Different kinds of conjunctivitis to consider as a differential.
Brief and concise summary of H&P findings presented to a preceptor
CC: Patient reports “gritty” sensation in the eyes, which feels “like sand caught in your eye” accompanied by mild to moderate discomfort which is characterized by itching, tearing, FB sensation and redness of the eyes.
19 y/o young male college student in NAD with temp-97.9, P-68, R-16, BP 120/75, 6’0 tall and 195 pounds heavy reported today with complains of constant bilateral eye discomfort in both eyes. He presented himself to the student health centre after about three days after the onset of the discomfort. He had discomfort, which was evaluated at 2/10 on pain scale. He has never had the condition before other than seasonal allergic rhinitis, which is triggered by springtime climatic conditions. He did not suffer from fever, chills, ST and throat redness, swelling and tenderness of lymph nodes, cough, wheezing, SOB, chest pain, crusting of lips, mucoid drainage or any other recent illness. He also claims to have never used contact lenses or eye glasses. Neither has he previously suffered eye injury, trauma, visual changes nor eye dryness. Also, he claims to suffer occasional running nose with intermittent nasal congestion, but denies sneezing. Nevertheless, he purports to control these seasonal nasal allergies, which are aggravated in the spring with Loratadine and fluticasone nasal spray, which is taken during peak season. However, he is taking neither of these medications right now. The patient took OTC visine drops once yesterday, which got rid of the redness temporarily while the gritty sensation, tearing, and itching remained.
Upon physical examination, it was noted that the eyes had visual acuity of 20/20 OU, PERRL, white sclera bilaterally with slight light sensitivity. There were no crusting, lesions or masses noted on the eyes.
This is the inflammation of the membrane lining the eyelids and covering the exposed surface of the sclera. It is the most prevalent cause of red eye and is of three types that is allergic conjunctivitis, bacterial conjunctivitis and viral conjunctivitis. Bacterial conjunctivitis is bilateral and purulent and affects both adults and children. However, it is mostly prevalent among children. It is caused by various bacteria such as Chlamydia trachomatis and Neisserai gonorrhoeae (Vivinoet al., 2016).
2. Dry eye syndrome
This disease entails the chronic reduction of the quantity and quality of tears, resulting in the insufficient lubrication of the eye. It can trigger mild to severe discomfort and damage tissues of the eye surface such as the cornea and the conjunctiva (Foulks et al., 2015).
It is an inflammation of the margin of the eyelid. It is characterized by the inflammation, scaling, reddening and crusting of the eyelid (Pflugfelderet al., 2014). It causes burning, itching and a grainy sensation in the eye or when foreign objects are introduced into the eye (Mand & Mannis, 2014).
Analysis of the differential diagnosis using the H&P findings
Conjunctivitis as the present disease is evidenced by the reddening of the bilateral conjunctiva, tearing of the eyes, burning, itchy and grainy sensation in the eye.
Blepharitis is evidenced by the reddening and tearing of the eyes and the burning, itchy and grainy sensation in the eye. However, the condition is disapproved in this case by the lack of crusting, lesions, masses on the lids and the lash-line.
Dry eye syndrome is evidenced by the irritation and reddening of the eyes, the gritty, grainy and burning sensation and the sensitivity to light. However, the condition is disapproved in this case by the tearing of the eyes and the absence of hemorrhage.
Additional tests/procedures necessary to narrow the differential diagnosis
It is essential to carry further tests to determine what type of conjunctivitis is ailing the patient. Since there was no mucoid discharge being released from the eyes, such a test would conclusively disapprove bacterial conjunctivitis. Additionally, the test would allow for the determination of the nature of conjunctivitis affecting the patient and if it is viral, then which virus is causing the diseases. If it is allergic conjunctivitis, then which is the allergen triggering the occurrence of the disease (Elliott, 2013).
Elliott, D. B. (2013). Clinical Procedures in Primary Eye Care E-Book. Elsevier Health Sciences.
Foulks, G. N., Forstot, S. L., Donshik, P. C., Forstot, J. Z., Goldstein, M. H., Lemp, M. A., … & Asbell, P. (2015). Clinical guidelines for management of dry eye associated with Sjögren disease. The ocular surface, 13(2), 118-132.
Mand, P., & Mannis, M. J. (2014). What is the best treatment approach for severe blepharitis?. Vision Pan-America, The Pan-American Journal of Ophthalmology, 13(3), 67-69.
Pflugfelder, S. C., Karpecki, P. M., & Perez, V. L. (2014). Treatment of blepharitis: recent clinical trials. The ocular surface, 12(4), 273-284.
Vivino, F. B., Carsons, S. E., Foulks, G., Daniels, T. E., Parke, A., Brennan, M. T., … & Hammitt, K. M. (2016). New Treatment Guidelines for Sjögren’s Disease. Rheumatic Disease Clinics, 42(3), 531-551.