Erin, an 8 year old girl is brought in by her father because her left eye is red. Her whole eye is red and painful, getting worse over the past 18 hours. There is mild watery discharge but no pus. There is no rash on her face or eyelids.
She was playing with her friends after school yesterday afternoon in the backyard when she noticed it coming on. She has also been complaining of aching joints over the past 1 month which the parents put down to a viral infection she had around this time. She has no past medical history.
What are the most likely differential diagnoses? List 4
- Iritis
- Scleritis
- Traumatic corneal ulcer
- Foreign body
RACGP – Good answers were relevant to the age of the child and not simply (as discussed previously) a knowledge dump of all causes of a unilateral red eye in a young child.
GPCC – Im not sure I agree with our own answers listed above – I might have said viral conjunctivitis, allergic conjunctivitis, foreign body. Not sure iritis and scleritis.
What further examination of the eye do you want to perform? List 8
- Visual acuity
- Visual fields
- Inversion of eyelids
- Examination of conjunctivae
- Examination of cornea
- Examination of iris
- Pupil examination for shape and reactivity to light (is this overcoding??)
- Fluoroscein staining
- Fundoscopy (maybe not??)
Likewise the examination component was focussed on the examination of the eye, so listing vital signs, examination of the joints or skin did not score. Many candidates provided up to 50% more responses than asked for because they either listed lots of examination issues or justified their answers with examples and further examination or explanation of their answers. It is important to remember that the examiners making the questions are all practicing GPs and so no explanation of answers or expanding of answers is required but medical language appropriate to communication with a clinical colleague is appropriate.
Case continued… This condition is treated appropriately and it resolves. 6 months later Erin comes back in with her mother. This time she has a irritated lump on her lower right eyelid as shown in the picture
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Chalazion
What is your diagnosis of this disorder?
- chalazion/meibomian cyst
The final part required the correct identification of a classic presentation of an eye-lid namely chalazion/meibomian cyst.
RACGP Feedback
In this case an 8 year old girl presents with a red watery eye and centres on the most likely differential diagnoses, subsequent key examination features and the assessment of a further unrelated eye problem in the same child at a further consult.
Good answers were relevant to the age of the child and not simply (as discussed previously) a knowledge dump of all causes of a unilateral red eye in a young child. Likewise the examination component was focussed on the examination of the eye, so listing vital signs, examination of the joints or skin did not score. Many candidates provided up to 50% more responses than asked for because they either listed lots of examination issues or justified their answers with examples and further examination or explanation of their answers. It is important to remember that the examiners making the questions are all practicing GPs and so no explanation of answers or expanding of answers is required but medical language appropriate to communication with a clinical colleague is appropriate.
The final part required the correct identification of a classic presentation of an eye-lid namely chalazion/meibomian cyst.
