Red eye resident survival guide (pediatrics): Difference between revisions

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==FIRE: Focused Initial Rapid Evaluation==
==FIRE: Focused Initial Rapid Evaluation==
Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.<ref name="SinghGalvis2018">{{cite journal|last1=Singh|first1=Gagandeep|last2=Galvis|first2=Alvaro|last3=Das|first3=Samrat|title=Case 1: Eye Discharge in a 10-day-old Neonate Born by Cesarean Delivery|journal=Pediatrics in Review|volume=39|issue=4|year=2018|pages=210–210|issn=0191-9601|doi=10.1542/pir.2016-0090}}</ref><ref name="AzariBarney2013">{{cite journal|last1=Azari|first1=Amir A.|last2=Barney|first2=Neal P.|title=Conjunctivitis|journal=JAMA|volume=310|issue=16|year=2013|pages=1721|issn=0098-7484|doi=10.1001/jama.2013.280318}}</ref><ref name="BieloryO’Brien2012">{{cite journal|last1=Bielory|first1=Brett P.|last2=O’Brien|first2=Terrence P.|last3=Bielory|first3=Leonard|title=Management of seasonal allergic conjunctivitis: guide to therapy|journal=Acta Ophthalmologica|volume=90|issue=5|year=2012|pages=399–407|issn=1755375X|doi=10.1111/j.1755-3768.2011.02272.x}}</ref><ref name="CheungChee2012">{{cite journal|last1=Cheung|first1=Chui Ming Gemmy|last2=Chee|first2=Soon-Phaik|title=Posterior Scleritis in Children: Clinical Features and Treatment|journal=Ophthalmology|volume=119|issue=1|year=2012|pages=59–65|issn=01616420|doi=10.1016/j.ophtha.2011.09.030}}</ref>
Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.<ref name="SinghGalvis2018">{{cite journal|last1=Singh|first1=Gagandeep|last2=Galvis|first2=Alvaro|last3=Das|first3=Samrat|title=Case 1: Eye Discharge in a 10-day-old Neonate Born by Cesarean Delivery|journal=Pediatrics in Review|volume=39|issue=4|year=2018|pages=210–210|issn=0191-9601|doi=10.1542/pir.2016-0090}}</ref><ref name="AzariBarney2013">{{cite journal|last1=Azari|first1=Amir A.|last2=Barney|first2=Neal P.|title=Conjunctivitis|journal=JAMA|volume=310|issue=16|year=2013|pages=1721|issn=0098-7484|doi=10.1001/jama.2013.280318}}</ref><ref name="BieloryO’Brien2012">{{cite journal|last1=Bielory|first1=Brett P.|last2=O’Brien|first2=Terrence P.|last3=Bielory|first3=Leonard|title=Management of seasonal allergic conjunctivitis: guide to therapy|journal=Acta Ophthalmologica|volume=90|issue=5|year=2012|pages=399–407|issn=1755375X|doi=10.1111/j.1755-3768.2011.02272.x}}</ref><ref name="CheungChee2012">{{cite journal|last1=Cheung|first1=Chui Ming Gemmy|last2=Chee|first2=Soon-Phaik|title=Posterior Scleritis in Children: Clinical Features and Treatment|journal=Ophthalmology|volume=119|issue=1|year=2012|pages=59–65|issn=01616420|doi=10.1016/j.ophtha.2011.09.030}}</ref><ref name="GuptaDhawan2010">{{cite journal|last1=Gupta|first1=Noopur|last2=Dhawan|first2=Anuradha|last3=Beri|first3=Sarita|last4=D'souza|first4=Pamela|title=Clinical spectrum of pediatric blepharokeratoconjunctivitis|journal=Journal of American Association for Pediatric Ophthalmology and Strabismus|volume=14|issue=6|year=2010|pages=527–529|issn=10918531|doi=10.1016/j.jaapos.2010.09.013}}</ref>


==Complete Diagnostic Approach==
==Complete Diagnostic Approach==

Revision as of 09:20, 7 August 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]

Red eye resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Red eye is defined as a symptom of red eye as the major clinical finding. A detailed history, baseline ophthalmological tests, and accompanying manifestations can narrow down the differential diagnosis. The duration and laterality of symptoms (uni- vs. bilateral) and the intensity of pain[1] are the main criteria allowing the differentiation of non-critical changes that can be cared for by a general practitioner from diseases calling for elective referral to an ophthalmologist and eye emergencies requiring urgent ophthalmic surgery.[2][3]

