Eye discharge
Eye discharge: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
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, clear, or white and stringy. Sometimes, the discharge can be expressed by applying pressure to the tear sac, punctum, meibomian glands, or canaliculi.
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 and physical examination
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?
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 eyelid movement. If the eyes seem to bulge, measure them with an exophthalmometer. Test the six cardinal fields of gaze. Examine the eye for conjunctival injection and follicles and for corneal cloudiness or white lesions.
Medical causes
Canaliculitis
This uncommon chronic disorder causes a scant purulent discharge, usually from the lower canaliculus of one eye. The eye is red and irritated, and its punctum bulges a bit.
Conjunctivitis
Five types of conjunctivitis may cause an eye discharge with redness, hyperemia, foreign-body sensation, periocular edema, and tearing.
In 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. Preauricular adenopathy is uncommon.
Viral conjunctivitis, which is more common than the bacterial form, usually produces a serous, clear discharge and preauricular adenopathy. 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 a scant mucoid discharge—especially in the morning—in both eyes, accompanied by pseudoptosis and conjunctival follicles.
Corneal ulcers
Both bacterial and fungal ulcers produce a copious, purulent unilateral eye discharge and crusty, sticky eyelids. Severe pain, photophobia, and impaired visual acuity may also occur.
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.
Dacryoadenitis
This disorder may cause a moderate purulent discharge associated with temporal eye pain, conjunctival injection, and severe eyelid edema and erythema. However, its most characteristic sign is unilateral exophthalmos.
Dacryocystitis
A lacrimal sac infection may produce a 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.
Erythema multiforme major (Stevens-Johnson syndrome)
Ocular effects of this disorder include a purulent discharge, severe eye pain, entropion, trichiasis, photophobia, and decreased tear formation. Also typical are erythematous, urticarial, bullous lesions that suddenly erupt over the skin.
Herpes zoster ophthalmicus
This disorder 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, this disorder typically causes a copious and 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
In this disorder, applying pressure on the meibomian glands may produce a continuous frothy, soft, foul-smelling, cheesy yellow eye discharge. The eyes also appear chronically red, with inflamed lid margins.
Orbital cellulitis
Although exophthalmos is the most obvious sign of this disorder, a unilateral purulent eye discharge may also be present. Related findings include eyelid edema, conjunctival injection, orbital pain, impaired visual acuity, limited extraocular movement, headache, and fever.
Pemphigus
This rare disorder may cause a thick, mucuslike discharge; eye pain, burning, and irritation; and blurred vision. Initially, the patient may develop unilateral or bilateral conjunctivitis that’s unrelieved by treatment; later, entropion and, occasionally, corneal ulceration may occur.
Psoriasis vulgaris
Usually, psoriasis vulgaris causes a substantial mucoid discharge in both eyes, accompanied by redness. The characteristic lesions it produces on the eyelids may extend into the conjunctivae, causing irritation, excessive tearing, and a foreign-body sensation.
Trachoma
A bilateral eye discharge occurs in this disorder along with severe pain, excessive tearing, photophobia, eyelid edema, redness, and visible conjunctival follicles.
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. Also, be sure to sterilize ophthalmic equipment after use. Teach the patient how to avoid contaminating the unaffected eye.
Explain any ordered diagnostic tests, including culture and sensitivity studies to identify the infectious organism.
Pediatric pointers
The prophylactic eye medication (silver nitrate), no longer commonly used with neonates, causes eye irritation and discharge. In children, discharges usually result from eye trauma, eye infection, or upper respiratory tract infection.
Patient counseling
Inform patients with bacterial or viral conjunctivitis that these disorders are contagious. Tell those with bacterial conjunctivitis to avoid contact with other people for 24 hours after receiving antibiotic treatment; not to share towels, pillows, or cosmetic eye products; and not to wear contact lenses until the conjunctivitis resolves. Tell patients with allergic conjunctivitis that this type of inflammation isn’t contagious.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Eye pain [Ophthalmalgia] (Professional Guide to Signs & Symptoms (Fifth Edition))
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