A 22-year-old woman comes to the office due to redness and discharge from her right eye for the past 3 days. She also has had a gritty sensation and crusting in the eye, which is "stuck shut" in the morning. Today, the patient noticed that her left eye has also become red. She has had no visual disturbances, photophobia, or eye pain or itching and reports no recent upper respiratory infection or exposure to a person with similar symptoms. The patient does not use contact lenses. Her other medical problem includes allergic rhinitis, for which she takes fexofenadine as needed.
Physical examination reveals bilateral diffuse conjunctival erythema with scant discharge that does not reappear when the initial discharge is wiped away. No corneal opacity is noted. Visual acuity is normal. The remainder of the physical examination is normal.
Which of the following is the most appropriate next step in management of this patient's eye symptoms?

Question

A 22-year-old woman comes to the office due to redness and discharge from her right eye for the past 3 days.  She also has had a gritty sensation and crusting in the eye, which is "stuck shut" in the morning.  Today, the patient noticed that her left eye has also become red.  She has had no visual disturbances, photophobia, or eye pain or itching and reports no recent upper respiratory infection or exposure to a person with similar symptoms.  The patient does not use contact lenses.  Her other medical problem includes allergic rhinitis, for which she takes fexofenadine as needed.
Physical examination reveals bilateral diffuse conjunctival erythema with scant discharge that does not reappear when the initial discharge is wiped away.  No corneal opacity is noted.  Visual acuity is normal.  The remainder of the physical examination is normal.
Which of the following is the most appropriate next step in management of this patient's eye symptoms?

Quizplus · Accepted Answer

11ec193a_9899_6505_853d_4581263825de_MD0002_00 This patient has conjunctival erythema and scant discharge without changes in visual acuity, which is consistent with viral conjunctivitis ("pink eye"). Most cases are caused by adenovirus and may be associated with upper respiratory symptoms. Typical findings include eye redness, irritation (often described as a gritty sensation), and scant watery discharge. Symptoms often begin unilaterally, but bilateral eye involvement may occur within 48 hours of onset. Symptoms typically last 1-2 weeks and are self-limited; management is directed at reducing patient discomfort. Topical antihistamines and ocular decongestants can reduce symptoms, and moist compresses (warm or cool) can also provide comfort. No treatment has been shown to shorten the duration of illness. Viral conjunctivitis is highly contagious, and patients should be counseled on infection precautions (eg, handwashing). (Choice A) Indications for ophthalmologic evaluation in acute red eye syndrome include loss of visual acuity, hyphema or hypopyon (red or white cells, respectively, layered in the anterior chamber), suspected bacterial keratitis (eg, contact lens user with pain, photophobia, and foreign body sensation), angle-closure glaucoma (eg, headache, vomiting, hazy cornea, fixed pupil), and iritis (eg, photophobia, erythematous flush around the iris). (Choice C) Topical antibiotics (eg, erythromycin, trimethoprim/polymixin) are indicated for bacterial conjunctivitis, which is typically associated with significant ocular pain and a purulent discharge that rapidly reappears after being wiped away. Morning mattering of the lids ("stuck shut") can be seen with conjunctivitis of any cause. (Choice D) Topical glucocorticoids are indicated for certain steroid-responsive ocular disorders but are not recommended for viral conjunctivitis. These agents have significant risk (eg, corneal perforation, cataract formation) and should be used only under the supervision of an ophthalmologist. (Choice E) Topical nonsteroidal anti-inflammatory drugs (eg, diclofenac) are useful for pain following ocular surgery (eg, cataract), inhibition of intraoperative miosis, and allergic conjunctivitis. They have not been studied extensively in viral conjunctivitis. Educational objective: Viral conjunctivitis is characterized by acute conjunctival erythema, discomfort, and watery or mucoid discharge. Most cases are caused by adenovirus and may be associated with upper respiratory symptoms. Viral conjunctivitis is a self-limited condition; moist compresses and topical antihistamines and decongestants can reduce the symptoms. __________ References: Conjunctivitis: a systematic review of diagnosis and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/24150468) Diagnosis and management of red eye in primary care. (http://www.ncbi.nlm.nih.gov/pubmed/20082509)

A 22-Year-Old Woman Comes to the Office Due to Redness