Red eye is one of the most common ophthalmologic conditions in the primary care setting. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye. Primary care physicians often effectively manage red eye, although knowing when to refer patients to an ophthalmologist is crucial.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.[4]

Common Causes[5][6][7][8][9]

infectious[10]

noninfectious

FIRE: Focused Initial Rapid Evaluation

Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.[11][12][13][14][15]

Complete Diagnostic Approach

localised, diffused and perikeratic injection. [16]

Shown below is an algorithm summarizing the diagnosis of [[red eye]] according the the [ Nelson Essentials of Pediatrics .] guidelines. [17]

Age Group Common Etiology
Neonates* < 24 hrs Chemical conjunctivitis
< 1 week Neisseria gonorrhea
1-2 wks Chlamydia trachomatis
Infants and Toddlers Without otitis Haemolphilus. influenzae, Streptococcus pneumoniae
With otitis H. influenzae
School Age Children 1-5 years Herpes simplex virusVaricella-zoster
School Age Children and Adolescents Viral conjunctivitisAllergic conjunctivtis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[Red eye ]] according the the [American family physician ] guidelines.

Good hygiene, such as meticulous hand washing, is important in decreasing the spread of acute viral conjunctivitis.[18][19]

Any ophthalmic antibiotic may be considered for the treatment of acute bacterial conjunctivitis because they have similar cure rates.[20] [21]

Mild allergic conjunctivitis may be treated with an over-the-counter antihistamine/vasoconstrictor agent, or with a more effective second-generation topical histamine H1 receptor antagonist.[22]

[23]Anti-inflammatory agents (e.g., topical cyclosporine [Restasis]), topical corticosteroids, and systemic omega-3 fatty acids are appropriate therapies for moderate dry eye.

Patients with chronic blepharitis who do not respond adequately to eyelid hygiene and topical antibiotics may benefit from an oral tetracycline or doxycycline.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's[24]

    • Your most important task is to detect potentially serious ocular presentations for immediate referral of the patient to an ophthalmologist and treatment. Conditions requiring referral to an ophthalmologist are orbital cellulitis, hyphaema, scleritis, iritis or uveitis, acute angle closure glaucoma, and corneal abrasions (unless very superficial).
    • Use caution when prescribing steroids: you should exclude the possibility of herpetic keratitis.
    • Ocular pain[25] and change in vision are two extremely specific warning signs of eye pathology, and unless you are absolutely certain of a benign diagnosis you must refer him for ophthalmological assessment if he has these.

Don'ts

  • The content in this section is in bullet points.


