Diagnostic Tests for Eye Herpes
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Eye Herpes Diagnosis: Book Excerpts
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EYE PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The primary care specialist may want to treat cases of obvious conjunctivitis without a culture and sensitivity. However, a smear and culture is useful especially if
Neisseria
is suspected. A smear may also reveal eosinophils suggesting allergic conjunctivitis. The primary care specialist may also use fluorescein dye to diagnose a foreign body. Most primary care physicians feel competent to use tonometry to diagnose glaucoma and may feel competent to use a slit lamp. However, when there is any doubt about the diagnosis, the most cost-effective approach is to refer the patient to an ophthalmologist.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Eye pain:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does he have headaches? If so, find out how often and at what time of day they occur.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Eye discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Eye pain [Ophthalmalgia]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s eye pain doesn’t result from a chemical burn or from acute angle-closure glaucoma, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or a discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of severe pain that developed suddenly. Does he have headaches? If so, find out how often and at what time of day they occur.
During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the eyelids and conjunctivae for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye, page 322.)
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Red Eye:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Vision. Visual acuity should be checked; it is usually normal in episcleritis, scleritis, blepharitis, and conjunctivitis unless associated keratitis, such as in epidemic keratoconjunctivitis, is present. Decreased vision is demonstrable in keratitis and acute angle-closure glaucoma, but only mildly decreased in uveitis.
B. Inspection. The location of conjunctival redness is important. It is usually peripheral or diffuse in conjunctivitis, whereas in keratitis it is central or diffuse. It is localized in episcleritis or scleritis. In uveitis, it is central with a “ciliary flush.” In glaucoma there is a central perilimbal injection. Tenderness of the globe is usually only present in scleritis or uveitis. Pupillary reaction is normal, except in glaucoma where it is often a fixed mid-dilated pupil and in uveitis where a sluggish, miotic pupil is invariably present. Consensual photophobia is present in uveitis also, because of iris response and movement. The corneal appearance is normal except for scarring and ulceration of Chlamydia trachomatis and the haziness or edema of glaucoma.
C. Special tests. Staining of the cornea with fluoroscein is normal, except with corneal ulceration and abrasion, herpes zoster or simplex keratitis, or a bacterial corneal ulcer. Tonometry will demonstrate increased intraocular pressure in glaucoma. If a slit lamp is available, a narrow chamber angle will be seen with glaucoma. The slit lamp is also helpful to confirm the swelling and to inspect scleritis, not present in episcleritis.
Testing
A. Microbiology studies. Immunofluorescent tests on ocular scrapings for
C. trachomatis and culture for Neisseria gonorrhoeae are sometimes required. Bacterial cultures are generally reserved for infections of the neonate, in persistent conjunctivitis, or with keratitis if a break has occurred in the corneal epithelium (5). Viral cultures are rarely performed. Gram’s stain or Giemsa’s stain of epithelial scrapings may also be helpful. Urethral cultures may be indicated. Immunofluorescent detection of the herpes-specific antigen is also possible.
B. Other laboratory studies. Additional testing is primarily indicated for scleritis or uveitis because of a high frequency of associated rheumatologic disorders. Workup should include a complete blood count, sedimentation rate, C-reactive protein, antinuclear antibodies, rheumatoid factor, and a serologic test for syphilis (VDRL). A spine x-ray study can be helpful in diagnosing ankylosing spondylitis.
Diagnostic assessment
The red eye most commonly results from conjunctivitis, which is benign. Other causes can threaten sight, so a thorough evaluation must be done to prevent permanent visual impairment. Chlamydial conjunctivitis of a chronic nature causes trachoma, which is the leading cause of blindness in humans. The history and physical for both are very important. The history should include trauma, infectious exposure, and the length of symptoms. The examination should be thorough and methodical as stressed in the introductions. An immediate referral to an ophthalmologist should be made with severe deep pain, proptosis, perilimbal injection, tenderness, photophobia, and decreased vision.
References
1. Bertolini J, Pelucio M. The red eye. Emerg Med Clin North Am 1995;13(3):561–579.
2. Davey CC. The red eye. Br J Hosp Med 1996;55(3):89–94.
3. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician 1998;57(4):735–746.
4. Hara JH. The red eye: diagnosis and treatment. Am Fam Physician 1996;54(8):
2423–2430.
5. Ruppert SD. Differential diagnosis of pediatric conjunctivitis (red eye). Nurse Practitioner 1996;21(7):12–26.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Eye Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A foreign body sensation occurs with a foreign body, corneal abrasion, or keratoconjunctivitis sicca. Itching is associated with allergic and vernal conjunctivitis. Photophobia occurs with iritis and herpes simplex keratitis. Deep pain suggests acute glaucoma or posterior scleritis. Pain on eye movement is found with optic neuritis, sinusitis, and influenza.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Red Eye:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Decreased vision, pain, photophobia, and a history of trauma are important indicators of serious pathology.
In conjunctivitis, the anterior chamber is clear and the pupil active. There is great overlap in the clinical spectrum of bacterial and viral conjunctivitis. Ciliary flush (dilation of the fine capillaries around the iris border producing a violet-red halo) is a differentiating sign indicating anterior uveal inflammation caused by iritis/uveitis, infectious keratitis, or acute angle closure glaucoma, rather than conjunctivitis.
An active corneal process is indicated by a foreign body sensation with the patient unable to spontaneously open the eye or keep it open. These patients will also have photophobia. The eye is tender in patients with
scleritis, iritis, and glaucoma, but not in conjunctivitis. A pinpoint pupil is seen in cases of corneal abrasion, iritis, or infectious keratitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Eye discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Eye pain:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctivae for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye, page 272.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Red Eye:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Historyand physical exam can distinguish many causes of red eye, includingconjunctivitis, trauma, lid disorders, nasolacrimal duct obstruction,allergic reaction, preseptal cellulitis, orbital cellulitis, keratitis,and uveitis.Age of child and presence of purulenteye discharge help narrow causes of conjunctivitis.If purulentdischarge occurs in neonates up to 3 wks of age, Gram stain andappropriate bacterial and chlamydial cultures should be performed.In this age group, it is especially important to determine whetherinfection is caused by N. gonorrhoeae.When infant presents with mucopurulentor purulent eye discharge between 3 wks and 3 mos of age, chlamydialeye culture should be performed.Because chlamydial infection is unusualafter 3 mos of age, infants with eye discharge may be presumed tohave bacterial infection, and broad-spectrum antimicrobial eye dropsmay be given as therapeutic trial without culture. If infectiondoes not resolve or is recurrent, bacterial culture should be performed.Presence of eosinophils on Wright stain from conjunctival scrapingsuggests allergic conjunctivitis. Fluorescein staining should be performedwith suspected corneal abrasion. Slit-lamp exam should be performedwith suspected keratitis or uveitis. Visual acuity should alwaysbe measured in anyone with significant eye pathology (e.g., trauma,keratitis, or uveitis).Ophthalmologic consultation is necessarywhenever significant eye pathology or injury occurs or is suspectedwith or without loss of vision.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Eye discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by finding out when the discharge began. Does it occur
at certain times of the 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 the patient's 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.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Eye pain [Ophthalmalgia]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does the patient wear contact lenses? How often are they removed or replaced if they're disposable? Does he have headaches? If so, find out how often and at what time of day they occur.
During the physical examination, don'tmanipulate the eye if you suspect trauma. Carefully assess the lids and conjunctiva for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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