1
NursingStandard
ophthalmology
REDEYE
Assessment,careandmanagementofpatientswitharedeyeWatkinsonS,SeewoodharyR(2017)Assessment,careandmanagementofpatientswitharedeye.NursingStandard.
Dateofsubmission:22May2017;dateofacceptance:1August2017.doi:10.7748/ns.2017.e10902
SusanWatkinson
Associatelecturer,CollegeofNursing,MidwiferyandHealthcare,UniversityofWestLondon,WestLondoncampus,Brentford,
Middlesex,England
RameshSeewoodhary
Seniorlecturer,CollegeofNursing,MidwiferyandHealthcare,UniversityofWestLondon,London,England
Correspondence
Conflictofinterest
Nonedeclared
Peerreview
Thisarticlehasbeensubjecttoexternaldouble-blindpeerreviewandcheckedforplagiarismusingautomatedsoftware
Online
Forrelatedarticlesvisitthearchiveandsearchusingthekeywords.Guidelinesonwritingforpublicationareavailableat:
rcni.com/writeforus
Abstract
Redeyeisacommonocularpresentationinprimarycare,andthereareseveralchallengesthatmaybeencounteredwhencaring
forsuchpatients.Themainocularconditionsthatcangiverisetoaredeyeare:primaryacuteangleclosureglaucoma,acuteiritis,
dryeye,chronicblepharitisandconjunctivitis.Redeyecanbeclassifiedassight-threateningornon-sight-threatening.Whenredeye
isassociatedwithpain,photophobia,wateringandblurredvision,itispotentiallysight-threateningandmustbeaddressedurgently.
Therefore,itisvitalforhealthcarepractitionerstobeabletoundertakeacarefulassessmentofthepatientandmakeanaccurate
diagnosisearly.However,manypatientspresentingwithapainlessredeyeandnormalvisionusuallyrecoverwell.Thisarticle
providesanoverviewofthecommoncausesofredeyeencounteredingeneralpracticeoraneyeclinic.Itdiscussesthenurse’srole
inthecareandmanagementofpatientswitharedeye,withreferencetopatientassessment,theskillsrequiredtomakeanaccurate
diagnosis,treatmentandhealthpromotion.
2
Keywords
blepharitis,conjunctivitis,eyeconditions,healthpromotion,iritis,ocularhealth,ophthalmology,primaryacuteangleclosure
glaucoma,redeye
REDEYEisacommonocularpresentationinprimarycare.Itcanbeclassifiedassight-threateningornon-sight-
threatening(Batterburyetal2009).Inthisarticle,primaryacuteangleclosureglaucoma(PAACG)andacuteiritiswillbe
consideredsight-threateningconditions,whiledryeye,chronicblepharitisandconjunctivitiswillbeconsiderednon-sight-
threateningconditions.Effectiverecognitionofthesignsandsymptomsofalltheseconditionsenableshealthcare
practitionerstodistinguishbetweenasight-threateningandnon-sight-threateningocularconditionandiscentralto
successfulmanagementandcareofthepatient(Watkinson2013).
Knowledgeofthemainstructuresoftheeye,showninFigure1,canassistthenursetodeveloptheirskillsinocular
observationandeffectiveassessmentofthepatientpresentingwitharedeye.Thisarticleisaimedatophthalmicnurses,
generalnursesandallalliedhealthcarepractitionersworkinginhospital,particularlythoseinemergencydepartments,GP
surgeriesandcommunitysettings.Itprovidesanoverviewofthenurse’sroleintheassessment,care,managementand
healthpromotionofpatientspresentingwitharedeye.Italsodiscussestheskillsandresponsibilitiesinvolvedin
establishingaccuratediagnosisandmakingpromptreferralforappropriatetreatmenttorelieveocularpain,restorevisionor
preventpotentialsightloss.
