treatment plan

Device Helps With Diagnosis of Acute Conjunctivitis

BY JAMIE C. REID, OD, & LEO SEMES, OD, FAAO

A 59-year-old female presented to the clinic complaining of an extremely red eye, foreign body sensation, and slight soreness around her right eye. Her symptoms had started one day previously. Upon awakening the morning of the examination, she reported mucous-discolored discharge OD. When asked if she had recently been in contact with anyone who had “pink eye,” she remembered a co-worker having a red eye, secondary to unknown etiology, a week ago. This individual developed severe complications and was hospitalized for three days. The patient's medical history was unremarkable; however, her drug allergies included penicillin, Bactrim (sulfamethoxazole and trimethoprim), and Ciprofloxacin.

Confirming the Diagnosis

Upon examination, her corrected visual acuities were 20/20- OD and 20/20 OS. Slit lamp exam showed no adnexal edema, no palpable preauricular nodes, 2+ follicles located on inferior palpebral conjunctiva, and 2 to 3+ bulbar injection with the anterior chamber deep and quiet OD. The cornea was clear with no subepithelial infiltrates or fluorescein staining. Superior palpebral conjunctiva showed 1+ follicles and no papillae OD. The left eye was uninvolved. Her intraocular pressures measured 16mmHg OD and 17mmHg OS.

We performed an adenoviral Rapid Pathogen Screening test using the RPS Adeno Detector (Rapid Pathogen Screening, www.rps-tests.com) after examination. The adenoviral test was positive for adenoviral conjunctivitis OD, confirming clinical observations.

Treatment Plan

We educated the patient about adenoviral conjunctivitis and that antibiotic therapy would not benefit her. We recommended a simple in-office Betadine (5% ophthalmic prep solution, Purdue Pharma) therapy followed by Pred Forte (1% prednisolone acetate, Allergan) 1gt q2h for one day, tapering to 1gt q.i.d. after 24 hours, and artificial tears every hour while awake for one day. We also educated her on washing hands, washing pillowcases and sheets, and using separate linens. We instructed her to return in two days for a follow up.

She returned one week later. Slit lamp examination revealed healthy ocular surfaces OD and OS. She was feeling much better and reported no redness, pain, or foreign body sensation. We recommended a quick tapering schedule for the topical steroid.

Povidone iodine is an effective, simple, and nearly foolproof treatment strategy for adenoviral conjunctivitis. A recent pilot study (Pelletier et al, 2009) revealed a combination of povidone iodine and topical steroid therapy resolved adenoviral conjunctivitis successfully within three or four days. We need to take a closer look at Betadine therapy and the value it has for our patients.

A Helpful Diagnostic Tool

Many times as eyecare professionals we base our diagnosis on symptoms. This patient's symptoms were vague, which often causes confusion between bacterial versus viral conjunctivitis. The RPS Adeno Detector was very helpful in guiding us to the correct diagnosis and treatment recommendations. It uses lateral flow immunochromatography and can provide results in 10 minutes. This is a simple, quick procedure to help aid diagnosis and management of red eye office visits. This test is FDA-approved and CLIA-waved. Medicare and other insurers will reimburse for it under the CPT code 87809QW. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #170.

Dr. Reid is an assistant professor at the University of Alabama at Birmingham School of Optometry. Dr. Semes is a professor of optometry at the UAB School of Optometry.