Red eye differential diagnosis can be a significant challenge for primary, emergency, and urgent care providers who don’t have a background in optometry. The eye is a highly complex and potentially fragile organ, and redness in or around the eye can indicate anything from a slight allergic reaction to a critical issue that needs to be referred to a specialist immediately.
Brianne Hobbs has been a practicing optometrist for 13 years, and is working with Premiere to develop continuing education courses in optometry. She created Diagnosis and Management of Red Eye in Primary Care, which provides primary, urgent, and emergency care providers with the knowledge and competence to examine, diagnose, and treat common red eye conditions that may present during point-of-entry healthcare services.
Premiere: Talk to us about your professional experience.
Brianne: I’ve been involved in a variety of spaces in optometry, from education, to assessment, to hospital-based practice. I am just getting started with Premiere, and I’ve developed one course so far. I’m looking forward to working on more eye care courses for primary care workers who might not have the specialized training required for managing eye conditions that may show up in their practice.
Premiere: What does your course focus on?
Brianne: This course is designed to help medical professionals regarding red eyes, because there are a lot of misconceptions about common causes, when referrals are appropriate, and what follow-up questions should be asked depending on factors like age, related trauma, and recurrence.
Premiere: It sounds like red eyes can indicate a wide range of possible conditions.
Brianne: Absolutely. However, in most cases that are very concerning, symptoms don’t present in isolation. Typically there’s a history of some ocular trauma, or a comorbidity like a systemic disease. It’s uncommon that someone arrives at a primary care facility with a very serious eye condition that’s not accompanied by other symptoms, comorbidities, or a history of trauma.
Premiere: What are some of the key questions healthcare professionals should ask?
Brianne: Whenever I’m diagnosing red eyes, I think about the four P’s: possibilistic, probabilistic, prognostic, and pragmatic.
Possibilistic thinking entails generating all the potential causes of the red eye without assigning any weight to a given diagnosis. In possibilistic thinking you are trying to think broadly so you don’t overlook a diagnosis.
Probabilistic means asking what’s most likely given specific attributes of a patient such as age. Children, for instance, tend to have red eye conditions that are fundamentally different from someone in their 40s.
The next step is prognostic thinking, or considering what the worst case scenario might be. That’s important with red eyes, because diseases can vary widely in severity and it’s easy to diagnose dismissively. Even if you don’t know what the cause of the red eye is, if you can rule out vision-threatening conditions like corneal ulcers, then you have helped maintain the integrity of the eye and preserved vision.
Finally, you need to consider what is pragmatic. Evaluate what conditions can be tested for and which can actually be treated. Some common causes of red eyes such as viral conjunctivitis don’t really have an effective treatment, but you want to ensure that you don’t miss the conditions which can be treated. In general, the challenge of red eyes is making sure that you’re not overdiagnosing or underdiagnosing, and don’t hesitate to refer or to contact an eyecare provider if you aren’t sure what to do.
Premiere: You mentioned that red eye diagnosis can vary by age groups. Can you explain?
Brianne: It’s very common in children to see conjunctivitis, but for older people there tends to be a wider range of possibilities. Recurrence, medical history, and ocular trauma often play a much bigger role in diagnosing older people, and you need to look more closely.
With older patients, we may need to determine if inflammation is deeper in the eye, because that would indicate something systemic that needs to be addressed. Then there’s herpes, the great masquerader of red eye diseases. Herpes lives on a particular nerve pathway, and if that pathway leads to the eye a patient may experience recurring eye redness. In that case, knowing a patient’s history with red eyes can quickly point you in the direction for a correct diagnosis.
Premiere: How has your experience with Premiere been so far?
Brianne: I am definitely looking forward to working with Megan Arbour on creating more courses and content for Premiere. I think the work they are doing is important, because they are creating collaborative courses which harness the expertise of multiple specialties.This interdisciplinary approach to continuing education helps minimize knowledge gaps by creating synergy between professions to examine a given topic from multiple perspectives.This method for creating CE also helps the content creators become familiar with knowledge gaps in other fields that they may be able to specifically target in their course.
For example, brainstorming with Megan has been great, because we were able to sit down, ask questions, and really figure out where the starting point for nurses was with red eyes. The fact is, I’m an optometrist and I know the eye, but I don’t really know that much about nurses.
Once I understood the basic knowledge gaps, I was able to craft Diagnosis and Management of Red Eye in Primary Care into something that would give nurses the core information they needed to deliver better care to their patients, and that’s what continuing education is all about.
