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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. LipiFlow thermal pulsation treatment for dry eyes caused by blocked meibomian glands

(crossover group). Inclusion/ exclusion criteria As stated in Finis et al. (2014a) (see table 5). Outcomes Primary: subjective dry eye symptoms (OSDI and SPEED questionnaires). Secondary: TBUT, tear osmolarity, LLT, tear meniscus height, meibography, bulbar redness, ocular surface staining, LIPCOF and number of expressible meibomian glands. Statistical methods Descriptive statistics were used to present data in the form of the mean and SD. Paired t-tests were used to analyse the changes between time (...) : ANOVA, analysis of variance; MGD, meibomian gland dysfunction; OSDI, ocular surface disease index; SD, standard deviation; SPEED, standard patient evaluation of eye dryness; TBUT, tear break-up time. LipiFlow thermal pulsation treatment for dry eyes caused by blocked meibomian glands (MIB29) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 18 of 38T T able 4 Summary of the Greiner (2013) follow-up report to Lane et

2015 National Institute for Health and Clinical Excellence - Advice

4. 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

5. 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 (...) (e.g. , sicca syndrome) Eye scratchy or gritty sensation Wear Risk of infectious Photophobia l involvement (e.g. , ) ( ) ( ) (esp. s) (esp. , also causes ) with Eye Pain (emergent ophthalmology evaluation needed) ( ) HSV s III. Exam Increased (esp. >40-50 mmHg) ( ) pain ( ) (or ) Eyelid s Photophobia on penlight test (light applied from 6 inches for 2 seconds) uptake defects Afferent pupil defect ( ) Aniscoria ( s) ( ) Fixed, dilated pupil IV. Causes: Eye Pain with Visible lesions See Ocular

2018 FP Notebook

6. A case report of an extranodal NK/T-cell lymphoma nasal type, occurring primarily in eyes with masquerade syndrome. Full Text available with Trip Pro

and presented as masqueraded uveitis PATIENT CONCERNS:: A 55 years old female, with vision loss in the right eye for approximately 6 months, and vision blurry, redness and pain in the left eye for 2 weeks, was referred to our hospital.Clinical examinations and images demonstrated bilateral anterior uveitis, retinal and choroidal detachment, and secondary glaucoma. After 3 months, the patient began to present a sore throat, fever, and headaches. The computed tomography (CT) and magnetic resonance imaging (...) A case report of an extranodal NK/T-cell lymphoma nasal type, occurring primarily in eyes with masquerade syndrome. Extranodal natural killer T-cell lymphoma nasal type (ENKL) is an extremely rare tumor with a very low survival rate. In recent decades, only a few ENKL cases have been published. Presenting a special ENKL case lead the authors to emphasize the primary features of ENKL in early diagnosis and therapy. Here we report an unusual ENKL case which was initially found in the eyes

2019 Medicine

7. Dry eye syndrome

it be? There are many causes of red and/or painful eye, some of which are serious or sight threatening and require same day assessment by ophthalmology — for further information, see the CKS topic on . The differential diagnosis of dry eye syndrome includes: Allergic, infective or giant papillary conjunctivitis. Blepharitis. Keratoconjunctivitis. Exposure keratopathy. Nocturnal lagophthalmos (failure to close eyes at night). Ocular pemphigoid. Sjogren’s syndrome. Basis for recommendation Basis for recommendation (...) of dry eye syndrome vary from person to person but are usually bilateral and may include: Irritation or discomfort — this may be described as burning, stinging or a ‘gritty’ sensation. Dryness. Intermittent blurring of vision. Redness of the eyelids or conjunctiva. Itching. Photosensitivity. Mucous discharge. Ocular fatigue. Basis for recommendation Basis for recommendation The information on the clinical features of dry eye syndrome is based on the clinical guidelines Dry eye syndrome Preferred

2017 NICE Clinical Knowledge Summaries

8. 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 (...) Ophthalmic Solution Drug: Placebos Placebo ophthalmic solution Outcome Measures Go to Primary Outcome Measures : Fluorescein staining [ Time Frame: Day 29 ] Fluorescein staining; regions: inferior, superior, central, corneal sum, temporal, nasal, conjunctival sum, total eye will be measured using Total Ocular Surface Disease Index (OSDI) Secondary Outcome Measures : Lissamine green staining [ Time Frame: Day 29 ] Lissamine green staining; regions: inferior, superior, central, corneal sum, temporal, nasal

