Tuesday, April 5, 2016

No, You MIGHT have Pink Eye

I've had this same conversation with a dozen people the past few weeks. I wonder if it isn't all some prank:

Patient comes to the window.

"Where's your stuff for dry eyes?"

Me, looking at the patient, seeing ONE red eye, "We keep that on aisle six, but you MIGHT have pink eye. You'll need to see a doctor and YOU MIGHT NEED an antibiotic."

"It's allergies."

"Allergies would likely affect both eyes. IT COULD BE conjunctivitis... pink eye. You MAY need an antibiotic for the eye."

"Where are your eye antibiotics?"

"You'll need to see a trained doctor."

"Can I just put Neosporin in it?"

"No, you need to see a medical doctor. Very few eyes actually meet the criteria for bacterial conjunctivitis to require and/or respond to antibiotics. Most are some other benign pathology that just needs symptomatic therapy like viral conjunctivitis, allergic rhinoconjunctivitis or noninfectious causes like nodular episcleritis or subconjunctival hemorrhages."

"Can't you just give me an antibiotic?"


"Where's your stuff for dry eyes again? I'm pretty sure it's just allergies."

"Aisle six."


Anonymous said...

Ew, seriously, so gross.

These are the same buttholes that sneeze, cough, and generally spread contagion all over the counter.

The one time I actually want these idiots to actually use the drivethru.

Anonymous said...

For some reason, I keep getting a stye in my left eye. Every time I come to work like that...

***Do you have pink eye?

-No, it's just a stye.

***You really should go to the doctor for your pink eye

-Is my eye pink?

***No, but it still could be pink eye. You shouldn't come to work when you are contagious. I'm going to stay away until you get to the doctor.

-Remember when it looked like this a few weeks ago? Sore, swollen, responded to warm compresses and time???

***It's pink eye, that is why you keep getting it. It is VERY contagious.

-No one else has gotten it.

***That is because you need to be careful with pink eye and wash your hands...



James Pookay said...

Please stop telling people that they need antibiotics for every red eye, it just leads to more inappropriate antibiotic use. But good advice to have them see a physician to get it checked.

"Pink eye" is one of the most common presentations I see in urgent care for people demanding antibiotics. Very few eyes that I see actually meet the criteria for bacterial conjunctivitis or require/will respond to antibiotics.

Most are some other benign pathology that just needs symptomatic therapy like viral conjunctivitis, allergic rhinoconjunctivitis or noninfectious causes like noduar episcleritis or subconjunctival hemorrhages.

Telling them they need antibiotics for their eye without being a trained physician or doing a complete eye exam just makes it harder for the physician to talk them out of inappropriate antibiotics.

Kassy said...

Agree with James Pookay,

I am still waging a 10+ year war against prescribing unnecessary antibiotics for every random red eye. I can count on one hand the number of actual bacterial conjunctivitis cases I have seen out of hundreds, if not thousands, of 'pink eye' complaints.

Anonymous said...

Pookay / Kassy

I wish more providers approached diagnoses and therapies like you two do. I just love the Rx's like Zpaks for every sniffle or Tussionex/Cheratussin for every tiny cough.

And if it makes you two feel better, I never suggest abx unless their eye is crusty and gross. Otherwise, its a generic 'gross, go see your doctor, they'll determine if you need abx or not.'

James Pookay said...

Thanks for the kind words.

It's probably nitpicking complaining about the wording, but it's already really hard to convince people that "red eye" does not reflexively equal "moxifloxacin".

I believe I'm probably only an average-skilled GP, but I do try hard to take the few extra minutes to nail down a clear provisional diagnosis with each patient with a complaint with red eye and then explain the diagnosis and pros/cons of therapy.

But unfortunately with the fee-for-service system here in Canada, I make 50-67% less than my other colleagues whom look at problems like conjunctivitis from across the room and then prescribe the drops.

I agree with Kassy that for every 100 patients I see with red eye, I can count the cases with clear bacterial conjunctivitis on two hands that will likely respond to antibiotics.

My heart also sinks everytime I see a young, healthy, nonasthmatic adult with no chest x-ray in follow-up saying their cough didn't stop after one of my colleagues prescribed them a Z-pak and Advair for their bronchitis two days ago and are back because they "need something stronger"

Anonymous said...

Keep referring to a doctor but make sure you refer them to an eye doctor. I started having issues with an eye and went to a family practice. I was prescribed antibiotics which seemed to help. Then the problem came back. I went to an eye doctor and was diagnosed with a serious corneal issue. Now I am being treated correctly, without antibiotics, and may have to have eye surgery in 3 months. Eye issues really need to be seen by eye doctors.

James Pookay said...

Anon 5:42

That's a good point that an optometrist can do a more extensive exam for eye issues than your average GP/NP. As a GP, I'm pretty much limited to my wits, my eye chart and my penlight.

But realistically, optometrists tend to be more expensive, don't tend to be available after hours when you need them and are probably overkill for your average cases of red eye.

A good rule is that any eye pain (like "ice pick in the brain", not just a little scratchy"), light sensitivity or acute loss of vision needs to see a doctor, ER or optometrist right away. Not a bad idea to see a doc if you wear contact lens or might have a foreign body either.

If your eye isn't acutely painful, light sensitive and you can still read small text with the affected eye, it probably isn't anything urgent or vision-threatening.

Hildy said...

The best part about this post is the way you modified it in response to the doctor's complaint about recommending antibiotics. I hope you actually memorized the new caution and will recite it to the next person wanting "stuff" for dry eyes. I know if you said that to me, I would be seriously impressed, would probably even applaud.

Anonymous said...

I've had one eye infection, and three cases of pink eye. The eye infection was massively painful and made me extremely sensitive to light. I ran, not walked, to my opthalmologist for that. If I lose eyesight, I lose my ability to communicate as I'm deaf.

The three cases of pink eye were also awful. All three were bacterial. One cleared up by itself but came raging back about two weeks later. The other one was when I also had pneumonia and laryngitis. Both bad cases were disgusting, I had to put hot wet cloths on my eyes in the morning to uncrust them so I could see.

I can't imagine going for antibiotics if my eyes were merely a bit pink.