Management and Determining the Cause

Chief Complaint: Eye Irritation

a. History: Dryness, burning, grittiness, and mild foreign body sensation

Differential Diagnosis

Decreased tear production Increased tear evaporation

 

 

  • Aging
  • Sjogren's syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency
  • Medicines, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and medicines for high blood pressure, acne, birth control and Parkinson's disease
  • Corneal nerve desensitivity caused by contact lens use, nerve damage or laser eye surgery
  • Pregnancy, using birth control pills or menopause.
  • Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils.

Blocked meibomian glands are more common in people with rosacea or other skin disorders.

Common causes of increased tear evaporation include:

  • Posterior blepharitis (meibomian gland dysfunction)
  • Blinking less often, which tends to occur with certain conditions, such as Parkinson's disease; or when you're concentrating during certain activities, such as while reading, driving or working at a computer
  • Eyelid problems, such as the lids turning outward (ectropion) and the lids turning inward (entropion)
  • Eye allergies
  • Preservatives in topical eye drops
  • Wind, smoke or dry air
  • Vitamin A deficiency
Pivotal Assessment Findings
x xxxxxx    

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 Tearing may be of two general types. Sudden reflex tearing is usually due to irritation of the ocular surface. In contrast, chronic watering and “epiphora” (tears rolling down the cheek) may indicate abnormal lacrimal drainage (see Chapter 4).

 

Ocular secretions are often diagnostically nonspecific. Severe amounts of discharge that cause the lids to be glued shut upon awakening usually indicate viral or bacterial conjunctivitis. More scant amounts of mucoid discharge can also be seen with allergic and noninfectious irritations. Dried matter and crusts on the lashes may occur acutely with conjunctivitis or chronically with blepharitis (lid margin inflammation).

 

 

Making the Diagnosis and Management_Adult

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