RIME - Pink Eye Sara Olack, PhD, MSIII Oct. 31, 2010

History Intake

· How long, how severe, getting worse or better

· Itchy, pain, or foreign body sensation

· Eye discharge: watery, mucoserous, purulent or thick

· Blurring vision

· History of eye trauma

· Contact lens use

Physical Exam

· Visual acuity in both eyes

· Pupil size and reactivity to light

· Discharge – purulent or serous

· Quality of redness – hemorrhagic or injection (dilated blood vessels)

· Pattern of redness – diffuse injection (involves palpebral and bulbar conjunctiva) or ciliary flush (redness most pronounced at transition zone of sclera and cornea)

· Corneal white spots or opacities

· Hypopyon (layer of WBCs in anterior chamber) or hyphema (layer of RBCs in anterior chamber)

· Fluorscein exam if abrasion is suspected

Differential Diagnosis of and Management

	Viral	Bacterial	Allergic	Other Conditions
Causes	Adenovirus (many serotypes)	Staphylococcus aureus Streptococcus pneumoniae Haemophilus influenza Moraxella catarrhalis Neisseria gonorrhea Chlamydia trachomatis	Airborne allergens	-Chemical irritants -Corneal abrasion -Corneal foreign body -Contact lens overwear -Acute angle glaucoma -Iritis -Infectious keratitis -Ulcerative keratitis Red Flags -Visual changes -Foreign body sensation -Severe pain -Photophobia -Fixed pupil -Severe headache with nausea -Corneal opacity -Ciliary flush -Hypopyon -Hyphema
Symptoms And Signs	-Watery or mucoserous discharge -Morning crusting common -Burning, sandy, or gritty feeling in one eye -Second eye frequently involved after 24-48 hrs	-Purulent, thick discharge at the lid margins and corners of the eye -Discharge reappears quickly after wiping the eye -Morning crusting common -Discharge may be yellow, white, or green	-Watery or mucoserous discharge -Morning crusting common -Itching predominates -Frequently bilateral
Treatment	-Self-limited process -Topical antihistamines/decongestants for symptomatic relief -1 to 2 drops QID PRN for no more than 3 weeks	-Antibiotic ophthalmic ointment, sulfa ophthalmic drops, or polymyxin/trimethoprim drops -1 to 2 drops QID, 5 to 7 days	-Usually self-limited -Avoidance of the allergen - Topical antihistamines/decongestants for symptomatic relief -1 to 2 drops QID PRN for no more than 3 weeks

Sources: UpToDate, American Optometric Association