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HistoryCertain historical features can help narrow the diagnostic etiology of a red eye and rapidly determine the need for patient referral. The medical history should include questions regarding the following:- Change of vision (“Can you read ordinary print with the affected eye?”)- Eye pain- Photophobia- History of eye trauma- Contact lens use- Time course of illness- Environmental or work-related exposures- Eye itching- Eye discharge- History of upper respiratory tract infection- Sexual history/history of sexually transmitted diseases- Medication history- Allergies- History of eye disease
Ocular ExaminationThe patient with a red eye should be examined in a well-lit room. The physician should carefully observe and examine the face and eyelids and search for regional lymphadenopathy. The ocular examination should focus on the following:- Measurement of visual acuity – If acuity is diminished, the physician should suspect a more worrisome diagnosis (angle closure glaucoma, infectious keratitis, uveitis) and immediately refer the patient to an ophthalmologist.- Examination of the pupils – The size and reactivity of the pupils should be closely observed. A fixed or nonreactive pupil should prompt immediate referral to an ophthalmologist.- Examination of the anterior segment – The clinician should note the presence of any discharge, appearance of the cornea, and pattern of redness. If either ciliary flush (circumcorneal injection) or hypopyon (a layer of leukocytes in the anterior chamber) are seen, urgent referral to an ophthalmologist is required.- Fundoscopic examination – This is usually not helpful in the differential diagnosis of the red eye.*32/348/5*

Sometimes, for some people, depression is too severe or it lasts too long. Severe, persistent depression is often best treated with medication. Talk to a doctor. If medication taken for another condition is causing depression, the doctor can change the drug or lower the dose. If the depression is part of dementia, the doctor will prescribe medications that ease the symptoms. Most of the persistent depression in people with HIV infection, however, is simply the natural reaction to knowledge of a devastating disease. Like the depression that accompanies the loss of a loved one or a diagnosis of cancer, it can be successfully treated with appropriate support and medications. In this case, the doctor will recommend a psychiatrist, who can prescribe medication that restores sleep, appetite, and mood. For most people, treatment of depression is temporary but critical.     Either the doctor or the psychiatrist might recommend professional psychological help. Psychiatrists, psychologists, and social workers can help you talk through whatever is blocking the healing process, though only psychiatrists are trained medically and can prescribe medications. Psychotherapy may concentrate on the overwhelming problems people must face and feel they cannot solve: How can I face rejection? How can I deal with anger? How can I feel less guilty? How can I have sex without hurting myself or anyone else? Why me? Why now? What will I do with the rest of my life? What will happen to my kids? My parents? The people I love? Will I die? How will I die? Am I a good person? By helping you confront problems you feel are unsolvable and find new perspectives on those problems, a psychotherapist will help you take control of your life. He or she will help you deny, not the fact of your infection, but your own helplessness and hopelessness in the face of it.     Thoughts of suicide are usually only temporary: the suicide rate among people with HIV infection is low. People seem to consider suicide mostly as a means of regaining a feeling of control over their lives. They seem to be saying, “This disease does not control whether I live or die, I do.” Nevertheless, if thoughts about suicide persist, and if thoughts of taking pills become plans to collect specific pills, and if these persistent, concrete thoughts are coupled with an increase in guilt and sense of punishment, then get help. Call your doctor or psychotherapist.
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There’s nothing like Botox for treating crow’s-feet, those little lines that hover on the outer corner of each eye. These lines are known as dynamic wrinkles, or wrinkles in motion, and their existence is related to the constant movement of that part of the face And like I said earlier, Botox is, without question, the treatment of choice for any type of movement-induced wrinkling. Plastic surgery does nothing for crow’s-feet but pull them tighter and collagen injections will make them appear softer when the patient isn’t animated, but daily facial expressions will bring them back in no time. As for treating them with lasers, you will see an improvement but it comes at the price of two weeks of recovery time and a risk of permanent changes in your pigmentation.A fatty deposit under the eyes is best treated with surgery but I’ve found that a lot of patients, particularly those who are past forty years old, mistake a bulge right under their eye for fat. This bulge is actually an overworked muscle and believe it or not, a touch of Botox injected there will soften it. As bizarre as it sounds to inject your eye with Botox, it is very safe to do so. The only consequence is that this can round out the eye shape. (Some of my Asian patients actually consider this to be a perk.) The bottom line is: if you love your almond-shaped eyes then I wouldn’t recommend this for you.*51\82\8*