Barbara 22 presents with 1 week of watery gritty eyes, on a background of current seasonal rhinitis, for which she is taking antihistamines.

What is the most likely diagnosis? (1)

1. Allergic conjunctivitis

What are the differentials in this presentation (4)

1. Viral conjunctivitis
   
2. Bacterial conjunctivitis
   
3. Bilateral foreign body
   
4. Bilateral trauma

What are the key features of history in this condition? (5)

1. Recurring bilateral itchy eyes
   
2. Bilateral watery eyes
   
3. History of rhinitis
   
4. Recent allergen exposure
   
5. Pain
   
6. Vision Loss not cleared with blinking

What are the key features of examination when considering your most likely diagnosis? (3)

1. Current rhinitis
   
2. Tarsal conjunctivae mildly red
   
3. Occasional papillae

What are the general principles of managament of this condition? (4)

1. Avoidance of allergen
   
2. Use topical eye drops
   
3. Use systemic rhinitis meds
   
4. Avoid rubbing eyes

What are the categories of pharmacological management that are applicable in this condition? (8)

1. Topical antihistamines
   
2. Topical Mast cell stabilisers
   
3. Topical Sodium cromogylcate
   
4. Topical Artificial tears
   
5. Topical vasoconstrictors
   
6. Topical corticosteroids
   
7. Oral antihistamines
   
8. Oral corticosteroids

What are the important diseases to be excluded before use of topical corticosteroids? (2)

1. Herpes Simplex Keratitis
   
2. Bacterial keratitis

What are the complications of topical corticosteroids? (3)

1. Cataract formation
2. Glaucoma
   
3. Bacterial keratitis

References

1. patient.info
2. Murtaghs
3. Colour Atlas of Family Medicine
4. Dynamed