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  • Dr Simon Moore MD CCFP

Three things not to miss - The Red Eye

Here are three things that you don’t want to miss on a Family Medicine exam question when a patient presents with a red eye.

HISTORY - Always Ask about Contact Lens Use

I met a patient this month who consented to letting me share her frightening story. She developed a red eye (without any red flags, surprisingly!). Her treating physician correctly recognized that she was at risk for pseudomonas due to her contact lens use, and she was prescribed a quinolone antibiotic upon initial presentation. (I’ll show you the photo of her eye and tell you how the story ends at The Review Course).

PHYSICAL - Flip The Lids

The cause of the patient’s eye problem may be found under the lid – a foreign body, or a stye. Add this to your eye exam, and also to your EMR typing template / stamp so it comes up every time you see a patient with a red eye.

MANAGEMENT - More than Medication

One of the key things you’ll be taught in The Review Course to prepare you for your exam and future practice is that Management = More than Medication. For example, in a patient who presents with a red eye, you may want to do at least two things beyond simply prescribing the appropriate medication:

- a patient with iritis may have another associated condition to consider: There are many other examples such as RA, polyarteritis nodosa, Crohn's, SLE, ank spond, and granulomatosis with polyangiitis (which you may be aware is the new name for Wegener's).

- provide counselling on appropriate topics, including symptomatic relief, return to work, when the condition is expected to resolve, and red flags i.e. when to return immediately.

BONUS - Don't Miss These Two Red Flags

In addition to the three things above, make sure you don't miss two major red flags. Refer to optometry, ophthalmology or ER if the patient has any red flags:

- pain in the eye, or

- decreased acuity

I've been very honoured to be invited to give a talk on The Red Eye at a few conferences including the CFPC Family Medicine Forum, the OCFP Annual Scientific Assembly, and the UBC Post Graduate Review in Family Medicine. I'll tell you about some more key tips about the red eye at The Review Course.

During The Review Course you’ll also learn the PQRST mnemonic to make sure you hit on all the management points for every question, so be sure to sign up for the course. Register now!

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