Red eye referral refinement

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Community optometry offers many opportunities for those looking to commission effective and efficient primary care services to make better use of increasingly hard-to-come-by funding for health. Eye care practitioners are distributed in a way that makes them easily accessible to the public and have a skillset enabling them to manage those conditions that would otherwise take up unnecessary and expensive chair time in secondary care. A significant number of external and adnexal eye conditions are either self-limiting or require simple management that might be perfectly adequately administered in optometric practice. Viral conjunctivitis is a good example of a self-limiting condition that is most often caused by one of the many forms of adenovirus. Classic signs include diffuse conjunctival hyperaemia and a watery discharge, usually bilateral, and a palpebral follicular response. Patients typically report flu-like symptoms and swollen glands on the side of the neck and are usually easily palpated – the condition has a strong association with upper respiratory tract infections. The infection almost always burns itself out in a week or so and symptoms may be alleviated with preservative-free comfort drops and solid advice about avoiding transmission. This last point is why unnecessary referral is so counterproductive as it may merely serve the purpose of exposing more people, often poorly ones, to the infection. A useful assessment should include careful examination of the cornea, as such symptoms might be related to an early herpetic infection – adenovirus causes significant diffuse punctate staining and may subsequently lead to deeper stromal opaque lesions that endure for some time. The advice is usually to refer if in any doubt about the cornea. Add to this the fact that there is often overlap in the signs of different forms of conjunctivitis and it becomes obvious that anything that might confirm diagnosis is likely to both prevent inappropriate referral ad also reassure the eye care practitioner about their management plan. The AdenoPlus is exactly that – a simple diagnostic tool that offers a quick way of detecting adenovirus from the tears of a patient with suspicious symptoms. AdenoPlus Each AdenoPlus test comes with two sachets which must be used within an hour of opening (Figure 2). Contained within one is the sample collector. This is gently pulled over the exposed inferior palpebral area for several strokes (Figure 3). The fleecy end becomes glistening when saturated and at this point sufficient test sample has been gathered. It is then clipped on to the test cassette (Figure 4) and the exposed tip of this immersed into the small phial of buffer that accompanies the kit (Figure 5). After 20 seconds, remove the tip from the buffer, replace the protective cap and then lie the cassette down flat for 10 minutes. During this time, stripes appear in the small cassette window in the same way as a pregnancy indicator test kit. The presence of a red line indicates adenovirus antigens, a blue line none (Figure 6) – simple and effective and no need for expensive lab tests. With sensitivity and specificity data both in the high 90s found in several peer review published studies, the test should offer the confidence to the practitioner needing to decide upon the appropriate plan. Practitioner view Practioner and independent prescriber Andrew Matheson has been using the strips in his own clinic. ‘It’s a really useful test, especially in patients who have had a simplex or zoster infection in the past and present with an acute red watery eye but no corneal involvement. A negative AdenoPlus test helps validate the early appropriate use of aciclovir or ganciclovir. If positive you can scrub up and disinfect your room before seeing your next patient! The test normally costs £15.00 to optom. I charge £29.00 as a surcharge to patient over the eye exam fee; ophthalmology will probably charge £50.’ ? ? For further information visit www.adenoplus.co.uk.