The text came from a college classmate who is also an Emergency Medicine physician. She and I caught up over the weekend when I asked her to donate to our college class’ upcoming 25th reunion gift. She declined and cited a wonderful endowed scholarship she had recently created in her mother’s memory for under-represented medical students who are “first in their family” to pursue advanced degrees.
I also have the privilege of being one of my classmate’s on-call phone consultants when she has difficulty finding an ophthalmologist in her local community. (Another friend who was then-president of the American Medical Association once 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.
My classmate texted, “Do you watch CNN? Poor Erin Burnett trying to hide a terrible r conjunctivitis or something…. please tweet her to take a day off!!! Poor girl is sick w adenovirus or rhinovirus ! Give her second a chance!!! She looks crazy!!!”
I immediately tuned to CNN, “The Most Trusted Name in News,” which I turn to daily along with NPR, ABC World News Tonight, the NY Times, and the Oldest College Daily.
The CNN segment included Ms. Burnett interviewing the expert on the recent UFO project. The numerous cameras kept going in and out with minimal time allotted to the anchor asking questions. A most unusual and adaptive technique. I turned to my iPad and took a quick screenshot of Ms. Burnett at the end of the segment.At low resolution, a viewer can appreciate the anchor’s “pink eye” with upper eyelid ptosis (secondary drooping of the right upper eyelid from inflammation) and conjunctival redness. On higher resolution, the findings are confirmed.
She likely also had light sensitivity, though it was difficult to assess with CNN strategic video angles.
The American Academy of Ophthalmology has a detailed Preferred Practice Pattern for conjunctivitis management (link). A patient friendly guide is here.
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 Ms. Burnett (whom I have not examined) and patients with similar symptoms I recommend ophthalmology consultation (a bias and 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 lens (if you wear them) – With any pink eye or conjunctivitis, stop wearing contact lens 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 Ms. Burnett and the CNN team! (I hope this potentially contagious conjunctivitis can be limited from spreading to colleagues).
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.