Figure1.Diagramofthemainstructuresoftheeye
[Ed note: figure to be re-used from Watkinson 2013]
AssessmentHistory-takingisanimportantcomponentofassessingapatientwithredeye.Box1listsquestionsthathealthcare
practitionerscouldaskthepatientaspartofhistory-taking.Listeningattentivelyandaskingappropriatequestionsrelatedto
visionareessentialtoeffectivepatientassessment.Thenurseshouldassessandrecordthevisualacuityofeacheye–a
medico-legalrequirement–toestablishthemainvisualcomplaint,durationoftheconditionanditseffectonthepatient’s
qualityoflife(WilliamsonandSeewoodhary2013).Itisimportanttoaskthepatientwhethertheeffectontheirvisionis
transient,deteriorating,orimproving.Usingapentorchisbestpracticeandrecommendedforexaminingtheanterior
segmentoftheeyeandmakingobservations(Watkinson2013).
Box1.History-takingquestionsinrelationtothesymptomsofredeye
Duration
• Howlonghastherednessbeenpresent?
• Istheeyepainfulorsore?
• Doestheeyeitch?
• Doestheeyewater?
• Isthereanylightsensitivity?
• Isthereapasthistoryofredeye?
• Isthereanyyellowpurulentdischargeorcrustiness?
• Isthevisionblurred?
• Doestheeyefeeldryandburning?
3
Onset
• Isitunilateralorbilateral?Whendiditcomeon?
• Wasthatsuddenorgradual?
• Isitconstantitchiness?
• Isitworsewhenoutdoors?
• Whendidyounoticethat?Whatcausedit?
• Isitworseonwakingup?Whendidyounoticeit?Describewhatyousee.
• Howlonghaveyounoticedit?
(AdaptedfromWatkinson2013)[Q1.Icouldn’tfindthisinformationinWatkinson2013–isitfromanothersource?]
Sight-threateningredeyeconditionsPrimaryacuteangleclosureglaucoma
PAACG(Figure2)isaconditioninwhichthereisasuddenincreaseinintraocularpressure(IOP).Thisresultsfrom
obstructionofaqueousoutflowbypartialorcompleteclosureofthedrainageanglebytheperipheraliris(Bowling2015).
ThenormalIOPisbetween14and21mmHg(YanoffandDuker2013).InPAACG,itcouldriseto70mmHg,causingdamageto
theopticnervehead(YanoffandDuker2013).Thisisanocularemergencyandshouldbetreatedimmediatelytoprevent
sightlosstobotheyes,sinceitispotentiallyabilateraldisease.ThesignsandsymptomsofPAACGarelistedinBox2.
Figure2.Primaryacuteangleclosureglaucoma
[Ed note: figure to be re-used from Watkinson 2013]
Box2.Signsandsymptomsofprimaryacuteangleclosureglaucoma
• Dusky,congestedredeye
• Hazycornea
• Limbus–markedciliaryinjection
• Shallowanteriorchamber
• Congestedanddulliris
• Oval-shapedandunreactivepupil
• Pupillaryblock
• Visionisreduced
• Seeinghaloesaroundlights
• Severeocularpainradiatingtotheforehead,lacrimationandphotophobia
• Headacheandnausea
• Abdominaldiscomfort
(AdaptedfromWatkinson2013)
Pre-disposingfactorsforPAACGinclude(Bowling2015):
• Olderagewithhypermetropia(long-sightedness).Olderwomenaremoreatriskthanmen.
• Sustainedpupildilation,whichmaybetriggeredbyinstillingdilatingdrugssuchas1%atropinesulfate.
4
• Occasionalexcessivepupildilation,whichmaybeprecipitatedbylowlightoremotionssuchasfear,anxiety,stressand
sadness.[Q2.bulletpointsreworded–pleasecheckthatyourmeaninghasbeenpreserved]
Treatmentandclinicalmanagement
DuringanacuteepisodeofPAACG,thepatientusuallyexperiencesanxiety,distressandnausea(Watkinson2013).
