A 13-year-old boy is brought to clinic by his parents due to copious, purulent discharge from his right eye. The patient's eye was crusted shut this morning. His father was able to open the eye by wiping it with a damp washcloth. The patient went to school but was sent home by the school nurse. He has not had ocular pain, visual changes, or fever. He lives at home with his parents and older sister, none of whom have similar symptoms. The patient has mild myopia and wears contact lenses. He takes loratadine daily for seasonal allergies. Vital signs are within normal limits. Examination shows conjunctival erythema and yellow exudate in the right eye. The conjunctiva of the left eye is also erythematous, but there are no secretions. Visual acuity testing with the patient's contacts removed shows 20/80 vision in both eyes, consistent with his well-child examination at age 12. The mother is very concerned about possible complications of the disease. Which of the following complications is most likely to occur with this patient's condition?

Question

A 13-year-old boy is brought to clinic by his parents due to copious, purulent discharge from his right eye.  The patient's eye was crusted shut this morning.  His father was able to open the eye by wiping it with a damp washcloth.  The patient went to school but was sent home by the school nurse.  He has not had ocular pain, visual changes, or fever.  He lives at home with his parents and older sister, none of whom have similar symptoms.  The patient has mild myopia and wears contact lenses.  He takes loratadine daily for seasonal allergies.  Vital signs are within normal limits.  Examination shows conjunctival erythema and yellow exudate in the right eye.  The conjunctiva of the left eye is also erythematous, but there are no secretions.  Visual acuity testing with the patient's contacts removed shows 20/80 vision in both eyes, consistent with his well-child examination at age 12. The mother is very concerned about possible complications of the disease.  Which of the following complications is most likely to occur with this patient's condition?

Quizplus · Accepted Answer

Explanation: Bacterial conjunctivitis can progress to bacterial keratitis, which most commonly occurs in patients who wear contact lenses improperly (eg, overnight use) or have decreased immunity (eg, corticosteroid use). Keratitis is an inflammation of the cornea, the clear tissue covering the pupil and iris and bordered by the bulbar conjunctivae. Infectious keratitis can be due to a variety of organisms, including bacteria (eg, Pseudomonas aeruginosa), viruses (eg, herpes simplex virus, varicella-zoster virus), fungi, or parasites (eg, Acanthamoeba). (Choice A) Cavernous sinus thrombosis is due to venous spread of nearby (eg, sinus, nasal, dental) infections to the cavernous sinus with subsequent clot formation. Patients present with headache, unilateral periorbital edema, photophobia, and cranial nerve palsies. Preseptal eye infections, such as conjunctivitis, are not associated with cavernous sinus thrombosis. (Choice B) Endophthalmitis is a bacterial infection of the deep eye (vitreous) due to either direct inoculation into the globe (eg, surgery, trauma) or hematogenous spread. It is not a complication of bacterial conjunctivitis. (Choice C) Hordeolum (stye) is a bacterial infection of the sebaceous glands in the eyelid. Patients have tenderness, redness, and swelling at the eyelid margins. Hordeolum is not a complication of bacterial conjunctivitis. (Choice E) Uveitis, or inflammation of the middle eye (eg, choroid, vitreous, iris, ciliary body), is due to autoimmune diseases (eg, juvenile idiopathic arthritis, Reiter syndrome) or systemic infection. Educational objective: Keratitis, or inflammation of the cornea, is a rare complication of bacterial conjunctivitis but is more common in patients who wear contact lenses. References: Challenges of corneal infections. (http://www.ncbi.nlm.nih.gov/pubmed/28090214) Bacterial conjunctivitis. (http://www.ncbi.nlm.nih.gov/pubmed/22348418)

A 13-Year-Old Boy Is Brought to Clinic by His Parents