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    Pearls for better diagnosis, treatment of red eye

    Consider the patient’s systemic health; harvest tissue when at all possible

    An unusual red eye could have many potential diagnoses—and ophthalmologists should consider several pearls to help get to its root cause, said C. Stephen Foster, MD, founder and president, Massachusetts Eye Research and Surgery Institution, Waltham, MA.

    Five steps Dr. Foster recommends are:

    1. Conduct a meticulous review of systems, and consider collaborating on the results with an internist.
    2. Have the room lights on to inspect the patient’s skin, face, hands, and nails.
    3. Perform the ocular examination.
    4. Carefully select lab tests that could be relevant.
    5. Harvest any abnormal tissue.

    Case examples

    Dr. Foster shared the cases of several patients with red eyes.

    In one patient, a red eye that may be considered viral conjunctivitis or allergic conjunctivitis  actually turned out to be lice at the base of the lashes.

    “Eradicating the lice infestation made the red eye problem vanish,” Dr. Foster said.

    In another patient, a persistent red eye eventually led to the diagnosis of dust mite allergy. Once the patient started immunotherapy (allergy shots), his eyes improved, Dr. Foster said.

    Yet another patient had a chronic red eye and was given a number of treatments, including steroids.

    “In fact, this was cancer,” he said. “Here’s where the biopsy can be crucial to getting a final diagnosis and appropriate therapy.”

    Several malignancies that can cause a red eye include sebaceous cell carcinoma, squamous cell carcinoma, fibrosarcoma, lymphoma, and melanoma.

    Systemic diagnosis

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