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Eye Pain without Redness

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1. CRACKCast E022 – Red and Painful Eye

CRACKCast E022 – Red and Painful Eye CRACKCast E022 - Red and Painful Eye - CanadiEM CRACKCast E022 – Red and Painful Eye In , by Adam Thomas January 12, 2017 This episode of CRACKCast cover’s Rosen’s Chapter 22, Red and Painful Eye 1 . The red and painful eye can be a vision-threatening medical emergency and should be treated urgently to avoid long-term sequelae. Shownotes – Rosen’s in Perspective: Review your eye anatomy in Rosen’s Eye anatomy review. From Rosen’s. Recap the key components (...) Miotic pupil Lens cataracts Blood in the vitreous Retinal detachment Bedside testing: Fluorescein testing – uptake occurs only in damaged corneal tissue. Under slit-lamp Cobalt blue light: Have the patient blink, if there is uncertainty regarding the uptake of fluorescein on the cornea Local anesthetic testing: If the anesthetic abolishes the patient’s eye pain – the pain is of corneal origin If the pain is mildly relieved – probable conjunctival origin Seidel’s sign: Use with the suspicion of ocular

2017 CandiEM

2. Eye Pain without Redness

Eye Pain without Redness Eye Pain without Redness Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Eye Pain without Redness Eye Pain (...) without Redness Aka: Eye Pain without Redness , Pain in the Quiet Non-Red Eye II. Causes See III. Evaluation: Eye Pain without Redness or visual field deficit Urgent ophthalmology Increased suggests History of cancer may prompt imaging for intraocular tumor assessment History autoimmune disorder may prompt additional labs and imaging Posterior Optic , or retrobulbar neuritis Associated neurologic deficits Tolosa-Hunt Syndrome or Associated Consider other diagnoses IV. References Images: Related links

2018 FP Notebook

3. Eye Pain without Redness

Eye Pain without Redness Eye Pain without Redness Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Eye Pain without Redness Eye Pain (...) without Redness Aka: Eye Pain without Redness , Pain in the Quiet Non-Red Eye II. Causes See III. Evaluation: Eye Pain without Redness or visual field deficit Urgent ophthalmology Increased suggests History of cancer may prompt imaging for intraocular tumor assessment History autoimmune disorder may prompt additional labs and imaging Posterior Optic , or retrobulbar neuritis Associated neurologic deficits Tolosa-Hunt Syndrome or Associated Consider other diagnoses IV. References Images: Related links

2015 FP Notebook

4. Eye Pain

foreign body Entropion Interstitial Ocular Herpetic infection calcification Band keratopathy V. Causes: Eye Pain without lesions (quiet non-Red Eye) See Visual Loss or visual field deficit Intraocular tumor Posterior Optic , or retrobulbar neuritis Associated neurologic deficits Tolosa-Hunt Syndrome or Associated (Ethmoid, Sphenoid, or involvement) Consider other diagnoses Eye strain VI. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing (...) Eye Pain Eye Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Eye Pain Eye Pain Aka: Eye Pain II. History sensation l involvement

2018 FP Notebook

5. WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents

WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents ISBN 978 92 4 155039 0 20 Avenue Appia CH-1211 Geneva 27 Switzerland www.who.int/ 9 789241 548397 WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC (...) MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTSWHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTSWHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents ISBN 978-92-4-155039-0 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org

2019 World Health Organisation Guidelines

6. Red Eye Evaluation (Treatment)

products or NSAIDs should be discouraged. With time and blood breakdown, the hemorrhage may become green or yellow, like a bruise, spreading around the circumference of the globe. Usually, this disappears within 2 weeks. Patients are told to return if the bruiselike appearance does not fully resolve, if pain ensues, or if the hemorrhage recurs. Treatment of red eye from a corneal or conjunctival foreign body consists of removal of the foreign body, administration of antibiotic drops, and follow-up (...) with an ophthalmologist to monitor for the development of an infection. An Alger brush or metal rotating burr is often required to remove the painful and cicatrizing residual rust ring seen commonly after iron-containing metallic foreign body removal. Treatment of red eye caused by dry eye syndrome (DES), or keratoconjunctivitis sicca (KCS), consists of administration of artificial tear drops and referral to an ophthalmologist if symptoms persist. Previous References Shields SR. Managing eye disease in primary care

2014 eMedicine.com

7. Red Eye Evaluation (Overview)

been enlargement of the lens. Associated systemic disease (eg, rheumatoid arthritis, herpes zoster ophthalmicus, or gout) is found in 40% of all patients with scleritis (anterior). Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. It may be spontaneous, traumatic, or related to systemic illness. [ , , , ] The classic presentation involves a patient without eye pain or visual disturbance who discovers the red eye (...) Red Eye Evaluation (Overview) Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MjEyMi1vdmVydmlldw== processing > Red Eye Updated: Sep

