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LEARNING OBJECTIVES

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  1. Accurately identify the most likely etiology when patients present with an inflamed, red eye and/or other eye symptoms, through history and patient findings on examination to enable the appropriate recommendation of effective treatment or referral to an appropriate provider.

  2. Use the knowledge of the pathophysiology, etiology, and common presentations of common eye complaints as a primary symptom to review prescription orders for appropriateness and to accurately educate patients about their disease and its treatment.

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INTRODUCTION

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Patients presenting with redness in the visible portion of the eye is a common symptom in primary and urgent care practice. Nearly 6 million cases of acute conjunctivitis also known as “pink eye” are reported annually in the United States. Approximately 15% of adult patients suffer from allergic ocular conditions. Patients routinely present to the pharmacy with eye complaints. However, minority of causes of red eye can be treated with nonprescription products so the primary role of the pharmacist is referral to either primary, emergent, or specialty care. The most common specific causes of a red eye are (1) infectious (viral or bacterial); (2) allergic; and (3) “nonspecific,” which includes irritative. There are other conditions that can be confused with conjunctivitis, including some that need urgent or emergent management.

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RELEVANT ANATOMY

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Location of the redness can be important so a brief review of eye anatomy is important. The term conjunctivitis means inflammation of the conjunctiva (singular) or conjunctivae (plural). The conjunctiva is usually described as having three parts, all of which are thin, transparent layers of mucous membrane. The most external and easily observable portion is that which overlies the white portion (sclera) of the eyeball itself. This is called the bulbar or ocular conjunctiva. It covers the entire sclera, but it does not cover the central anterior portion of the eyeball (the cornea). That is, it extends onto the eyeball up to, but not beyond, the limbus. The limbus is the union of the cornea and the sclera and a conjunctivitis limited to the limbus is an important clue to more serious cause of a red eye. When the bulbar conjunctiva is normal (not inflamed), it cannot be differentiated from the sclera beneath it, because it is clear. Another portion of the conjunctiva, visible if the eyelids are inverted, covers the inner linings of both upper and lower eye lids (the palpebrae). This portion of the conjunctiva is called the palpebral or tarsal conjunctiva. There is a third portion of the conjunctiva that is difficult to visualize, because of its anatomic location. This portion is located at the fornix, which is the communication between the palpebral and bulbar conjunctivae. In practical terms, conjunctivitis can be bulbar (the lining over most of the eyeball) or palpebral (the linings inside the eye lids) or both. The pink or red coloration is due to increased visualization of blood vessels in the conjunctivae due to ...

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