Ophthalmology KFP 1.7 – James has irritated red eyes

by | Jan 14, 2018

James, 25, presents with bilateral red eye, which started suddenly 3 days ago in one eye then spread to the other eye, on a background of recent viral URTI. He describes watery discharge and says her eyes feel gritty. He has never had this problem before.

Image result for viral conjunctivitis

What is your primary diagnosis? (1)

  1. Viral conjunctivitis

What are the pathogens that cause this presentation? (4)

  1. Adenoviral conjunctivitis
  2. Herpes simplex virus (HSV) conjunctivitis
  3. Varicella (herpes) zoster virus (VZV) conjunctivitis
  4. Molluscum Contagiosum

What are the key features of history in this presentation? (8)

  1. Red eye
  2. Watery discharge
  3. Started in 1 eye, then second eye 1-2 days late
  4. Recent URTI
  5. Foreign body sensation
  6. Burning
  7. Itching
  8. Sudden onset
  9. Eyes glued shut
  10. Eyelid swelling

What are the features that favour viral conjunctivitis over bacterial conjunctivitis in children?  (3)

  1. Age ≥ 6 years
  2. Presentation in April through November
  3. No discharge or watery discharge
  4. No glued eye in morning

What are the features that would favour bacterial conjunctivitis over viral conjunctivitis in adults? (3)

  1. Early morning glued eye(s)
  2. Absence of itching
  3. Absence of history of Conjunctivitis
  4. Purulent discharge

What are the key features of history that would favour another diagnosis? (3)

  1. Red eye
  2. Pain
  3. Vision Loss not cleared with blinking

What is the most important feature of history not to be missed in evaluation of this presentation? (1)

  1. Contact lens use

What are the key features of examination in this presentation?  (6)

  1. Red conjunctiva
  2. Watery discharge
  3. Follicular tarsus,
  4. Pre-auricular lymphadenopathy
  5. Chemosis
  6. Eyelid swelling
  7. Pinpoint conjunctival haemorrhages

What are the differentials of this presentation? (5)

  1. Bacterial conjunctivitis
  2. Allergic conjunctivitis
  3. Episcleritis
  4. Scleritis
  5. Uveitis
  6. Keratitis
  7. Acute angle closure glaucoma
  8. Foreign body
  9. Trauma
  10. Herpes zoster ophthalmicus

What are the key features of management in this presentation? (4)

  1. Hand hygiene
  2. Remove contact lenses
  3. Artificial tears
  4. Cold compresses
  5. Saline wash

There is generally no role for corticosteroids, antibiotics or antihistamines.  If the patient is at high risk of secondary infection then topical antibiotics may be used.

 

What are the prognosis of this presentation? (1)

  1. Self-limiting condition

References

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