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. The patient's diagnosis is discussed with the family. The mother says, "I've heard that this condition is very contagious, and I don't want him to get his classmates sick. When can he return to school?" Which of the following is the most appropriate response?

Question

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. The patient's diagnosis is discussed with the family.  The mother says, "I've heard that this condition is very contagious, and I don't want him to get his classmates sick.  When can he return to school?"  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: Eye drainage caused by viral conjunctivitis is the primary route of viral shedding. Patients are highly contagious due to the large amount of virus present in eye discharge. Transmission is facilitated by contamination of surfaces by patients who are touching or rubbing their eyes. To minimize transmission, the American Academy of Pediatrics recommends that children remain home, even if afebrile, until their eye drainage has resolved (Choice E). Participation in school and sports can then be resumed. Other symptoms, such as morning crusting or eye redness, may persist longer than eye discharge but do not contribute to infectivity (Choices A and D). (Choice B) Topical antibiotic therapy for 24 hours is considered sufficient to prevent transmission of bacterial conjunctivitis. Topical therapy does not treat or prevent the spread of viral conjunctivitis and is not indicated for this patient. Educational objective: Viral conjunctivitis is spread by contact with eye discharge or contaminated surfaces, and patients are highly infectious until eye discharge resolves. References: Conjunctivitis: a systematic review of diagnosis and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/24150468)

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