ProvidingreassurancethatocularpainwillsubsideoncetheIOPisundercontroliscomfortingandreducesanxiety.The
patientshouldbeencouragedtorestinaquietenvironment(Bowling2015).
TreatmentofPAACGvariesaccordingtohospitalpolicy.Itisimportanttorecordbaselineobservationsofvisualacuity
andIOP.First,500mgintravenousacetazolamide,acarbonicanhydraseinhibitor,isadministeredtoreduceIOPby
decreasingaqueousproduction.After20minutes,2-4%pilocarpineeyedropsareinstilledintotheaffectedeyeto
openupthedrainagesystembyconstrictingthepupil.ThisalsoreducestheIOP.0.25%timololmaleateeyedrops,a
beta-blocker,and0.5%apraclonidineeyedrops[Q3.couldn’tfind0.5%apraclonidineintheBNF-isthiscorrect?],
analpha-adrenergicagonist,arealsoinstilledtoachieveimprovedoutcomes[Q4.istheinformationherean
exampleofthetreatmentthatcouldbeusedforPAACG?Suggestclarifyingsincepreviouslyitstatesthattreatment
variesaccordingtohospitalpolicy](Bowling2015).Beta-blockersshouldbeusedwithcautionbecausetheyare
contraindicatedinpatientswithchronicobstructivepulmonarydiseaseorcardiovasculardisease(BritishNational
Formulary2017).0.1%dexamethasoneeyedropsareinstilledtoreduceinflammationandcongestion.Artificialteardrops
arealsousedtoprovidecomfort.Anantiemeticmaybeadministeredasrequired.TheIOPismonitoredintheemergency
department.Theultimatesurgicaltreatmentiscataractsurgeryorlaseriridotomytoimprovedrainageofaqueoushumour,
thusloweringIOP(Azuara-Blancoetal2016).
Acuteiritis
Acuteiritisisanacuteinflammationoftheiris(Figure3).Thecauseisusuallyunknown,butmaybeassociatedwith
underlyingsystemicconditions,suchasrheumatoidarthritis,Crohn’sdisease,Still’sdisease,andankylosingspondylitis.One
orbotheyescanbeaffected(YanoffandDuker2013)andtheconditionoftenprogressesconsiderablybeforeanaccurate
diagnosisismade(Batterburyetal2009).Box3liststhesignsandsymptomsofacuteiritis.
Thereisachronicformofiritisthatcanoccur,butwithlesspainandrednessthaninacuteiritis.Chroniciritiscanbe
causedbysarcoidosis,heterochromiaandtuberculosis(YanoffandDuker2013).Suchpatientsrequireregularfollow-upin
aneyeclinic.
Figure3.Acuteiritis
[Ed note: figure to be re-used from Watkinson 2013]
Box3.Signsandsymptomsofacuteiritis
• Redeyewithmarkedciliaryinjection
• Lidsmayappearswolleninsomepatients
• Cornea:maybeclearbuthaskeraticprecipitates(clumpsofinflammatorycellsonthecornealendothelium)
• Anteriorchamber:inflammatorycellsandflare(aproteinaceousexudateintheanteriorchamber)andpossible
hypopyon(acollectionofinflammatorycellssettlingintheinferioranteriorchamber)
• Iris:muddyanddull
• Pupil:smallandsluggishreaction,andmaybeirregularfromposteriorsynechiae(formationofadhesionsbetweenthe
irisandthelens)
• Dullpainatthebackoftheeye,lacrimation,photophobia,blurredvision
5
• Vision:normalinitiallybutbecomingblurredifsevere
(Seewoodhary2009)
Treatmentandclinicalmanagement
Followingdiagnosis,treatmentiscommencedwithdilatingdropssuchas1%cyclopentolatehydrochloridetoprevent
adhesionandrelieveciliaryspasmandpain.Corticosteroideyedropssuchas0.5%dexamethasone[Q5.couldn’tfind0.5%
dexamethasoneintheBNF-isthiscorrect?]areprescribedtotreattheinflammationandpromotehealing(Batterburyet
al2009).Asubconjunctivalinjectionofmydricaineisgiventopatientswhohavedevelopedposteriorsynechiae,tobreak
adhesionsbetweentheposterioririsandlenssurface.Delayintreatmentusuallyresultsinadhesionformation.Systemic
corticosteroidsandimmunosuppressantsarereservedforsight-threateningdisease(Batterburyetal2009).
