Eye discharge
Eye discharge: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Usually associated with conjunctivitis, an eye discharge is the excretion of any substance other than tears. This common sign may occur in one or both eyes, producing scant to copious discharge. The discharge may be purulent, frothy, mucoid, cheesy, serous, or clear, or a stringy white discharge. Sometimes, the discharge can be expressed by applying pressure to the tear sac, punctum, meibomian glands, or canaliculus.
An eye discharge commonly results from inflammatory and infectious eye disorders but may also occur in certain systemic disorders. (See Sources of eye discharge.) Because this sign may accompany a disorder that threatens vision, it must be assessed and treated immediately.
History
Begin your evaluation by finding out when the discharge began. Does it occur at certain times of day or in connection with certain activities? If the patient complains of pain, ask him to show you its exact location and to describe its character. Is the pain dull, continuous, sharp, or stabbing? Do his eyes itch or burn? Do they tear excessively? Are they sensitive to light? Does he feel like something is in them?
Physical assessment
After taking vital signs, carefully inspect the eye discharge. Note its amount, color, and consistency. Then test visual acuity, with and without correction. Examine external eye structures, beginning with the unaffected eye to prevent cross-contamination. Observe for eyelid edema, entropion, crusts, lesions, and trichiasis. Next, ask the patient to blink as you watch for impaired lid movement. If the eyes seem to bulge, measure them with an exophthalmometer. Test the six cardinal fields of gaze. Examine for conjunctival injection and follicles and for corneal cloudiness or white lesions.
Medical causes
Conjunctivitis
Five types of conjunctivitis may cause an eye discharge with redness, hyperemia, foreign-body sensation, periocular edema, and tearing.
With allergic conjunctivitis, a bilateral ropey discharge is accompanied by itching and tearing.
Bacterial conjunctivitis causes a moderate purulent or mucopurulent discharge that may form sticky crusts on the eyelids during sleep. The discharge is commonly greenish white and usually occurs in one eye. The patient may also experience itching, burning, excessive tearing, and the sensation of a foreign body in the eye. Eye pain indicates corneal involvement.
Viral conjunctivitis is generally more common than the bacterial form. A serous, clear discharge and preauricular adenopathy are usually present. The history includes a runny nose, an upper respiratory tract infection, or recent contact with a person who had these signs. Onset is usually unilateral.
Fungal conjunctivitisproduces a copious, thick, purulent discharge that makes the eyelids crusty and sticky. Also characteristic are eyelid edema, itching, burning, and tearing. Pain and photophobia occur only with corneal involvement.
Inclusion conjunctivitis causes scant mucoid discharge — especially in the morning — in both eyes, accompanied by pseudoptosis and conjunctival follicles.
Corneal ulcers
Both bacterial and fungal corneal ulcers produce a copious, purulent unilateral eye discharge. Related findings are crusty, sticky eyelids and, possibly, severe pain, photophobia, and impaired visual acuity.
Bacterial corneal ulcers are also characterized by an irregular gray-white area on the cornea, blurred vision, unilateral pupil constriction, and conjunctival injection.
Fungal corneal ulcers are also characterized by conjunctival injection and eyelid edema and erythema. A painless, dense, whitish gray central ulcer develops slowly and may be surrounded by progressively clearer rings.
Dacryocystitis
With dacryocystitis, lacrimal sac infection may produce scant but continuous purulent discharge that’s easily expressed from the tear sac. Additional signs and symptoms include excessive tearing, pain, and tenderness near the tear sac. Eyelid inflammation and edema are most noticeable around the lacrimal punctum.
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus yields a moderate to copious serous eye discharge accompanied by excessive tearing. Examination reveals eyelid edema and erythema, conjunctival injection, and a white, cloudy cornea. The patient also complains of eye pain and severe unilateral facial pain that occurs several days before vesicles erupt.
Keratoconjunctivitis sicca
Better known as dry eye syndrome, keratoconjunctivitis sicca typically causes excessive, continuous mucoid discharge and insufficient tearing. Accompanying signs and symptoms include eye pain, itching, burning, a foreign-body sensation, and dramatic conjunctival injection. The patient may also have difficulty closing his eyes.
Meibomianitis
Meibomianitis may produce a continuous frothy eye discharge. Applying pressure on the meibomian glands yields a soft, foul-smelling, cheesy yellow discharge. The eyes also appear chronically red, with inflamed lid margins.
Orbital cellulitis
Although exophthalmos is the most obvious sign of orbital cellulitis, a unilateral purulent eye discharge may also be present. Related findings include eyelid edema, conjunctival injection, headache, orbital pain, impaired visual acuity, limited extraocular movement, and fever.
Psoriasis vulgaris
Usually, psoriasis vulgaris causes a substantial mucus discharge in both eyes, accompanied by redness. The characteristic lesions it produces on the eyelids may extend into the conjunctiva, causing irritation, excessive tearing, and a foreign-body sensation.
Special considerations
Apply warm soaks to soften crusts on the eyelids and lashes. Then gently wipe the eyes with a soft gauze pad. Carefully dispose of all used dressings, tissues, and cotton swabs to prevent the spread of infection. Teach the patient how to avoid contaminating the unaffected eye. Also, be sure to sterilize ophthalmic equipment after use. Explain any ordered diagnostic tests, including culture and sensitivity studies to identify infectious organisms.
Pediatric pointers
In infants, prophylactic eye medication (silver nitrate) commonly causes eye irritation and discharge. However, in children, discharges usually result from eye trauma, eye infection, or upper respiratory tract infection.
Patient counseling
Inform patients that bacterial and viral conjunctivitis are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people until 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and to stop wearing contact lenses until conjunctivitis resolves. Tell patients with allergic conjunctivitis that this isn’t a contagious type of inflammation.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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