An 11-year-old boy is brought to the clinic by his parents due to eye redness and discharge. He has had a sore throat for 4 days and right eye redness for 2 days. The boy says, "It sometimes feels like my eye is burning!" This morning, both eyes were crusted shut. His father used a moist towel to open the patient's eyelids and saw that the left eye was also red. The boy has had no eye pain, visual changes, or itching. He has a history of eczema for which he uses topical moisturizers at night. The patient lives with his parents, 2 younger sisters, 7 dogs, 3 cats, and a turtle. No one in his family has similar symptoms. Temperature is 37.4 C (99.4 F) . Physical examination reveals conjunctival injection and clear mucoid discharge in both eyes. Mild rhinorrhea and pharyngeal erythema are also present. The lungs are clear to auscultation, and the remainder of the examination is normal. Item 1 of 2
Which of the following is the most likely diagnosis?

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Explanation: 11ec2b69_c00e_0f94_8f63_ebf7f96647ae_MD0005_00 Viral conjunctivitis is the most common cause of conjunctivitis in school-aged children. Presentation includes eye redness that can be unilateral or bilateral and watery or mucoid discharge that can cause the eye to crust shut in the mornings. Most commonly due to adenovirus, viral conjunctivitis can present alone or in the setting of a viral prodrome (eg, pharyngitis, rhinorrhea, fever), as in this patient. Patients often report a "sandy" or "burning" sensation in one or both eyes. The usual course of viral conjunctivitis is similar to viral upper respiratory tract infections: 3-5 days of worsening symptoms followed by gradual improvement and resolution in 1-2 weeks. Treatment is supportive (eg, cool compress, lubricating drops). (Choice A) Allergic conjunctivitis can also present with bilateral eye redness and watery discharge. However, this patient lacks the hallmark ocular itching (pruritus) found in allergic conjunctivitis. In addition, allergic conjunctivitis does not cause the gritty or burning sensation that this patient is experiencing. (Choice B) In contrast to viral conjunctivitis, bacterial conjunctivitis causes a more profuse, purulent discharge that accumulates soon after being wiped away. Also, bacterial conjunctivitis generally presents in isolation rather than in the setting of other viral symptoms. (Choices C and D) Corneal abrasion and keratitis (corneal infection) present with intense eye pain, photophobia, and foreign body sensation, none of which are present in this patient. Educational objective: Viral conjunctivitis is the most common cause of conjunctivitis in school-aged children. Presentation includes eye redness and mild watery or mucoid discharge, often in the setting of upper respiratory tract symptoms (eg, pharyngitis, rhinorrhea). References: Conjunctivitis. (http://www.ncbi.nlm.nih.gov/pubmed/26319341)

An 11-Year-Old Boy Is Brought to the Clinic by His