Itisimportantthatpatientspresentingwithrecurrentacuteiritishavebaselineinvestigationsundertaken.Theseinclude
erythrocytesedimentationrate,fullbloodcount,serumangiotensin-convertingenzymelevel,syphilisserology,human
leucocyteantigentyping,andchestandsacroiliacjointXraystoestablishevidenceofunderlyingsystemicdisease.The
patientmayrequiremedicalreferralforfurtherinvestigationandmanagement(Batterburyetal2009).
Thenurseshouldexplaintothepatientthatadilatedpupilcausesblurredvision,thusdrivingisnotrecommendeduntil
theireyehasfullyrecovered.Regularattendanceataneyeunitforassessmentandmonitoringoftheconditionisessential
untilthishasresolved.Counsellingabouttherecurrentnatureoftheconditionandtheneedfortreatmentofrecurrent
episodesisimportanttopreventseriouslong-termcomplications(ShawandLee2016).
Non-sight-threateningredeyeconditionsBlepharitis
Blepharitisisachronicinflammatoryconditionaffectingtheeyelidmargin(DinandPatel2012),andaccountsfor5%of
allophthalmologicalconditionspresentinginprimarycare(NationalInstituteforHealthandCareExcellence2015).The
eyelidmarginsarelinedwithsebaceousglandsthatproduceathin,clearoilymaterialcontributingtotearfilmstabilityand
cornealclarity.Unexplainedinflammationofthoseoilyglandsmaycontributetotearfilminstabilityanddryeyes
[Q6.resultinginblepharitis?](DinandPatel2012).Box4liststhesignsandsymptomsofblepharitis.
Box4.Signsandsymptomsofblepharitis
• Asymptomatic
• Redness
• Itching
• Burning
• Crusting
• Stickinessand/orlossofeyelashes
• Tearing
• Lightsensitivity(sometimes)[Q7.doesthismeanlightsensitivityonlyoccursinsomepatientswithblepharitis,orthatit
onlyoccurssometimesi.e.occasionally?]
• Blepharospasm(spasmoftheorbicularismuscle)
(AdaptedfromYanoffandDuker2013)
Blepharitisisclassifiedasbeinganteriororposterior(TheCollegeofOptometrists2016).Anteriorblepharitis(Figure4)
isacommonchronicbilateralinflammationofthelidmargins(Riordan-EvaandCunningham2011).Itiscommonlycaused
byStaphylococcusaureus,seborrhoeaandDemodexfolliculorum(DinandPatel2012).
6
Figure4.Anteriorblepharitis
[Ed note: authors to obtain permission for use and send figure as separate jpg]
Posteriorblepharitis(Figure5)iscausedbydysfunctionofthemeibomianglands,whichareinthetarsalplateofthe
eyelid.Thereareusually30-40meibomianglandsinthetarsalplateoftheuppereyelidand20-30inthetarsalplateofthe
lowereyelid(YanoffandDuker2013).Thickeningofthelipidcompositionofthoseglandsleadstoreduceddeliveryofoily
secretiontotheocularsurface.Tearfilminstabilityanddryeyesarecommoninposteriorblepharitis(YanoffandDuker
2013).
