Why prescribing medications on phone may be dangerous

Imagine you are at the junction of three nearly similar looking roads. One leads to a chaotic city called Helonarth, another to a slightly more orderly but still hellish town called Purgasity and the third to a fairly peaceful city called Paradisity. You are among the three privileged persons to make a choice of which one of the cities to live in.

A few minutes to take off, all three of you receive a briefing from a sage about the characteristics of the three cities and the subtle differences that would help you  decide the correct route to your chosen destination. Once you commence your journey, there is no turning back. All three of you are united on the choice of Paradisity.

While the briefing is on, your mind wanders momentarily and you miss some little information but undaunted you feel you have sufficient facts to make an informed decision about the road to take to Paradisity. As you are about to take the first step, your mind tells you you’ve chosen the wrong route. You decide to take what you consider to be the friendliest of the three roads. “This must be it!” you tell yourself.

All seem fine initially but unexpectedly it becomes so hot and with every step it gets hotter and hotter. You try to turn around to retrace your steps but find it impossible to turn. You can’t even stand still on one spot as the earth beneath your feet is like fire. “Am I on the road to Helonarth?” you ask yourself.

You take a quick glance at the man on the adjoining road. He seems to be a little more comfortable than you are. You are in great pain but you can read on his face some signs of moderate distress. You wished you had taken that road. All of a sudden you look beyond him at the man on the third road. He seems very fine; maybe a bit of discomfort but not in pain. He can even manage a smile.

“He must be on the road to Paradisity. That’s the road I should have taken! The other road must lead to Purgasity.” You remember what the sage said about the subtle differences and wished you had paid attention.  The die is cast and you are definitely on your way to Helonarth.

The three common causes of a painful red eye typify the parable of the three roads leading to three contrasting destinations. Helonarth represents Acute Angle Closure Glaucoma; Purgasity represents Acute Uveitis and Paradisity Acute Conjunctivitis. Whenever anyone calls me on the phone to complain about a red eye and ask me to recommend treatment, I always refuse except he can provide reliable answers to the following questions. First, I need to know about the nature of the pain.

“Is it mild, moderate or severe?” If I am told that the pain is like “hell on earth” then I know it is a very serious condition and may be due to Acute Angle Closure Glaucoma. The pain cannot be ignored; all activities usually come to a standstill.  In acute uveitis, the pain is much milder and worsened by exposure to light. Hence the sufferer doesn’t want to open the eye.  In acute conjunctivitis there is just a mild to moderate discomfort. Hence unlike the man on the road to Purgasity, he can still manage a smile.

The second thing I would like to know is the nature of the redness. Is it beefy red involving the entire conjunctiva? Or is the redness located to the area around the cornea (the black of the eye)? Or is it more visible when you ask the sufferer to look down and you lift up the upper lid? Then I would like to know if there is any discharge and the nature of the discharge. “Is the discharge frankly purulent or a mixture of pus and mucus?”

I certainly would ask the person, “Is your vision affected? And how bad is it?” This could be an ominous sign – that tells unmistakably if you are on the way to Helonarth. There are other questions I would like to ask and signs that I would like to confirm before starting treatment. Now you can see that prescribing medications for a simple red eye is not as simple as it sounds.

The medication for Acute Uveitis can lead to blindness if mistakenly prescribed for a person with Angle Closure Glaucoma or acute purulent conjunctivitis. Notwithstanding distance medications can be still be safely prescribed if in addition to a full description of the symptoms, clear pictures of the face focusing on the eyes are provided – telemedicine.

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