringe with bevel away from cornea
to dislodge FB
• Any residual rust ring from metallic FB needs
removal  refer
• Antibiotic coverage following corneal abrasion
guidelines, prefer ointment, need more coverage
than erythromycin
• If any corneal infiltrate / clouding  refer
• Follow-up in 2 days to ensure no signs of infection
• Counsel regarding protective eyewear!
Corneal Ulcer / Keratitis  Refer!
• Symptoms/History
▫ Red eye, pain, decreased
vision, photophobia,
discharge
▫ Poor contact lens hygiene
High risk of permanent vision loss,
perforation, loss of the eye!
If you see anything like this, refer to
ophthalmology immediately!!
Episcleritis
• Symptoms/History:
▫ Red eye, mild if any pain, often history of
recurrent episodes, often young patients, no
discharge
• Signs:
▫ Sectoral, occasionally diffuse hyperemia, deeper
than conjunctiva, engorged radially oriented
episcleral vessels, normal vision
▫ If nodular redness, can move the area with
anesthetic moistened cotton tip applicator
(anesthetize patient too!)
Episcleritis
• Etiology: typically idiopathic,
may be associated with VZV
(by history), recurrent may be associated with
gout, collagen vascular disease, rosacea
• Treatment:
▫ Condition is self-limited (days to weeks)
▫ Supportive treatment with artificial tears and oral
NSAIDs if patient has discomfort
▫ Refer to ophthalmology if recurrent episodes
Conjunctivitis vs Episcleritis vs Scleritis
All images: © 2013 American Academy of Ophthalmology
Scleritis  Refer!
• Symptoms:
▫ Severe “boring” eye pain, red eye, decreased vision,
often recurrent episodes
• Signs:
▫ Injection of blood vessels at all levels (conjunctival,
episcleral, scleral) with characteristic “violaceous hue”,
ciliary flush, globe very tender to palpation, may have
scleral thinning, if infectious, may have infiltrate, unable
to move inflammed scleral vessels with cotton tip
• Etiology: 50% associated with systemic disease (RA,
Wegener, SLE, reactive arthritis, relapsing
polychondritis, PAN, IBD, syphillis, gout), also
infectious causes (TB, Pseudomonas, Lyme, etc.)
Iritis / Iridocyclitis  Refer
• Symptoms:
▫ Blurred vision, mild to moderate pain with brow/retro-orbital
ache, direct and consensual photophobia, tearing, red eye
• Signs:
▫ Ciliary flush, anterior chamber cell and flare, no discharge,
variable decreased vision
• Etiology:
▫ Autoimmune (HLA-B27, Behçet’s + see scleritis list of
causes)
▫ Infectious: TB, syphillis, Lyme, HSV, VZV
▫ Idiopathic, sarcoid
• Do a great ROS! (rashes, sexual hx, arthritis patterns,
ulcers, travel, etc.)
Iritis / Anterior Uveitis  Refer
http://www.medscape.com/viewarticle/540129_2
http://drsobol.com/Default.aspx?blogcategory=Cases
http://www.cyberounds.com/cmecontent/art281.html?pf=yes
Chemical Injury
• Your management could be sight or eye-saving!
• Signs:
▫ minimal to complete epithelial defect, chemosis,
hyperemia, conjunctival/episcleral blanching (severe),
corneal edema/opacification, moderate to severe
anterior chamber cell/flare, increased intraocular
pressure, burns on eyelids/surrounding skin
• Alkali burns are worse than acidic burns
• Ask if patient has a label from the chemical product
Chemical Injury
• Management (Contraindication = ruptured globe)
▫ Emergent irrigation (always neutral fluid like saline,
sterile water, or LR) for at least 30 minutes
▫ Evert eyelids and irrigate, may need to swab conjunctival
fornices
▫ Check pH with litmus paper (target is 7.0 to 7.4), any
higher, continue irrigation
▫ May require up to 10 liters of irrigation!