Figure5.Posteriorblepharitis
[Ed note: authors to obtain permission for use and send figure as separate jpg]
7
Treatmentandmanagement
Lidhygieneisessentialinthemanagementofblepharitisandtwice-a-daybathingofeyelidsisrequiredforpatientswith
anteriorblepharitis(DinandPatel2012).Theuseofawarmedflanneltoaclosedeyeisalsorecommendedtoloosenand
softentheencrustationsandsecretionsfromtheglands.Thisisoftencombinedwithwarmcompressesandeyelidmassage,
whichreducethebacterialloadonthelidmarginsandimprovethequalityofmeibomianglandsecretions[Q8.whatis
meantbyqualityinthiscontext(andbelow)?](Jackson2008).
Patientsrequireinstructionsonlidhygieneandhowtoapplyawarmcompressusingaflanneldippedincomfortably
warmwatertotheclosedeyelidfor5-10minutes.Oncetheconditionsettles,patientsareadvisedtocontinuewithdailylid
hygienetopreventarecurrence.Intheacutestage,anantibioticointmentisprescribed,suchaserythromycin,forapplication
specificallytothelidmargintoavoidcornealtoxicity(YanoffandDuker2013).Patientswithposteriorblepharitisrequire
long-termsystemicantibioticssuchas20mgoraldoxycycline.Morerecently,topical1%azithromycin[Q9.couldn’tfind1%
azithromycinintheBNF–isthiscorrect?]–aneyedrop–hasbecomeaneffectivetreatmentforposteriorblepharitis
becauseitimprovesthequalityoftearsandglandsecretionandprovidesoverallsymptomrelief(YanoffandDuker2013).
Artificialteardropsarealsorecommendedforocularcomfort.Healthyeating,includingoilyfishrichinomega3,hasbeen
foundtoimprovethequalityofthemeibomiansecretion(DinandPatel2012).VitaminEisalsobeneficialinmaintainingthe
integrityoftheoilylidsecretion.Theuseofacorticosteroidcombinedwithantibioticsmaybeusefulifthelidinflammationis
severe.However,thepatientshouldbemonitoredinaneyeclinicforside-effectssuchascataract,glaucomaandcorneal
thinning(DinandPatel2012).
Dryeye
Dryeyeisreducedtearflowandincreasedevaporationoftearsthatischaracterisedbyocularirritationandvisual
disturbance.Excesstearingcanalsobeasymptom(YanoffandDuker2013).However,itcancauseredeyeandocularsurface
disease,whichmaydevelopintomoresevereeyecomplicationssuchascornealulcerationandconjunctivitis(Foulks2007).
Itrangesinseverityfrommildlyirritatingtoseverelydisabling(SeewoodharyandAwelewa2014).Theincidenceofdryeye
rangesfrom3%to15%inpatientsagedover50yearsandto17%inthoseover80years[Q10.pleasecheckthese
figuresarecorrect–Icouldn’tfindthe15%or17%figuresinthereference](Schaumbergetal2009).Dryeyeisan
under-recognisedcondition,whichcanaffectthepatient’squalityoflifebecauseitreducestheabilitytodriveandread
(SeewoodharyandAwelewa2014).
Dryeyecanaffectanyoneofthethreelayersofthetearfilm,namelytheouterlipid,middlewateryandinnermostmucin
layers.Figure6showsthetearfilmlayers,whileFigure7showsaredeyecausedbydryeye.
Figure6.Tearfilmlayers
(Watkinson2014.CreatedbyMaryBloodforMikeRoberts.ReproducedwiththekindpermissionofM&KPublishing)[Q11.isthis
correct?]
