Ocular Infections (Conjunctivitis, Iritis)

Definition/Etiology:

• Any infection that occurs in or around the eye is considered an ocular emergency. The reason being is the concern for its effects on the patient’s vision. 
• The etiology of different infections is based on their origin. Ocular infections can be bacterial, viral, fungal, chemical, or allergic. 
• In this session we are going to talk about conjunctivitis (pink eye), as well as some infections of the eyelids and cornea.

Pathophysiology:

• Most cases of pink eye are typically caused by adenovirus but can also be caused by herpes simplex virus, varicella-zoster virus, and various other viruses, including the virus that causes coronavirus disease 2019 (COVID-19). Yes you heard right, you could get eye covid!!!
• Infections of the eyelids or the cornea are most likely caused by Staphylococcus aureus.

Clinical Presentation:

Pink Eye

• Eyelids crusted shut when waking up
• Sensation of a FB in the eye
• Purulent drainage (bacterial)
• Serous discharge (allergic or viral)
• Pruritus (allergic)

With other infections of the eyelids and cornea

• Burning and tearing of the eyes
• Reddened lids and sclera
• Pain
• Photophobia
• Decreased vision
• Swelling

Collaborative Management:

• First things first, and easiest… check visual acuity. This is usually done in the ED using a Snellen chart, placed about 20 feet from the patient. Check the affected eye first, then the unaffected, then both.
• If the patient can’t see the Snellen, walk towards them while holding up several fingers. Stop walking when they can tell you how many. Document what you find, for example, “three fingers at 12 feet”.
• You might want to instill some topical anesthetic before checking visual acuity. Might help to facilitate it.
• The exception to all this is a patient with a chemical burn to the eye. That’s a true emergency and needs irrigation before you need anything else.

Evaluation | Patient Monitoring | Education:

• Evaluation of interventions is basically how the patient is doing. How is their pain, how is their vision. If the case is too severe and infection has gotten bad, they might need optho consult.
• Most of these patients will probably not need much more after their ED treatment and the symptoms should resolve. If not, they may require optho follow up.

Linchpins: (Key Points)

• Visual Acuity is key eval
• Anesthetic prior to test.