You are red eye doctors

ByMartha R. Camara

Jun 1, 2014

Take care of your daily tasks so that patients can be treated earlier and more efficiently.


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It was a typical Wednesday afternoon at the SkyVision clinic. We were stuffed to the gills; every chair in the lobby was occupied and every lane was used. Virtually all of the patients were in the office for exactly the same thing. For a good 4 hours all I saw was a steady stream of patients with some sort of red eye. I introduce myself as an eye surgeon, live for my time in the OR, and continually think about how best to discuss the latest developments in advanced IOL technology or LASIK with my patients. But like all who live and work in the anterior segment but very few, pre-surgery, surgery and post-surgery are not the majority of what we do. The reality is that you and I are red-eye doctors.

I know, I know – it’s not very sexy to be a red-eye doctor. You’re having dinner at a fancy restaurant and meet the parents of your son’s fiancée when they find out you’re a doctor. Do you really want to tell them the truth, that what you do most of your day is seeing people walk in with red and sometimes gooey eyes? Not at all. You’re going to tell them you’re an eye surgeon, like I would.

Whether you’ve accepted the reality that you’re a red-eye doctor publicly or privately, acceptance leads to the inevitable conclusion that as long as that’s what you’re doing, you should go ahead and do it as well. as possible. Much like treating dry eye, caring for people with red eyes will generate a lot of goodwill, both in your patients and in their GPs. Making an accurate diagnosis of the underlying cause of the redness, and then targeting that diagnosis with an appropriate and effective treatment, saves your patients the prolonged suffering caused by their red eye, as well as the time and money sometimes required if it diagnosis is incorrect.

Darrell E. White, MD

Darrell E. White

Common and complex causes

Red eye is incredibly common as a presenting complaint in the clinic, and fortunately there are some rather common and benign entities that can diagnose and treat it with little more than a grip and a little of comfort. The best example of this, of course, is benign subconjunctival hemorrhage. Although this is actually diagnosed by your receptionist when the patient walks through the front door, your patient is still likely to be very concerned about their red eye. The few minutes you spend explaining that it’s probably only due to her straining in the toilet and not some spooky, rare cancer could save her countless sleepless nights, even though you know she didn’t even have to be in the office That day. Red eyes are always a big problem for the patient.

As easy as it is to diagnose and “treat” some of the common causes of red eye, a substantial percentage of patients who complain of redness actually represent some of the most complex diagnostic challenges we face. Almost all of our arsenal of ocular surface diseases comes into play for these patients. Dry eye, meibomian gland disease, infectious conjunctivitis, and allergies are all present in virtually all patients. Indeed, all the cool new diagnostic tools we’ve put together to work with the more traditional aspects of care when it comes to making an accurate diagnosis or at least narrowing down possible diagnoses to the point where treatment is more finely targeted.

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Diagnose

The magic of being a red-eye doctor is, I think, making the diagnosis. “If it’s X, then the treatment is Y” is pretty well established for us with most entities we might encounter. All good medical care begins with a thorough history of the problem, whether done entirely by you or primarily by one of your technicians. Simple stuff like “How long has this been going on?” and “Do you wear soft contact lenses?” can almost seal the deal even before turning on the slit lamp. A contact lens patient who slept in their daily contact lenses for the entire week of spring break in Cabo makes you think of a corneal ulcer, for example. The history, especially if taken by a technician, can also lead to the use of some of the wonderful point-of-care diagnostic tests I’ve written about – tests that will rule out or rule out certain broad categories of diagnostic. For example, a patient with a watery red eye and symptoms that appeared about a week after the onset of an upper respiratory tract infection would likely benefit from testing with AdenoPlus (RPS); a positive result sets your course of action before you even step into the room.

AdenoPlus, TearLab tear osmolarity and InflammaDry (RPS) are available to help guide our diagnosis, and we can expect to have point-of-care tests that will soon allow us to detect IgG and IgA levels. in tears (note to device makers: Hurry!). Incidentally, it is now possible to determine a probable cause of allergic conjunctivitis in our offices thanks to the new Doctor’s Allergy Formula test program. Ultimately, however, diagnostic rubber meets the road for us once we sit down at the slit lamp. Are there follicles or papillae? What’s under that upper eyelid? Do these vessels cause episcleral or scleral redness? Is the cornea clear and the anterior chamber deep and silent? How about those meibomian glands – what happens when you press on the eyelids? The red-eye doctor makes a living when she settles in the eyepieces.

In these less-than-peaceful days of “healthcare reform,” it will become more important to justify your place in the health care systems that will emerge. One way to do this is to demonstrate that your ability to diagnose and treat common problems is superior to other options available to patients. Your “competition” here is not just a family doctor or a pediatrician, but also the emergency room and a nurse from an urgent care clinic. Making an accurate diagnosis of the underlying cause of red eye is key to choosing the most appropriate treatment, and making that effective treatment call sooner is not just better care, but more cost-effective care. You are an anterior segment expert; it’s right in your wheelhouse. Embrace your status as a red-eye doctor and encourage these patients to come to your practice first. Having an ophthalmologist to treat red eye is better for the patient and better for our healthcare system as well. Repeat after me: “I’m a red-eye doctor and I’m proud!”

There, isn’t it better?

  • Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; 440-892-3931; fax: 440-892-3416; email: [email protected]
  • Disclosure: White is a consultant for Bausch + Lomb, Allergan, Nicox and Eyemaginations. He is a member of the speaker committee for Bausch + Lomb, Allergan and TearLab.