Figure7.Dryeye
8
[Ed note: authors to obtain permission for use and send figure as separate jpg]
Patientsexperiencingdryeyesusuallyreportburning,itching,foreignbodysensation,stinging,dryness,photophobia,
ocularfatigueandredness(YanoffandDuker2013).Theconditionismadeworseifthepatientalsohasanteriorand/or
posteriorblepharitis.Posteriorblepharitisiscommoninmeibomitis,aconditionwherethemeibomianoilglandsbecome
inflamedandinfected(Törnquist2012).Thepatient’shistoryisclassic[Q12.meaningunclear–couldthisbeclarified/
rephrased?],butholisticassessmentisimportantbecausesystemicdiseasessuchasthyrotoxicosis,Sjogren’ssyndrome,
diabetesmellitus,arthritis,lupuserythematosus,sarcoidosis,shinglesorvitaminAdeficiencyarealsoknowntoleadtodry
eyes(YanoffandDuker2013).Somemedicationsmayalsocausepoortearsecretion[Q13.whatismeantbypoorinthis
context?Reduced?],includingantidepressants,aspirin,antihistamines,diuretics,beta-blockers,post-menopausaloestrogen
therapy,corticosteroidsandatropineeyedrops(Törnquist2012).Additionalcausesincludealossofsensorydrivetothe
lacrimalglandthatoccursinherpeszosterophthalmicus,andoveruseofanaestheticeyedrops(Törnquist2012).
Management
Replacementteardroptherapy,treatingtheunderlyingcauseandmaintainingoptimumlidhygieneareimportantto
preventcomplications,promoteocularcomfortandpreservesight.Adietrichinomega3and6isrecommendedtomaintain
healthymeibomianoilsecretion.Therefore,oilyfishsuchassalmonandtunashouldberecommended(RoyalNational
InstituteoftheBlind2016).Patientswhoarevegetarianmaybenefitfromaddingflaxseedtotheirdailydiet(RoyalNational
InstituteoftheBlind2016).Dryeyeisproblematicandrequireseffectivemanagementinaneyeclinictopreventblindness.
Conjunctivitis
Conjunctivitisisthemostcommoncauseofredeye(Cronauetal2010).Infectiousconjunctivitisisclassifiedasbacterial,
viral,chlamydialandfungal(YanoffandDuker2013),ofwhichbacterialandviralinfectionarethemostcommontypes.
Chemicalirritants,traditionaleyeremediesorallergyshouldberuledout[Q14.couldwesay‘shouldbeinvestigated
aspossiblecauses’,ratherthanruledout?].Table1liststhecausesofconjunctivitisandhowtheyprimarilyaffectvarious
agegroups.
Table1.Causesofconjunctivitisandhowtheyprimarilyaffectvariousagegroups
New-bornbabies Children Adults
Viralinfection Uncommon Usuallyaffectsbotheyes Usuallyaffectsbotheyes
Bacterialinfection Maybesevereandsight-
threatening
Mayaffectoneorboth
eyes.Maybesevereand
sight-threatening
Mayaffectoneorboth
eyes.Maybesevereand
sight-threatening
Chlamydia Cancauseconjunctivitis Causestrachoma,which
usuallyaffectsbotheyes
Usuallyaffectsbotheyes
Allergy Uncommon Usuallyaffectsbotheyes Uncommon
Chemicalirritants Uncommon Canaffectoneorbotheyes Canaffectoneorbotheyes
Traditionaleyeremedies Uncommon Canaffectoneorbotheyes Canaffectoneorbotheyes
(SenaratneandGilbert2005)[Q15.note:somewordingchangesmadeinaccordancewiththereference.Doyouhave
permissiontoreproducethistableinyourarticle?]
Bacterialconjunctivitis(Figure8),commonlycausedbyS.aureus,ischaracterisedbyarapidonsetofbilateralredeyes,
lidswellingandapurulentyellowdischarge(Watkinson2013).Thepatient’svisionandpupilresponseareunaffected,unless
thecorneabecomesinfected(YanoffandDuker2013).Itisimportantthatthenurseisthoroughwhenassessingpatients
presentingwitharedeye,sinceanaccuratediagnosisisessentialtoinitiateappropriatetreatmentorreferraltoaclinic.
Marsden(2011)emphasisedtheuseoftriageforpatientswhoattendwitharedeye,toavoidunnecessarydelayfor[Q16.
treatmentandmanagementof?]emergencyredeyeconditions,forexamplegonococcalconjunctivitis.
