A 19 Year Old Woman With A Red Eye

A 19 year old woman presents to her school health officer after she woke up this morning with a red and a painful left eye. She says that she had some mild itching in her left eye when she went to bed the previous night. She also reports that she never had these symptoms previously. her eye feels mildly painful, itchy and teary. She has no visual difficulties and denies any problem in the right eye, fever, headache, neck pain sore throat or ear pain. She has no significant illnesses in the past but mentions working at a daycare 3 times in a week.

Physical Examination:

• Sclera and the conjunctiva of her left eye are inflamed. 
• No purulent discharge is notable.
• Left eye is watery.
• Her right eye has slight inflammation of the conjunctiva.
• Pupils are symmetrical and reactive to light.
•  Fundoscopic examination detects normal vascular markings in each eye.
• Slit lamp examination with fluorescein staining detects no corneal defects.
• Her periauricular lymph node is palpable on the left side.

The picture of her left eye is shown below:

Based on the history , physical examination and the picture shown what is the differential diagnosis?

Differential Diagnosis:

• Conjuctivitis
• Uveitis
• Closed angle glaucoma
• Corneal Abrasion

What is the final Diagnosis and How would you support your diagnosis on the basis of history and examination?

Viral Conjunctivitis:

• History of itchy, painful and red eye.
• Conjuctival ans scleral inflammation on examination, periauricular lympadenopathy, watery eye with no purulent discharge and normal corneal examination. 

Case Discussion
Conjuctivitis is the inflammation of the eye mucosa that occurs as a result of viral infection (most common), bacterial infection or an allergic reaction. 

It is typically highly contagious and spread by close contact or through towels and linens.

Causes: Adenovirus is the most common cause. other cause may include infection from bacteria (Staphylococcus aureus and Streptococcus pneumoniae). Nisseria gonnorhoeae and chlamydia  trachomatis may be transferred by sexual contact or to a newborn by an infected mother. 

Clinical Features:

• Mild eye pain
• Pruritis
• Excessive tearing
• Inflamed conjunctiva
• Possible periauricular lymphadenopathy
• Possible purulent discharge in bacterial infections.

Treatment:

1. The condition is typically self-limited.

2. Conservative management with artificial tears and cold compresses provide symptomatic relief.

3. Broad spectrum antibiotic drops decrease the duration of bacterial infections and serve a prophylactic role in viral infections.

4. Antihistamines are helpful in allergic causes.

5. Prevention of spread through hand washing, and laundry services is important.