OSN Cornea Health Round Table: Infection detection, prevention and treatment

At OSN New York 2014, Terry Kim, MD, OSN Cornea/External Disease Board Member, led a panel of experts in a discussion on detection, prevention and treatment of adenovirus, TASS, MRSA and MRSE, and endophthalmitis. Off-label uses were discussed.

Red eye protocol

Terry Kim, MD: Here is the case: A 39-year-old ophthalmologist complains of unilateral red eye and photophobia with watery discharge of 2 days’ duration. The eye is inflamed with some follicular response and acute conjunctivitis that may be viral, allergic or bacterial. How are you diagnosing patients such as this?

Jodi Luchs, MD: An accurate diagnosis is made only 27% to 50% of the time; even cornea specialists get it wrong half the time because the clinical picture can be confusing. There is a diagnostic tool that can help increase the accuracy of the diagnosis, at least to rule out adenoviral conjunctivitis, and that is the RPS Adeno Detector Plus, which is a simple test. Technicians can use it as kind of a red eye protocol when a patient comes in with those findings. The limit of detection is low — 6 ng/mL — so these tests are extremely sensitive and specific for epidemic keratoconjunctivitis (EKC). If you get the diagnosis wrong and you tell this patient that he has EKC when he does not, then he is going to be out of work for 2 weeks so he does not spread it around. There is a huge economic impact, not only for the individual but also for the system. Diagnostic accuracy is important.

Kim: A lot of these patients are treated with antibiotics because of the possibility that there is a bacterial component to the infection.

Terrence P. O’Brien, MD: That is a major problem. Prescribing unnecessary antibiotic not only adds costs to the whole health care pool, but also promotes increased selection pressure and increasing antimicrobial resistance. Adenovirus is an occupational hazard for all of us, so it is something that we want to watch out for and diagnose accurately with high sensitivity and specificity.

Penny A. Asbell, MD, FACS, MBA: One thing we have not mentioned is how contagious this is, and that is true in your office as well. You can train your staff to note a patient with a red eye and begin to evaluate him, instead of bringing him from room to room, from the auto-keratometer to some other machines, contaminating a lot of space and equipment. That impacts not just you as the treating physician, but also your other patients who will be seen thereafter. Those patients will remember if they came to your office for a cataract check and a couple of days later have a red eye. So if somebody comes in with red eyes, we right away begin this protocol to try to determine more specifically what is going on.

O’Brien: At Bascom Palmer Eye Institute in Florida, certain strains of adenovirus are always present in the community, and then at certain times of the year we may have appearance of the more virulent strains that can cause EKC. We have a red eye room where patients who are triaged initially in a Checkpoint Charlie-type system are put in the room, but they must be triaged correctly.

Click here to read the cover story published in Ocular Surgery News U.S. Edition, March 25, 2015.