9
Figure8.Acutebacterialconjunctivitis
[Ed note: figure to be re-used from Watkinson 2013] Conjunctivitismaysettlebyitselfinmostadultpatients.However,babiespresentingwithapurulentgreenishyellow
dischargeandswollenlidsshouldbeclassifiedasanemergencybecauseGram-negativeNeisseriagonococcuscanpenetrate
theintactepitheliumandprogressrapidlytocornealperforationandsightloss(YanoffandDuker2013).Conjunctivitisin
new-bornbabies[Q17.wherenew-bornbabiesisused,oktochangetoneonates?]isreferredtoasophthalmia
neonatorum.Prompttreatmentwithlocalandsystemicantibiotictherapywillimprovethecondition.Themotherandher
sexualpartnershouldalsobetreatedwithasystemicantibiotic(Marsden2011).
Management
Patientswithacutebacterialconjunctivitisareprescribedtopicalantibioticstospeedrecovery(Marsden2011).Itisthe
nurse’sresponsibilitytoinformpatientsaboutthehighlycontagiousnatureofthecondition(Watkinson2013).Therefore,it
isimportantthatallpatientsandtheirparentsaregivenwritteninformationontheprecautionarycarerequiredtoprevent
spreadofthediseasetoothers.Forexample,thismightincludekeepingthepatient’stoiletries,towelsandfaceflannels
separatefromthoseofotherfamilymembers.Papertissuesshouldbeusedanddisposedofafterasingleuseandthe
importanceofhandwashingbeforeandaftertheinstillationofantibioticeyedropsshouldbereinforced(Watkinson2013).
Thepatientshouldalsobeadvisedtoweardarkglassesforcomfort,buttheuseofaneyepadisnotrecommended
(Watkinson2013).
HealthpromotionPromotinghealthisanessentialnursingresponsibility,andthisshouldbepatient-centred,empoweringandtailoredto
thepatientandtheirdiagnosis(NursingandMidwiferyCouncil2015).Followingocularassessmentanddiagnosis,thenurse
hasadutytoeducatepatientsandrelevantothersaboutthenatureoftheocularcondition(Marsden2017)andadviseabout
promotingrecoveryorhealing(Tallouzi2011).Forexample,healthyeatingisessentialforocularhealth.Itisimportantto
considerpainmanagementininflammatoryeyeconditions.Healtheducationinformationshouldalsobegiventoensurethe
patientunderstandshowtousemedicationbeforeleavingtheclinic(Marsden2011).InPAACG,patientsshouldbetaught
howtousetheeyedropsuntiltheirsurgery.Teachingtheprinciplesofhygieneisvitalininfectedcasesofredeye.
Furthermore,ifthepupilisdilated,thepatientshouldbeadvisedaboutthehazardsofdriving(Marsden2017).
ConclusionNursingskillsandresponsibilitiesinvolvedinestablishingaccuratediagnosisofredeyeandmakingpromptreferralfor
appropriatetreatmentispivotaltorelievingocularpain,restoringvisionorpreventingpotentialsightloss.Ifdiagnosisis
unclear,referraltoanophthalmologistisessentialtoavoidadversevisualconsequences.Thefivemainocularconditions
givingrisetoaredeyearePAACG,acuteiritis,dryeye,chronicblepharitisandconjunctivitis.Itisimportantforthenurseto
beabletorecognisethesignsandsymptomsofsuchconditions.Moresignificantly,thenurseshouldbeabletodistinguish
betweenasight-threateningandnon-sight-threateningocularconditionandtakeappropriateaction.Thenurse’srole
remainsvitalinaddressingthechallengesassociatedwiththecareandmanagementofpatientswitharedeyeand
preventingthepossibilityofsightloss.
ReferencesAzuara-BlancoA,BurrJ,RamsayCetal(2016)Effectivenessofearlylensextractionforthetreatmentofprimaryangle-closureglaucoma(EAGLE):arandomisedcontrolledtrial.TheLancet.388,10052,1389-1397.