2018 Clinical Trials

9. 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

10. Treatment for Acute Pain: An Evidence Map

.* Swedish Health System, Swedish Pain Services Seattle, WA * These Key Informants also provided comments on the draft report. vi Peer Reviewers Prior to publication of the final evidence report, EPCs sought input from independent Peer Reviewers without financial conflicts of interest. However, the conclusions and synthesis of the scientific literature presented in this report do not necessarily represent the views of individual reviewers. Peer Reviewers must disclose any financial conflicts of interest (...) of these priority acute pain conditions have recent, high-quality systematic reviews evaluating acute pain treatments? a. Which populations, acute pain conditions, and treatments have been sufficiently systematically reviewed? b. What evidence gaps were identified in systematic reviews? 4. What original comparative effectiveness research is available evaluating acute pain treatments for priority acute pain conditions without recent high-quality systematic reviews? a. Which populations and settings have been

2019 Effective Health Care Program (AHRQ)

11. 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

12. 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 (...) : Sep 18, 2018 Author: Robert H Graham, MD; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Red Eye Overview Background A red eye is one of the cardinal signs of ocular inflammation, which can result from many conditions. Subconjunctival hemorrhage (see the image below), defined as blood between the conjunctiva and the sclera, is usually not secondary to inflammation. [ , ] Most cases of subconjunctival hemorrhage are benign and can be effectively managed

2014 eMedicine.com

13. 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

14. 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 (...) 18, 2018 Author: Robert H Graham, MD; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Red Eye Overview Background A red eye is one of the cardinal signs of ocular inflammation, which can result from many conditions. Subconjunctival hemorrhage (see the image below), defined as blood between the conjunctiva and the sclera, is usually not secondary to inflammation. [ , ] Most cases of subconjunctival hemorrhage are benign and can be effectively managed

2014 eMedicine.com

15. 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

16. Pupillometry Dynamic Measures in Patients Without Ocular or Neurological Disease

Pupillometry Dynamic Measures in Patients Without Ocular or Neurological Disease Pupillometry Dynamic Measures in Patients Without Ocular or Neurological Disease - 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. Pupillometry Dynamic Measures in Patients Without Ocular or Neurological Disease (PCT) 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: NCT02894281 Recruitment Status : Completed First Posted : September 9, 2016 Last Update Posted : July 7, 2017 Sponsor: Fondation Ophtalmologique Adolphe de

2016 Clinical Trials

17. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

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

18. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Comparative Effectiveness Review Number 209 Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review eComparative Effectiveness Review Number 209 Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290 (...) nonpharmacological treatments for common chronic pain conditions improve function and pain for at least 1 month after treatment. Key Messages • Interventions that improved function and/or pain for at least 1 month when used for— o Chronic low back pain: Exercise, psychological therapies (primarily cognitive behavioral therapy [CBT]), spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR). o Chronic neck pain: Exercise

2018 Effective Health Care Program (AHRQ)

19. Clinical Ultrasonography 101: Seeing Clearer with Ocular Ultrasound

Clinical Ultrasonography 101: Seeing Clearer with Ocular Ultrasound Clinical Ultrasonography 101: Seeing Clearer with Ocular Ultrasound - CanadiEM Clinical Ultrasonography 101: Seeing Clearer with Ocular Ultrasound In by Puneet Kapur November 16, 2016 Ever feel frustrated with your eye exam? Confused by the slit lamp and even more distressed at the thought of doing funduscopy? Point-of-care ultrasound (POCUS) is taking over emergency medicine and can definitely help improve your eye evaluation (...) . The eye is an ideal structure for viewing with ultrasound since it is a superficial structure that is conveniently filled with fluid. However, the spherical three-dimensional structure of the ocular globe can be confusing when trying to view it using a two-dimensional ultrasound image. This POCUS post offers an introduction to ocular ultrasound and some tips to make sure you capture every detail. Ocular Ultrasound Applications Ocular ultrasound has a range of clinical applications: painless vision

2016 CandiEM

20. 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

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