References

  1. ↑ Aguilera, Zenia P.; Chen, Pauline L. (2016). "Eye Pain in Children". Pediatrics in Review. 37 (10): 418–425. doi:10.1542/pir.2015-0096. ISSN 0191-9601.
  2. ↑ Frings A, Geerling G, Schargus M (2017) Red Eye: A Guide for Non-specialists. Dtsch Arztebl Int 114 (17):302-312. DOI:10.3238/arztebl.2017.0302 PMID: 28530180 : 28530180
  3. ↑ Cronau H, Kankanala RR, Mauger T (2010) Diagnosis and management of red eye in primary care. Am Fam Physician 81 (2):137-44. PMID: 20082509 PMID: 20082509
  4. ↑ Wirbelauer C (2006). "Management of the red eye for the primary care physician". Am J Med. 119 (4): 302–6. doi:10.1016/j.amjmed.2005.07.065. PMID 16564769 PMID: 16564769 Check |pmid= value (help).
  5. ↑ Frings A, Geerling G, Schargus M (2017) Red Eye: A Guide for Non-specialists. Dtsch Arztebl Int 114 (17):302-312. DOI:10.3238/arztebl.2017.0302 PMID: 28530180 : 28530180
  6. ↑ Pflipsen M, Massaquoi M, Wolf S (2016) Evaluation of the Painful Eye. Am Fam Physician 93 (12):991-8. PMID: 27304768 PMID: 27304768
  7. ↑ Wong MM, Anninger W (2014) The pediatric red eye. Pediatr Clin North Am 61 (3):591-606. DOI:10.1016/j.pcl.2014.03.011 PMID: 24852155 PMID: 24852155
  8. ↑ Wirbelauer C (2006) Management of the red eye for the primary care physician. Am J Med 119 (4):302-6. DOI:10.1016/j.amjmed.2005.07.065 PMID: 16564769 PMID: 16564769
  9. ↑ Ismail, M.; Adel, A. (2020). "Prediction of α -decay chains and cluster radioactivity of 121300–304 and 122302–306 isotopes using the double-folding potential". Physical Review C. 101 (2). doi:10.1103/PhysRevC.101.024607. ISSN 2469-9985. line feed character in |title= at position 15 (help)
  10. ↑ Høvding, Gunnar (2008). "Acute bacterial conjunctivitis". Acta Ophthalmologica. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. ISSN 1755-375X.
  11. ↑ Singh, Gagandeep; Galvis, Alvaro; Das, Samrat (2018). "Case 1: Eye Discharge in a 10-day-old Neonate Born by Cesarean Delivery". Pediatrics in Review. 39 (4): 210–210. doi:10.1542/pir.2016-0090. ISSN 0191-9601.
  12. ↑ Azari, Amir A.; Barney, Neal P. (2013). "Conjunctivitis". JAMA. 310 (16): 1721. doi:10.1001/jama.2013.280318. ISSN 0098-7484.
  13. ↑ Bielory, Brett P.; O’Brien, Terrence P.; Bielory, Leonard (2012). "Management of seasonal allergic conjunctivitis: guide to therapy". Acta Ophthalmologica. 90 (5): 399–407. doi:10.1111/j.1755-3768.2011.02272.x. ISSN 1755-375X.
  14. ↑ Cheung, Chui Ming Gemmy; Chee, Soon-Phaik (2012). "Posterior Scleritis in Children: Clinical Features and Treatment". Ophthalmology. 119 (1): 59–65. doi:10.1016/j.ophtha.2011.09.030. ISSN 0161-6420.
  15. ↑ Gupta, Noopur; Dhawan, Anuradha; Beri, Sarita; D'souza, Pamela (2010). "Clinical spectrum of pediatric blepharokeratoconjunctivitis". Journal of American Association for Pediatric Ophthalmology and Strabismus. 14 (6): 527–529. doi:10.1016/j.jaapos.2010.09.013. ISSN 1091-8531.
  16. ↑ Sauer A, Speeg-Schatz C, Bourcier T (2008). "[Red eye in children]". Rev Prat. 58 (4): 353–7. PMID 18506971 PMID: 18506971 Check |pmid= value (help).
  17. ↑ Teoh DL, Reynolds S (2003) Diagnosis and management of pediatric conjunctivitis. Pediatr Emerg Care 19 (1):48-55. DOI:10.1097/00006565-200302000-00014 PMID: 12592117 PMID: 12592117
  18. ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823 PMID: 17970823 Check |pmid= value (help).
  19. ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425 PMID: 10922425 Check |pmid= value (help).
  20. ↑ "Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis--a review of four clinical studies. The Trimethoprim-Polymyxin B Sulphate Ophthalmic Ointment Study Group". J Antimicrob Chemother. 23 (2): 261–6. 1989. doi:10.1093/jac/23.2.261. PMID 2540136 PMID: 2540136 Check |pmid= value (help).
  21. ↑ Protzko E, Bowman L, Abelson M, Shapiro A, AzaSite Clinical Study Group (2007). "Phase 3 safety comparisons for 1.0% azithromycin in polymeric mucoadhesive eye drops versus 0.3% tobramycin eye drops for bacterial conjunctivitis". Invest Ophthalmol Vis Sci. 48 (8): 3425–9. doi:10.1167/iovs.06-1413. PMID 17652708 PMID: 17652708 Check |pmid= value (help).
  22. ↑ Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ; et al. (2019). "Conjunctivitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P94–P169. doi:10.1016/j.ophtha.2018.10.020. PMID 30366797 PMID: 30366797 Check |pmid= value (help).
  23. ↑ Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK; et al. (2019). "Dry Eye Syndrome Preferred Practice Pattern®". Ophthalmology. 126 (1): P286–P334. doi:10.1016/j.ophtha.2018.10.023. PMID 30366798 PMID: 30366798 Check |pmid= value (help).
  24. ↑ Bal, Sharon K; Hollingworth, Gary R (2005). "Red eye". BMJ. 331 (7514): 438. doi:10.1136/bmj.331.7514.438. ISSN 0959-8138.
  25. ↑ Aguilera, Zenia P.; Chen, Pauline L. (2016). "Eye Pain in Children". Pediatrics in Review. 37 (10): 418–425. doi:10.1542/pir.2015-0096. ISSN 0191-9601.


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