I graduated from college in May 1993 and went straight to my state medical school.  My student loan debt was $100k+ after 4 years (I missed out on the NYU College of Medicine’s remarkable tuition free initiative earlier this week). When I saw Troy Aikman’s tweet earlier today asking for a Twitter ophthalmology consult, I Googled the former Dallas Cowboys QB’s name and learned he signed an 8-year, $50 million deal the same week I had taken my anatomy final! (link)

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I love Twitter and have embraced the American Academy of Ophthalmology’s hashtags #ProtectingSight & #EmpoweringLives. I also follow many ophthalmology colleagues, eye hospitals and ophthalmology related organizations.

I have the privilege of being an on-call phone consultant when colleagues have difficulty finding an ophthalmologist in their local communities (including the Great State of Texas!).  One friend who was then-president of the American Medical Association called me with a curbside question while managing patients in his ER. (Emergency Medicine colleagues know how to get the information they need to help patients with efficiency!) Ophthalmology is a visual specialty, and the patient history and clinical findings dictate management.

The American Academy of Ophthalmology has a detailed Preferred Practice Pattern for conjunctivitis management (link). A patient friendly guide is here. (“Pink eye,” or “red eye” are among the many descriptions for this acute or chronic condition.)

Acute conjunctivitis is a common ailment which affects upto 6 million people in the US yearly. Viral conjunctivitis is the most common cause, followed by bacterial conjunctivitis. The cost of antibiotics therapy for bacterial conjunctivitis alone is estimated to be $377 million to $857 million per year (Azari AA in JAMA 2013; 310(16): 1721-1730. doi:10.1001/jama.2013.280318 ). In addition, allergic conjunctivitis affects 15-40% of the population.

For Mr. Aikman (whom I have not examined) and patients with similar symptoms, I recommend ophthalmology consultation. Specialists consider the zebras of rare conditions when they hear the horse hoofbeats of common infections. In the absence of immediate ophthalmology availability I recommend:

1. Maintain contagious precautions – Wash your hands and your workplace frequently. Do not shake hands and avoid door knobs. Literally walk with your hands in your pockets. Take time off work and keep kids out of school as you may cause others to become infected.

2. Discontinue contact lenses (if you wear them) – With any pink eye or conjunctivitis, stop wearing contact lenses and throw away the current case and contact lens solutions.

3. Seek medical (preferably ophthalmology) consultation immediately – As the American Academy of Ophthalmology Preferred Practice Pattern alludes, there are numerous vision threatening conditions which need to be assessed in a timely fashion and treated immediately. Azari offers a helpful algorithm for clinicians and patients to approach suspected acute conjunctivitis:

The AAO Preferred Practice Pattern has a helpful high yield summary paragraph:

“The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently with soap and water (as opposed to sanitizer only) and use separate towels, and to avoid close contact with others during the period of contagion. Avoiding contact with others is especially important for individuals in professions with high potential for transmission, such as health care workers and child care providers. While the exact length of the period of infectivity is variable, many consider 7 days from the onset of symptoms as the contagious period, because the recovery of virus from infected cases drops off after 7 days of infection.43 However, other studies have suggested that patients should be considered potentially contagious for at least 10 to 14 days.44,45″

Good luck to Mr. Aikman.  With his public stature, I hope this potentially contagious conjunctivitis can be limited from spreading to colleagues and fans.

And #FlyEaglesFly!

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Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.

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