Thursday, October 29, 2015

Company Nurse Experience: What will you do in case of sore eyes?

Company Nurse Experience: What will you do in case of sore eyes?

Company Nurse Experience: What will you do in case of sore eyes?



by: Arlene Gentallan

What if someone comes to your clinic with a pink eye?

Definition: Conjunctivitis (aka. pink eye) is a communicable eye infection commonly spread through hand contact.


Assessment & History taking

    If an employee (aka. patient) comes to our company clinic with a slight red sclera, I do assessment and history taking first.

ASK for any unusual eye discomfort like:
- pain
- itchiness
- drainage
- blurring of vision
- photophobia (increased sensitivity to light)

There are times when the patient will just complain of having a reddened eye without other symptom like itchiness and pain. I have a patient before who went to our clinic because his coworkers keep commenting of how red his eyes were, but he doesn't really feel anything unusual with his eyes.


SINCE WHEN? Ask the patient how long he/she've been suffering from this condition.

If it's already more than one day without relief or if the patient reports that it's worsening, then it's probably not just a simple eye irritation.

But if it just happened today or just a couple of hours earlier, there may be a possibility that that he/she may have been exposed to a mild irritant. And if it's just slight redness of the eye and mild itchiness chances are, it will subside after a couple of hours of rest/application of eye drops(artificatial tears/lubricant.)


INSPECT the eye. Inspect the lower conjunctiva. You can use a penlight (or as what I've seen in informal clinical setting...a cellphone's flashlight) in order to visualize this area. The normal color of the conjunctiva should be pink or a light shade of red. So if the color is bloody red, that's not normal.

Inspect the periorbital area. Does it appear normal or is it edematous, puffy or inflammed?


USE YOUR JUDGEMENT.
Scenario # 1:

    Usually, when a patient complaining of slightly redenned eye and itchiness comes to our clinic mentioning that he/she just had the condition a couple of hours earlier, we just give them eye drop (two drops each eye) and advise them to return after an hour if the condition still persist.

There's an advantage to this: If in case the patient is just suffering from mild eye irritation, there's a chance that his/her condition will be alleviated by the eye drop.

There's also a disadvantage: If the client's condition is indeed sore eyes. Congratulations! Good job helping the patient spread the infection. So to aid this part, we instruct the patient to avoid touching his/her eyes and habitually wash his/her hands.


Scenario # 2:

    On the spot. If a patient comes to the clinic with a too obvious red sclera, red conjunctiva upon inspection, positive itchiness, drainage and pain, we send them home for good measure and advise them to follow up on their doctor. They still have to consult a doctor (if there's no doctor available in the clinic) and get a medical certificate (one for the consultation and one with the fit to work remark.)


Scenario # 3:

    Obcourse, why will anybody let sore eyes stand between them and work if work is the priority. Some patient usually don't come back to the clinic even after one hour, even if their eye problem isn't resolved by eye drop (aritificial tear).

Yep, I've encountered just that. I have a patient before who came back to the clinic after three days from the day I gave her eye drops (...imagine, 1 hour versus 3 days.) It's only her right eye that's sore. The sclera is slightly red while the conjunctiva is bloody red. At this point, I've sent her to the nearby hospital to be checked by a doctor (because at that time as well as the time before, there's no doctor available in our clinic.) She was diagnosed there to be having conjunctivitis and was given prescription for a tobramycin eye drop and to follow up with an opthalmologist.

Remembering this, it's really important to be able to identify if the patient's condition is indeed sore eyes (pink eye/conjunctivitis) during the initial contact because there may not be a second one :(


Scenario # 4:

    I had a patient who requested for eye drop because of his painful reddened left eye. But upon inspection, I've noticed that his left periorbital area is swollen. He reported there's blurring of vision. He has diabetes and and a recent cataract surgery.

Apparently, his condition is serious so a simple eye drop won't help. He needs medical attention :( So, I accompanied him to the hospital where the doctor advised him to be confined.


    Note: These are based from my experience as a company nurse. The purpose of this article is to serve as a helpful guide, not as standard. Please don't hesitate to check on your policy / guideline / regulation / standard / protocol.