Is This the New Norm?

Is Point-of-Care Testing for Red Eye the New Norm?

BY MILE BRUJIC, OD, FAAO, & DAVID L. KADING, OD, FAAO

A 26-year-old female who wears contact lenses came in for an emergency appointment. She said that a few days earlier, her right eye started to get red and had been getting worse since then. She had been wearing her contact lenses for the last few days, but on the morning of the exam she arrived without her contact lenses on. She reported decreasing comfort and some mild light sensitivity. She also reported some discharge in her right eye. She denied abusing her contact lenses and reported using the same multipurpose care solution that had been recommended.

With this clinical presentation, we often assume that patients have abused their contact lenses, resulting in a red eye associated with overwear or noncompliant behaviors, even when they report otherwise. But, are we ruling out all of the other possibilities?

The Cause

Clinically, we know that a lot of conditions can cause conjunctival hyperemia. Contact lens abuse can cause this to occur, but a number of other conditions may result in an acute red eye—most common ones include bacterial, viral, and allergic disease.

When infiltrates are present, we need to rule out contact lens abuse, Thygeson’s superficial punctate keratitis, epidemic keratoconjunctivitis, and adult inclusion conjunctivitis, among others. We cannot assume that the red eye is secondary to contact lens abuse until we rule out other etiologies.

The Test

The AdenoPlus (Rapid Pathogen Screening, Inc.) is a point-of-care test that allows clinicians to determine the presence or absence of adenovirus within 10 minutes of testing. To perform the test, the sample collector is dabbed and dragged six to eight times along the palpebral conjunctiva of the affected eye. The sample collector is then snapped into the test cassette, which is then dipped into a buffered vial for 20 seconds. The test then sits for 10 minutes. If the test is performed properly and an adequate sample has been collected, a blue line will show up in the test. If adenovirus is present, a second red line will show up in the viewing window (Figure 1).

Figure 1. The top test is negative for adenovirus. The bottom test is positive for adenovirus.

This test allows for the immediate determination of the presence or absence of adenoviral antigens in the tissue to help guide the course of treatment. Additionally, a number of our patients are contact lens wearers, which adds another level of complexity to the differential.

The Verdict

Although this test checks only for the adenovirus, it allows us to determine whether a red eye is secondary to an adenoviral infection. This can lead to a greater chance of an accurate diagnosis and proper treatment. It is definitely worth considering in your assessment of patients who present with an acute red eye. CLS

Dr. Brujic is a partner of Premier Vision Group, a three-location optometric practice in northwest Ohio. He has received honoraria in the past two years for speaking, writing, participating in an advisory capacity, or research from Alcon Laboratories, Allergan, B+L, Optovue, Nicox, Paragon, SpecialEyes, TelScreen, Transitions, Valeant Pharmaceuticals, Valley Contax, VMax Vision, VSP, and ZeaVision. Dr. Kading owns the Specialty Dry Eye and Contact Lens Center in Seattle, Wash. He is the co-owner of Optometric Insights with Dr. Brujic. He has received honoraria for consulting, performing research, speaking, and/or writing from Alcon Laboratories, Allergan, Bausch + Lomb, Biotissue, Contamac, Essilor, Nicox, Oculus, RPS Detectors, TearScience, Valley Contax, and ZeaVision. Follow him on Twitter @davekading.