A 28-year-old kindergarten teacher complains of a gritty sensation and discharge from the right eye for 3 days. She also has rhinorrhea, mild sore throat, and low-grade fever of 37.9 C (100.3 F). The symptoms began a week after classes started in the fall. Her medical history is significant for genital herpes and endometriosis. Eye examination shows mild injection and granular appearance of the tarsal conjunctiva of the right eye with profuse watery discharge. Nasal mucosa is normal, and the pharynx has mild erythema without exudates. Which of the following is the most appropriate next step in management of this patient?

Question

A 28-year-old kindergarten teacher complains of a gritty sensation and discharge from the right eye for 3 days.  She also has rhinorrhea, mild sore throat, and low-grade fever of 37.9 C (100.3 F).  The symptoms began a week after classes started in the fall.  Her medical history is significant for genital herpes and endometriosis.  Eye examination shows mild injection and granular appearance of the tarsal conjunctiva of the right eye with profuse watery discharge.  Nasal mucosa is normal, and the pharynx has mild erythema without exudates.  Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d29a_cdc4_bc81_61375b60da57_MD0003_00 This patient, with conjunctival inflammation and watery discharge in the setting of an upper respiratory illness, has typical features of viral conjunctivitis ("pink eye"). Most cases are caused by adenovirus, and outbreaks are common among small children and caregivers in late summer and early fall. Symptoms typically last several days and are self-limited. Occasional cases can develop a secondary bacterial infection ("bacterial superinfection") with more severe pain and grossly purulent exudate. Purulent bacterial conjunctivitis responds to topical antibiotic therapy (Choice B), but uncomplicated viral conjunctivitis can be managed symptomatically (eg, with warm or cool compresses to provide symptomatic relief). (Choice C) Olopatadine and azelastine, which are mast cell stabilizing agents and antihistamines, are indicated for treatment of allergic conjunctivitis. Although symptoms of allergic and viral conjunctivitis are often similar, allergic conjunctivitis typically occurs episodically with a shorter duration of symptoms. In addition, although many viral conjunctivitis symptoms may be due to release of histamine from mast cells, mast cell stabilizers have not been well studied for this purpose and are generally not needed; they may be used in very frequent episodes. (Choice D) Oral antiviral medications, such as acyclovir and valacyclovir, are recommended for treatment of herpes simplex keratitis. This condition causes a painful, red eye with impaired vision, opacification of the cornea, and corneal ulcers. Antiviral agents would not be effective in this patient with typical adenoviral conjunctivitis. (Choice E) Prednisolone ophthalmic drops are approved for use in ocular inflammatory and allergic conditions. They are relatively contraindicated in viral conjunctivitis because of the risk of complications and are not needed as symptoms will resolve spontaneously. Educational objective: Viral conjunctivitis is a self-limited condition associated with adenovirus and other viral upper respiratory illnesses. It is common in sporadic outbreaks, especially among children and caregivers in late summer and early fall. No specific treatment is needed, although some patients may develop a bacterial superinfection which requires topical antibiotics. References: Adenovirus. (http://www.ncbi.nlm.nih.gov/pubmed/21858752)

A 28-Year-Old Kindergarten Teacher Complains of a Gritty Sensation and Discharge