A 40-year-old woman comes to the office due to a red left eye. She was feeling well until 2 days ago when she awoke in the morning with sudden onset of redness and tearing of the eye. The patient has had no ocular itching or pain, but says, "I feel like there is something caught in my eye but I can't find anything." Medical history is notable for asthma, for which she uses an albuterol inhaler as needed. The patient does not use tobacco, alcohol, or illicit drugs. She works as an elementary school teacher and lives with her husband and 2 teenage children.
Vital signs are normal. Examination shows normal extraocular movements, pupillary reflexes, funduscopic findings, and visual acuity. Inspection of the eye is as shown in the exhibit.
Which of the following is the most appropriate next step in management of this patient's eye condition?

Question

A 40-year-old woman comes to the office due to a red left eye.  She was feeling well until 2 days ago when she awoke in the morning with sudden onset of redness and tearing of the eye.  The patient has had no ocular itching or pain, but says, "I feel like there is something caught in my eye but I can't find anything."  Medical history is notable for asthma, for which she uses an albuterol inhaler as needed.  The patient does not use tobacco, alcohol, or illicit drugs.  She works as an elementary school teacher and lives with her husband and 2 teenage children.
Vital signs are normal.  Examination shows normal extraocular movements, pupillary reflexes, funduscopic findings, and visual acuity.  Inspection of the eye is as shown in the exhibit.
Which of the following is the most appropriate next step in management of this patient's eye condition?

Quizplus · Accepted Answer

11ec193a_989d_83bc_853d_11ea9b55e9f4_MD0002_00 This patient has redness and tearing of the eye and examination findings consistent with (nodular) episcleritis. Episcleritis is characterized by acute inflammation of the white of the eye, without involvement of the uveal tract (ie, iris, ciliary body, choroid). It often causes mild irritation or a foreign-body sensation. Episcleritis is most common in young to middle-aged women. It is usually self-limited (with most attacks resolving within 3 weeks) and idiopathic, although evaluation for systemic disease (eg, rheumatoid arthritis) should be considered for recurrent cases. Management is generally conservative with topical lubricants. Topical or oral nonsteroidal anti-inflammatory drugs can be considered for persistent symptoms. In contrast to episcleritis, scleritis is a potentially dangerous eye condition often associated with active systemic rheumatologic disease. Significant pain, visual impairment, and a dark red sclera (in contrast to bright red in episcleritis) with scleral edema are classic features, and manifestations generally progress (eg, worsening pain) over days to weeks. Systemic glucocorticoids and immunosuppressants are typically employed (Choice C). scleritis (Choice A) Topical antibiotics (eg, erythromycin) are appropriate for bacterial conjunctivitis, which typically presents with ocular pain, mucoid/purulent discharge and crusting, and diffuse conjunctival redness. conjunctival redness (Choice D) Topical antihistamines are used for allergic conjunctivitis, which is characterized by prominent itchiness and diffuse redness of the conjunctiva and is often bilateral. (Choice E) Patients with acute angle-closure glaucoma often require urgent iridotomy. This condition is much more common in older patients, and is associated with ocular pain, headache, nausea, corneal opacity, and decreased visual acuity. Educational objective: Episcleritis is characterized by acute inflammation of the white of the eye, without involvement of the uveal tract. Episcleritis causes mild irritation or a foreign-body sensation without significant pain, visual impairment, or photophobia and is usually self-limited and idiopathic. Treatment is primarily with topical lubricants. __________ References: Diagnosis and management of red eye in primary care. (http://www.ncbi.nlm.nih.gov/pubmed/20082509)

A 40-Year-Old Woman Comes to the Office Due to a Red