2014 eMedicine.com

8. Red Eye Evaluation (Follow-up)

products or NSAIDs should be discouraged. With time and blood breakdown, the hemorrhage may become green or yellow, like a bruise, spreading around the circumference of the globe. Usually, this disappears within 2 weeks. Patients are told to return if the bruiselike appearance does not fully resolve, if pain ensues, or if the hemorrhage recurs. Treatment of red eye from a corneal or conjunctival foreign body consists of removal of the foreign body, administration of antibiotic drops, and follow-up (...) with an ophthalmologist to monitor for the development of an infection. An Alger brush or metal rotating burr is often required to remove the painful and cicatrizing residual rust ring seen commonly after iron-containing metallic foreign body removal. Treatment of red eye caused by dry eye syndrome (DES), or keratoconjunctivitis sicca (KCS), consists of administration of artificial tear drops and referral to an ophthalmologist if symptoms persist. Previous References Shields SR. Managing eye disease in primary care

2014 eMedicine.com

9. Red Eye Evaluation (Diagnosis)

been enlargement of the lens. Associated systemic disease (eg, rheumatoid arthritis, herpes zoster ophthalmicus, or gout) is found in 40% of all patients with scleritis (anterior). Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. It may be spontaneous, traumatic, or related to systemic illness. [ , , , ] The classic presentation involves a patient without eye pain or visual disturbance who discovers the red eye (...) Red Eye Evaluation (Diagnosis) Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MjEyMi1vdmVydmlldw== processing > Red Eye Updated

2014 eMedicine.com

10. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

prioritized question list remained without recommendation. Conclusions: We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain , Agitation/ sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain , Agitation (...) Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Clinical Practice Guidelines for the Prevention and Manageme... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me

2018 Society of Critical Care Medicine

11. A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without

reperfusion, lack of chest pain, and only subtle findings which would not generally be accepted by the cardiologist. A bedside US was performed which did not show any clear wall motion abnormality (this is not unexpected in reperfusion). Dr. Thompson was concerned by the subtle findings above and kept a close eye on the patient. Sure enough, 40 minutes later, his pain returned. Here is his repeat ECG: Similar to initial ECG, but the T-waves in II, III, aVF, and V3 are slightly larger, and the T-wave (...) A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without Dr. Smith's ECG Blog: A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without Sunday, September 2, 2018 Submitted by Nic Thompson, Written by Pendell Meyers, edits by Steve Smith This is a long post, but well worth the read because it clearly delineates the difference in patient outcomes between advanced ECG interpretation and STEMI criteria! Dr. Thompson

2018 Dr Smith's ECG Blog

12. Management of Opioid Therapy (OT) for Chronic Pain

complaints (e.g., depression, anxiety, poor self-efficacy, poor general emotional functioning) more often than patients without chronic pain.[47] Further, there can be social and psychological consequences such as decreased ability to successfully maintain relationship and career roles and increased depression, fear, and anxiety as a result of pain.[3,11] E. Epidemiology and Impact a. General Population Chronic pain is among the most common, costly, and disabling chronic medical conditions in the U.S.[48 (...) Management of Opioid Therapy (OT) for Chronic Pain VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed

2017 VA/DoD Clinical Practice Guidelines

13. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

is best considered to be active. It is noted that, without limb signs, a diagnosis of CRPS according to the ‘Budapest criteria’ can sometimes not be made (see Table 1). These patients (who have fulfilled the criteria in the past, but now have lost some or all limb signs, yet have ongoing pain) may be diagnosed with ‘CRPS-NOS’ (not otherwise specified, see also footnote † ). 17 Table 1 Diagnostic criteria for CRPS (Budapest criteria) 17 (A–D must apply) † A) The patient has continuing pain which (...) or secondary care). Information about pain clinics is available through NHS Choices. After trauma or surgery ? When a patient is already discharged from the trauma or surgical team, the GP should consider re-referral – for example, to the attending orthopaedic specialist/surgeon or trauma service – to allow for definite exclusion of ongoing pathology. Without trauma (or after minor trauma) ? Patients with suspected CRPS without preceding trauma should be referred to secondary care (eg rheumatology

2018 British Society of Rehabilitation Medicine

14. Intermittent increasing exertional chest pain and serial negative troponins

of ECG #1 and ECG #2 reveals another very important finding. Note that despite no more than minimal change in R wave progression and QRS morphology in the chest leads — T wave amplitude in leads V2-thru-V6 has clearly increased in ECG #2. This confirms that there have been d ynamic S T- T w ave c hanges in this 2nd ECG done 7 hours later after complete resolution of chest pain. Note that the nonspecific ST-T wave straightening persists in many leads in ECG #2. =================================== K EY (...) ). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, a... Written by Pendell Meyers, with edits by Steve Smith Thanks to my attending Nic Thompson who superbly led this resuscitation We receive... This was sent by a recent ultrasound fellow, asking for my ECG diagnosis. He stated that it is "an acute change from previous" ... Written by Pendell Meyers, with edits from Steve Smith Let's consider this nearly pathognomonic ECG without the clinical context (be... Below

