Eye Pain, Discharge, and Redness

Joshua Strommen MD, FACEP

 Many times we have heard the phrase, “life, limb, or eyesight” in reference to triaging the severity of trauma or illness that a person may have. No explanation is needed as to why our eyes are considered in the same category of importance as our arms, hands, or legs.

So how do clinicians know if your eyesight is in danger? Well, it comes down to a couple findings that can be evaluated with a physical exam and a few tools. However, most commonly, losing eyesight is of small concern to the average person with a red or painful eye because simple infections or minor trauma are the usual causes.

- Benign conditions are those where limited intervention is necessary and things like antibiotics, steroids, anti-histamines, or even watchful waiting is the treatment.

- Acutely urgent or emergent conditions may entail surgery, medicines that lower eye pressure, intra-ocular antibiotics, or even draining fluid from the eye.

- The treatment of dangerous conditions are usually under the care of an Ophthalmologist, but at times an Emergency Medicine physician may initiate eye saving treatment in the Emergency Department.

Externally, the eye is made up of the sclera, which is the white area that surrounds the iris. In the middle of the eye is the pupil, and along with the iris, a superficial layer called the cornea protects them both. Lying over the entire eye and along your eyelids is the conjunctiva. Inside the eye there are several structures that work in conjunction with nerves, arteries, and veins to give us eyesight.

 What could possibly go wrong?

 1.     Conjunctivitis – This is a red, itchy, draining eye. The sclera will be red, you may have clear or mucous drainage, and you may have matting or crusting on your eyelids in the morning upon waking. Conjunctivitis can be from bacteria, viruses, or allergens.

 2.     Corneal abrasion – Usually occurs secondary to minor trauma to the eye, and is described as a red and painful eye that can also have tearing with it. It is diagnosed with putting a fluorescent dye in the eye under black light and seeing uptake of the dye by the cornea.

 3.     Keratitis – This is an infection of the cornea by either bacteria or viruses. It also presents with redness, pain, pain that’s worse with bright light, and a feeling that something is in your eye.

 4.     Subconjunctival hemorrhage – This is a bruise of the eye. It is a red area noted within the sclera. It occurs after being hit in the eye, or with prolonged bouts of coughing, sneezing, or vomiting.

5.     Glaucoma – The 2nd leading cause of blindness in the world. This condition presents with a red, painful eye where there may be halos, headaches, and worsening of the vision.

6.     Iritis – This is inflammation of the iris, and sometimes the muscles that control the lens. It is characterized by redness around the iris. There is minimal discharge and tearing. There is also photophobia or pain with bright lights in the affected AND unaffected eye.

 There are a lot of overlapping symptoms within these conditions, and this is only the short list of potential eye problems. At PremiER we have all the tools to diagnose sight-threatening problems. We can also begin treatment on any of those conditions as well. We have an urgent care, which can diagnose and treat the less acute diagnoses.

It would be helpful to keep in mind these symptoms for indications of when you need to be seen by a physician:

1.     Eye pain + redness

2.     Photophobia – Pain with looking at light

3.     Constant blurred vision

4.     Eye redness + discharge

Urinary Tract Infection and Kidney Infection

Joshua Strommen MD, FACEP

            A urinary tract infection (UTI) is a bacterial infection of the bladder. This infection occurs in males and females, but is much more common in women due to a shorter urethra and an environment more suitable for bacterial growth. A UTI may or may not be associated with an infection of the upper urinary tract. If so, this may be referred to as a kidney infection, also known as pyelonephritis.

            A UTI occurs when bacteria that normally lives in the colon (E. coli), gets in the urethra, which then makes its way to the bladder. Conditions that increase the likelihood of obtaining a UTI include recent instrumentation with a catheter, having diabetes, or advanced age. In men, being uncircumcised or having anal intercourse can be risk factors in addition to the above. Being diagnosed with a kidney infection indicates that the bacterium has spread from the bladder to the kidneys directly, or there has been bacterial spread to the kidneys via the bloodstream.

            Common symptoms that indicate a UTI are painful urination, urinating frequently, feeling like you need to urinate but can’t, or having blood in your urine. If you have back pain, vomiting, fever, chills, or abdominal pain in addition to UTI symptoms, you likely have a kidney infection.

            A urinalysis that shows elevated white blood cells or specific enzymes released from those white blood cells confirms the diagnosis. Additionally, a urine culture will give results on which antibiotic will be effective at killing the bacteria found in the urine. A simple UTI can be treated as an outpatient, with oral antibiotics. With a kidney infection you may be admitted into the hospital for intravenous antibiotics if you have abnormal vital signs, excessive vomiting, or certain medical comorbidities.

