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Test provides diagnostic evidence for patients who have acute red eye
The test lets practitioners tailor treatment options to improve outcomes and avoid unnecessary antibiotics.
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More and more frequently, acute red eye is treated at the front line by general practice ophthalmologists, pediatric ophthalmologists and optometrists because ophthalmic specialists are relied on more for surgical care.
In my multispecialty practice, the Red Eye Protocol with the point-of-care diagnostic test AdenoPlus (Nicox) is used to aid in the differential diagnosis of acute red eye by validating the presence of or ruling out adenoviral conjunctivitis. The protocol allows for appropriate management based on diagnostic evidence rather than an empirical diagnosis. The benefits of adopting the Red Eye Protocol in my practice have been that it provides an accurate diagnosis, prevents the spread of infection and reduces unnecessary antibiotic prescriptions. Furthermore, it is easy for my staff to implement, allowing my patients to be managed more efficiently. Additionally, the AdenoPlus test is reimbursable, so it makes sense from a business perspective, as well.
Defining red eye
To understand the confusion associated with the differential diagnosis of an acute red eye, it is important to define it. Red eye can present in the form of dry eye, allergic, bacterial or viral conjunctivitis, or blepharitis. Symptoms of dry eye may include decreased tear production and increased tear evaporation. Under the diagnostic tree of allergic conjunctivitis, symptoms include a bilateral presentation, conjunctival edema and/or hyperemia, chemosis, lid edema, watery discharge, ocular itching, burning, tearing, photophobia, foreign body sensation and blurred vision. Under the diagnostic tree of bacterial conjunctivitis, a patient may present with unilateral or bilateral acute onset, pain, marked lid edema, a large amount of purulent discharge, marked conjunctival hyperemia and possible membrane formation. Patients with blepharitis may experience redness, irritation, burning, tearing, itching, crusting of the eyelashes and many other symptoms.
Each of these conditions often has a similar presentation to one another and presents similarly to viral conjunctivitis. As a result, viral conjunctivitis — of which the majority of cases are caused by adenovirus — is often missed. It has been reported that one out of every four cases of conjunctivitis seen by eye care professionals is actually caused by adenovirus, which is a lot higher than many of us would think. These patients who are misdiagnosed end up being treated for the wrong condition, potentially infecting others. They can experience a delay in recovery, unnecessary side effects and costs associated with unnecessary treatments. Granted, many of the cases self-resolve, so we as practitioners often do not hear about it. I personally have made a commitment to do better for my patients by instituting the Red Eye Protocol. By doing so, I can treat based on diagnostic evidence and subsequently improve patient outcomes.
Karl G. Stonecipher
Different seasons bring different types of acute red eye, so around April or September in the Carolinas, when everything is coated in yellow pollen or ragweed is at a peak level, we are more likely to see allergic conjunctivitis. At the start of the school year, we are more likely to see bacterial conjunctivitis, which is not seen as frequently and is more popular in Southern and humid states. Because it is not common, it has been difficult to distinguish.
Treating red eye
If a person walks into my practice complaining of a red eye and has a draining, infectious-looking eye, he or she is seen right away. My assistants are trained to screen patients at the door. Once my staff suspects that a patient may have a contagious infection, they immediately sequester the patient in a no-traffic room that can eventually be shut down and cleaned. This is extremely important because an epidemic can occur in a clinic in no time. If an infectious person is moved from room to room, he or she may expose up to three or four different work areas.
After the patient is isolated, the first task is to differentiate between conjunctivitis and a red eye with no conjunctival involvement. In many cases, we cannot differentiate very well between the various presentations of conjunctivitis using an empirical diagnosis; accordingly, the Red Eye Protocol quickly becomes necessary. Currently, AdenoPlus is the only diagnostic test that can aid the differentiation of acute conjunctivitis by ruling out or confirming adenovirus. Once a red eye is determined to have any form of conjunctivitis, my staff conducts the test, which takes less than 2 minutes to perform and 10 minutes to yield results, and the results await me when I walk in the exam room to begin my assessment. My diagnosis is now based on diagnostic evidence in addition to my clinical judgment.
AdenoPlus is an efficient diagnostic tool for both patients and medical staff. When patients are given an evidence-based diagnosis of adenoviral conjunctivitis, medical staff can offer an accurate timeline of when they can return to work or school, as well as better instructions for interacting with family members and preventing the spread of infection.
Using the Red Eye Protocol, I am able to offer better, targeted treatment options. Patients hate it when they walk out of their eye care provider’s office with artificial tears. They feel that they have paid their money and been given a diagnosis, and they expect to receive a prescription. Often times, eye specialists will prescribe an antibiotic just to satisfy the patient’s need for medication, a practice that contributes to antibiotic resistance. The evidence can give us the confidence to show the patient that his or her infection is viral in nature and help us not prescribe unnecessary antibiotics. Additionally, when the results are positive, we can recommend more treatment options. For example, ganciclovir ophthalmic gel 0.15% is a topical ophthalmic antiviral that appears to be a beneficial off-label option for the treatment of adenoviral conjunctivitis. More studies are showing that ganciclovir ophthalmic gel can shorten the time and severity of adenoviral conjunctivitis, making it an increasingly appealing solution for the treatment of acute red eye from a viral etiology.
Early diagnoses with the Red Eye Protocol and adoption of this potential treatment have enabled me to make a rapid, accurate diagnosis for acute red eye and prevent both the spread of infection and antibiotic resistance.