10
BatterburyM,BowlingB,MurphyC(2009)Ophthalmology.AnIllustratedColourText.Thirdedition.Elsevier,Edinburgh.BowlingB(2015)Kanski’sClinicalOphthalmology:ASystematicApproach.ElsevierHealthSciences,London.BritishNationalFormulary(2017)BritishNationalFormulary.No.73.BMJGroupandtheRoyalPharmaceuticalSocietyofGreatBritain,London.CronauH,KankanalaRR,MaugerT(2010)Diagnosisandmanagementofredeyeinprimarycare.AmericanFamilyPhysician.81,2,137-144.DinN,PatelNN(2012)Blepharitis–areviewofdiagnosisandmanagement.InternationalJournalofOphthalmicPractice.3,4,150-155.FoulksGN(2007)DEWSReport:amissioncompleted.OcularSurface.5,2,65-66.JacksonWB(2008)Blepharitis:currentstrategiesfordiagnosisandmanagement.CanadianJournalofOphthalmology.43,2,170-179.MarsdenJ(2011)Redeye:presentation,diseaseprocessandevidence-basedcare.InternationalJournalofOphthalmicPractice.2,2,80-88.MarsdenJ(Ed)(2017)OphthalmicCare.Secondedition.M&KPublishing,Cumbria.NationalInstituteforHealthandCareExcellence(2015)Blepharitis:Prevalence.cks.nice.org.uk/blepharitis#!backgroundsub:2(Lastaccessed:8November2017.)NursingandMidwiferyCouncil(2015)TheCode:ProfessionalStandardsofPracticeandBehaviourforNursesandMidwives.NMC,London.Riordan-EvaP,CunninghamETJr(2011)Vaughan&Asbury’sGeneralOphthalmology.18thedition.McGraw-HillMedical,NewYorkNY.RoyalNationalInstituteoftheBlind(2016)NutritionandtheEye.www.rnib.org.uk/eye-health/looking-after-your-eyes/nutrition-and-eye(Lastaccessed:8November2017.)SchaumbergDA,DanaR,BuringJEetal(2009)PrevalenceofdryeyediseaseamongUSmen:estimatesfromthePhysicians’HealthStudies.ArchivesofOphthalmology.127,6,763-768.SeewoodharyM(2009)Eyeemergencies–accidentandemergencyophthalmicpractice.InWatkinsonS(Ed)IssuesinOphthalmicPractice:CurrentandFutureChallenges.M&KPublishing,Cumbria,47-90.SeewoodharyM,AwelewaC(2014)Commonexternaleyedisordersinolderpeople.InWatkinsonS(Ed)OlderPeoplewithVisualImpairment:ClinicalManagementandCare.M&KPublishing,Cumbria,101-124.SenaratneT,GilbertC(2005)Conjunctivitis.CommunityEyeHealthJournal.18,53,73-75.ShawME,LeeA(2016)OphthalmicNursing.Fifthedition.CRCPress,BocaRatonFL.TallouziM(2011)Chlamydialconjunctivitis:presentationandinvestigations.InternationalJournalofOphthalmicPractice.2,3,139-143.TheCollegeofOptometrists(2016)Blepharitis(LidMarginDisease).Version14.TheCollegeofOptometrists,London.TörnquistAL(2012)Dryeyedisease:simpletodiagnosebutcomplextomanage.InternationalJournalofOphthalmicPractice.3,5,194-202.WatkinsonS(2013)Assessmentandmanagementofpatientswithacuteredeye.NursingOlderPeople.25,5,27-34.WatkinsonS(Ed)(2014)OlderPeoplewithVisualImpairment:ClinicalManagementandCare.M&KPublishing,Cumbria.WilliamsonS,SeewoodharyR(2013)Cataractblindnessinolderpeopleandsightrestoration:areflection.InternationalJournalofOphthalmicPractice.4,5,212-218.YanoffM,DukerJS(Eds)(2013)Ophthalmology.Fourthedition.SaundersElsevier,PhiladelphiaPA.