            Having an infection of the bladder is easily identifiable and treatable. Most of the time a 5-7 day course of antibiotics is effective treatment. However, some bacteria are resistant to normal medicines or a patient’s immune system may be weakened due to their medical problems, which can cause a potentially serious bacterial infection necessitating hospitalization. At PremiER we have the ability to diagnose and treat both conditions, and if you need hospitalization, we arrange direct admission to your hospital of choice.

2017 Flu Update

Joshua Strommen MD, FACEP

Influenza A and B are the two strands of virus that are known to cause the coughing, aching, feverish, nauseating, head pounding constellation of symptoms we refer to as the “flu”. Influenza is a virus that infects the upper and lower airway and is predominately seen during the winter months. As of January 2017, Texas’ region has the highest rates of healthcare visits for influenza illnesses compared to the rest of the United States!

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Cold or Flu?

Influenza Symptoms

Fever (Temp > 100.4 F)

Cough

Sore Throat

Nasal Discharge

Weakness

Muscle Aches

Headache

Nausea & Vomiting

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 Is Influenza a dangerous illness?

Typically, influenza is a self-limiting virus, which means you will improve in 5-7 days with no complications.

 Influenza can be more dangerous if

• Age over 65

• Age < 2

• You have Asthma, COPD, heart disease, diabetes, or kidney problems

• You are pregnant

What are the potentially serious complications of Influenza?

Pneumonia

 How is Influenza treated?

• If diagnosed within 48 hours of symptom onset, you may be given Tamiflu. Tamiflu is known to shorten your duration of symptoms by 1 day.

• Tamiflu is safe for kids and pregnant women.

• Tylenol, Ibuprofen, oral fluids, and other symptomatic medicines are perfect for treatment.

What we know about the 2016 – 2017 Influenza season

• Only 2 out of 5 people over 6 months old is vaccinated.

• Influenza type A has been the most identified virus by the CDC.

• The H3N2 subtype has been isolated in most of these Influenza A samples.

• The CDC states that the H3N2 subtype has been most associated with increased hospitalizations and death over the last decade.

How can PremiER help me?

• We still have flu vaccines to administer for free, its not too late.

• If your symptoms last longer than 5-7 days come see us for an evaluation.

• If you have significant shortness of breath, chest pain, significant weakness, or if you have an extensive medical history being seen sooner rather than later is best!

Concussions - A Heads Up

Dr. Guido Zecca | August 26th, 2016

Fall and school are upon us, meaning time for sports.  With this comes practice, games, and potential injuries.  One of the more concerning issues that has come to the forefront in recent years is head injuries and concussions.

Concussions account for about 13-15% of all sports-related injuries that occur in high school athletes.  A concussion occurs as a result of a direct blow to the head, face or neck area, but can also be caused by a blow elsewhere on the body with force transmitted to the head.  Concussions do not result in structural damage to the brain, rather a concussion is a disruption of function. 

Symptoms of a concussion are typically brief, lasting several seconds, but symptoms may evolve over several minutes to hours.  These include headache, confusion, disorientation, inattentiveness, difficulty with speech, vomiting, trouble with balance.

When should you worry?  What do you look for?

Most concussions are mild and people usually fully recover.  There are instances when symptoms are more worrisome.

·         Repeated vomiting

·         Worsening headache

·         Changes in behavior, such as irritability

·         Seizures

·         A definite loss of consciousness for longer that one minute

·          Signs of a skull fracture (defect that you can feel on the skull)

·          Vision changes

·          An alteration in mental status that is persistent (worsening confusion or disorientation)

·         Any neurological abnormalities (weakness or numbness affecting any of the extremities, problems with balance)

  Presence of any of these signs or symptoms should prompt a visit to the Emergency Room for further evaluation.

 Are certain injuries more worrisome? 

High speed bicycle crashes, diving injuries, falls greater than body height, or any high-impact head injury, particularly a mechanism that results in “double hit” (struck on the head, followed by an impact with the ground or turf). 

What role does a CT of the head play?

A CT scan of the head cannot “diagnose” a concussion, but it can rule out a more serious injury, such as bleeding in the brain, skull fracture and swelling of the brain.  Diagnosis of a concussion is based on clinical judgment and you can suffer a concussion without losing consciousness or being “knocked out”.

When can the athlete return to play?

No one should return to play if any signs or symptoms of a concussion are present.  An athlete with a concussion should be medically evaluated by a health care professional to determine when they may return to sports.

The following is an example of progression of activity for return to play after a concussion:

1. Rest until asymptomatic (physical and mental rest)

2. Light aerobic exercise (e.g. stationary cycle)

3. Sport-specific exercise

4. Non-contact training drills (start light resistance training)

5. Full contact training after medical clearance

6. Return to competition (game play)

Many professional, collegiate and school districts have their own programs and referrals in place for return to play and should be followed for the well being of the athlete.   Failure to follow these guidelines can lead to long lasting symptoms and chronic conditions.

Premier hopes that you and your family have a safe and enjoyable fall season.