Eye Disorders Case

A 7-year-old child has spent the majority of the summer afternoons swimming in the community pool.

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Sep 04, 2019
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He develops a bright red eye with scant discharge; the eye is irritated and has a sandpaper feeling to it. Two days later, the other eye becomes involved. The conjunctival injection lasts for 3 weeks. 


The most likely diagnosis is:

A. Viral conjunctivitis, likely adenoviral

B. Bacterial conjunctivitis, likely streptococcal

C. Corneal abrasion

D. Foreign body in the eye

E. Chemical reaction to chlorine





The correct answer is A.

Viral conjunctivitis often starts in 1 eye and then spreads to the second, less severely affected, eye several days later, with conjunctivitis lasting from a few days to 1 month. Adenoviral epidemic keratoconjunctivitis can also involve the cornea, and it lasts for many weeks. This conjunctivitis is treated with artificial tear drops for comfort, and by following precautions to prevent spread to other individuals: strict hand washing and not sharing towels or linens. Occasionally, an ophthalmologist treats corneal involvement due to adenoviral conjunctivitis with topical steroids. Topical steroid eye drops should not be prescribed by the pediatrician. Bacterial conjunctivitis usually has more purulent discharge; Streptococcus pneumoniae is a common pathogen. A corneal abrasion and foreign body would be unilateral, not spread to the other eye, and associated with tearing and with photophobia. Corneal abrasions typically heal within a few days. A chemical reaction to chlorine could cause similar symptoms; however, it would have bilateral simultaneous onset, usually cause a lesser degree of irritation, and would improve during the course of a day. (Pages 2300-2304, Section 30: Disorders of the Eyes, Part 2: Disorders of the Eye, Chapter 588)


Sources:

Question & Explanation: Cabana MD. Rudolph’s Pediatrics, 22e, Self-Assessment and Board Review; 2014.

Photo: Lueder GT. Pediatric Practice: Ophthalmology; 2011.

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