▫ Once pH neutralized, apply antibiotic ointment
(erythromycin) and prescribe q1-2 hours
▫ Oral pain medication
▫ Urgent ophthalmology referral, need daily monitoring
Chemical Injury
https://www.proceduresconsult.jp/Home/ProcedureListing/ProcedureDetails/tabid
/74/c/379/language/en-US/Default.aspx
http://www.morganlens.com/
Preseptal and Orbital Cellulitis
• Presentation of both: tender,
erythematous, edematous,
warm periorbital tissues
• Orbital cellulitis: concern
when there is marked
conjunctival injection with
chemosis, pain with eye
movement, restricted motility,
diplopia, blurred vision,
proptosis, fever
• Clinical diagnosis, but may
CT if uncertain
http://emedicine.medscape.com/article/1217858-overview
Preseptal and Orbital Cellulitis
• Treatment
▫ Preseptal cellulitis: mild, afebrile
 10 days oral antibiotics (amoxicillin/clavulanate,
trimethoprim/sulfamethoxazole, doxycycline, clindamycin)
 Daily follow-up until consistent improvement seen, then
every 2-4 days until resolved
▫ Preseptal cellulitis: more severe, toxic-appearing,
resistant to therapy, or less than 5 yrs of age
 Hospitalize for IV antibiotics (Vancomycin + Gm- coverage)
 Daily follow-up, involve ophthalmology
▫ Orbital cellulitis: same as severe preseptal
Acute Angle Closure Glaucoma
• Symptoms:
▫ Typically sudden onset, unilateral severe aching or throbbing
pain, blurred vision, photophobia, halos around lights,
nausea/vomiting
• Signs:
▫ Fixed, mid-dilated pupil, diffuse injection, diffusely
hazy/“steamy” cornea, flat or shallow anterior chamber, very
high IOP (eye feels hard)
• Treatment: Emergent ophthalmology referral (call the
provider and discuss treatment measures you can initiate
while the patient is on their way)
• Know the patient’s visual acuity, helpful if you can check a
pressure
Acute Angle Closure Glaucoma
This can blind or seriously
impair vision in your patient!
http://shop.onjoph.com/catalog/popup_image.php?pID=3791
From: Conjunctivitis: A Systematic Review of Diagnosis and Treatment
JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318
Figure Legend:
Selected Nonconjunctivitis Causes of Red Eyea
Date of download: 3/27/2014
Copyright © 2014 American Medical
Association. All rights reserved.
References
CONTENT SOURCES
•
American Academy of Ophthalmology. Basic and Clinical
Science Course: External Disease and Cornea. Section 8. San
Francisco: AAO; 2013.
•
Science Course: Fundamentals and Principles of
Ophthalmology. Section 2. San Francisco: AAO; 2012.
•
Science Course: Orbit, Eyelids, and Lacrimal System. Section 7.
San Francisco: AAO; 2012.
•
American Academy of Ophthalmology. Preferred Practice
Patterns. Blepharitis. http://one.aao.org/preferred-practicepattern/blepharitis-ppp--2013. Accessed March 29, 2014.
•
Patterns. Conjunctivitis. http://one.aao.org/preferred-practicepattern/conjunctivitis-ppp--2013. Accessed March 29, 2014.
•
Patterns. Dry Eye Syndrome. http://one.aao.org/preferredpractice-pattern/dry-eye-syndrome-ppp--2013. Accessed March
29, 2014
•
Azari AA, Barney NP. Conjunctivitis: A Systematic Review of
Diagnosis and Treatment. JAMA. 2013;310(16):1721-1730.
•
Cronau H, Kankanala RR, Mauger T. Diagnosis and
management of red eye in primary care. Am Fam
Physician. 2010 Jan 15;81(2):137-44.
•
Gerstenblith AT and Rabinowitz MP (Eds.). (2012). The Wills
Eye Manual: Office and Emergency Room Diagnosis and
Treatment of Eye Disease. Sixth ed. Philadelphia, PA: Lippincott
Williams & Wilkins.
•
Leibowitz HM. The Red Eye. N Engl J Med. 2000; 343:345-351
MULTIPLE IMAGE SOURCES
•
American Academy of Ophthalmology ONE Image Collection
http://one.aao.org/browse-multimedia?filter=image
•
EyeRounds: Online Atlas of Ophthalmology – University of
Iowa http://webeye.ophth.uiowa.edu/eyeforum/atlas/index.htm
•
Digital Reference of Ophthalmology. http://dro.hs.columbia.edu
•
Wills Eye Hospital Health Library. “Dry Eye Syndrome”
http://www.willseye.org/health-library/dry-eye-syndrome
SOURCES AS CITED WITH IMAGES
•
Encyclopaedia Iranica. FĀRESĪ, KAMĀL-AL-DĪN ABU’L-ḤASAN
MOḤAMMAD. http://www.iranicaonline.org/articles/faresi-2
•
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A Primary Care Approach to Treating the Red Eye

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