Case 5

A 27-year-old medical student with a red eye

Q1

A 27 yo medical student presents to your office with a chief complaint of redness, itching and foreign body sensation in the left eye.

What additional history do you want to obtain?

Q2

A 27 yo medical student presents to your office with a chief complaint of redness, itching and foreign body sensation in the left eye.

What physical examinations would you perform?

Q3

A 27 yo medical student presents to your office with a chief complaint of redness, itching and foreign body sensation in the left eye.

What is the most likely diagnosis?

Q4

Based on the recency of his URI, scant eye discharge, and the unilateral conjunctival injection, you diagnose viral conjunctivitis.

What is the most appropriate treatment for this patient?

Summary

Conjunctivitis is a common cause of red eye. There are three common varieties – bacterial, viral, and allergic. Bacterial conjunctivitis is acute, often unilateral, very red, and associated with purulent discharge. Most common pathogens are Streptococcus and Staphylococcus. Viral conjunctivitis is usually subacute, often associated with a viral prodrome, and is associated with a water mucoid discharge. It usually starts off unilateral, but can easily spread to other eye. Adenovirus is the most common pathogen. Allergic conjunctivitis is often associated with other allergic symptoms e.g. runny nose, sneezing. It is usually bilateral and associated with profuse watery discharge from eyes. The redness may be less evident than in other forms of conjunctivitis and it responds to topical antihistamines.

Neonatal conjunctivitis is becoming less common but is still important for boards. Three flavors of neonatal conjunctivitis, with distinct temporal differences. Chemical conjunctivitis is usually secondary to silver nitrate drops and develops within hours of birth. Gonococcal conjunctivitis develops within 2-4 days of birth, and Chlamydia conjunctivitis develops about a week after birth and may be associated with pneumonia.