2019 Dr Smith's ECG Blog

15. A PACE-gate or an editorial without perspectives?

A PACE-gate or an editorial without perspectives? A PACE-gate or an editorial without perspectives? Search National Elf Service Search National Elf Service » » » » A PACE-gate or an editorial without perspectives? Jul 19 2017 Posted by The PACE-trial is a large-scale randomised controlled trial set up to investigate the efficacy of graded exercise therapy (GET) and cognitive behaviour therapy (CBT) for patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Some months ago (...) a general criticism against the widespread use of patient reported outcome measures (PROMs). Keeping in mind that CFS/ME is diagnosed based on subjectively reported symptoms, it is not strikingly odd that trials focus on patient reported outcomes.” This missed the point entirely. The headline case against PACE is that is an unblinded trial without objective outcome measurements. You can have a valid trial that is unblinded, you can have a valid trial that relies solely on patient reported outcome

2017 The Mental Elf

16. SpO2 Validation of Noninvasive Red Diamond Disposable Pulse Oximeter Sensor

SpO2 Validation of Noninvasive Red Diamond Disposable Pulse Oximeter Sensor SpO2 Validation of Noninvasive Red Diamond Disposable Pulse Oximeter Sensor - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. SpO2 (...) Validation of Noninvasive Red Diamond Disposable Pulse Oximeter Sensor The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03124602 Recruitment Status : Completed First Posted : April 24, 2017 Last Update Posted : November 1, 2018 Sponsor: Masimo Corporation Information provided by (Responsible Party): Masimo

2017 Clinical Trials

17. Effect of Topical Naltrexone Ophthalmic Solution on the Signs and Symptoms of Dry Eye in Diabetic Subjects

, conjunctival sum, total eye will be measured using an Ocular discomfort (0-4 scale) Tear film break-up time [ Time Frame: Day 29 ] Tear film break-up time Conjunctival redness [ Time Frame: Day 29 ] Number of patients with conjunctival redness will be assessed and conjunctival pain will be assessed using a visual analog scale Schirmer's Test [ Time Frame: Day 29 ] Schirmer's Test (without anesthesia) Cochet-Bonnet Corneal Sensitivity Test [ Time Frame: Day 29 ] Cochet-Bonnet Corneal Sensitivity Tear (...) Effect of Topical Naltrexone Ophthalmic Solution on the Signs and Symptoms of Dry Eye in Diabetic Subjects Effect of Topical Naltrexone Ophthalmic Solution on the Signs and Symptoms of Dry Eye in Diabetic Subjects - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100

2018 Clinical Trials

18. Persistent Pain with Breastfeeding

, sensitivity, purulent drainage, presence/absence of rashes, col- oration, lesions) B Breast examination (masses, tenderness to light/deep pressure) B Sensitivity to light or sharp touch on body of breast, areola, and nipple B Manual expression of milk (assess for pain with maneuver) B Assessment of maternal mood using a validated in- strument,suchastheEdinburghPostnatalDepression Scale Infant B Symmetry of head and facial features (including jaw angle, eye/ear position) B Oral anatomy (presence/absence (...) or feeding expressed breast milk to infants from an affected breast/nipple until the lesions are healed Vasospasm Shooting or burning breast pain with blanching and other color changes (purple or red) of the nipple associated with pain 38,39 Warmth (compresses, heat pads) following a breastfeed or whenever the mother experiences pain. Avoid cold on the breasts and nipples. Nifedipine 30–60mg sustained release daily or immediate release 10–20mg thrice a day for 2 weeks initially if pain persists. 54 (I

2016 Academy of Breastfeeding Medicine

19. Chest Pain and RBBB. What do you think?

episode of new chest pain ( TOP tracing in Figure-1 ). K EY P OINT — For as helpful as availability of the prior tracing in this case is in proving beyond doubt that there have been ECG changes since the prior tracing was done — this prior tracing should not be essential to “justify” the need for prompt cath lab activation. That’s because ample evidence was already present in ECG #1 by itself to justify prompt cath in this elderly patient with new-onset chest pain. Figure-1: TOP — Initial ECG (...) in this case, obtained from an elderly woman with new-onset chest pain. BOTTOM — Important abnormal ECG findings in this initial ECG are highlighted in RED ( See text ). ========================== For clarity — I have highlighted a number of important ECG findings in this patient’s initial ECG in RED in the BOTTOM illustration of Figure-1 . Some of these findings are subtle — but I believe they all are real. I also suspect that while ALL of these findings are “new” since the prior ECG was done

2018 Dr Smith's ECG Blog

20. Intense Pulsed Light Study for Dry Eye Disease

DED can experience symptoms of discomfort, blurry vision, redness, and pain. DED can also cause tears to become unstable which could result in damage to the front surface of the eye. There are two types of DED. The one the investigators are studying is called evaporative dry eye disease. This type of DED occurs because the pores on the eyelids are not functioning properly. In preliminary studies, a new treatment called Intense Pulsed Light (IPL) has shown promise to reduce signs and symptoms (...) treatment that was approved in 1995 by the FDA for dermatology. Participants will receive a total of 4 treatments over the course of the study. Placebo Comparator: Sham Treatment Participants will have the other eye randomized to receive a sham treatment. The sham treatment will be conducted by placing the intense pulsed light (IPL) device to approximately 15 areas around the eye, lower eyelid, cheek, side of nose and temple without delivery of the light. The sham treatment will mimic the IPL treatment

2017 Clinical Trials

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