Based on these findings, this child is diagnosed with acute mucopurulent conjunctivitis of both eyes.
Conjunctivitis is commonly known as “pink eye” and refers to conjuntival inflammation that may be secondary to a variety of etiologies (viral, bacterial, allergic). Other causes include drug toxicity, dry eye, and contact lens use. The conjunctiva is a clear mucous membrane that covers the sclera (bulbar), palpebra, and fornix. Patients who present with conjunctivitis can complain of unilateral or bilateral eye redness, a foreign body/gritty sensation, itching, discharge, tearing.
Bacterial conjunctivitis is usually associated with minimal itching, hyperemia, moderate tearing, profuse mucopurulent exudate, and occasionally itchy sore throat and fever. Preauricular adenopathy is uncommon and bacteria/PMNs are found in stained scrapings/discharge. Patients also usually report that their eyelid is “stuck” or “glued” shut after a night of sleep. Palpation of the eyes should not elicit pain or discomfort. Pathogens that cause bacterial conjunctivitis include streptococcus pneumoniae, haemophilus influenzae, and staphylococcus aureus and can spread from one eye to the next in 24 to 48 hours.
Treatment is indicated despite being generally self-limiting to reduce person-to-person spread, corneal ulceration, and extraocular spread. Cultures should be taken if atypical in appearance. Prior to pathogen identification, empiric treatment can be begun with a topical broad spectrum antibiotic agent (eg. polymyxin-trimethoprim). In patients who use contact lenses, suspect Pseudomonas and begin treatment with a fluoroquinilone.
Advising the patient to perform frequent handwashing, changing pillowcases daily, changing towels daily and not touching near eyes without washing hands before and after is very important to prevent spreading.
Viral conjunctivitis generally presents with symptoms of injection, profuse watery/stringy discharge, and burning/gritty irritation. Like bacterial conjunctivitis, it is also associated with matting of the eyelids on awakening but has little mucus or discharge. Other signs of a viral etiology include a viral prodrome with tender preauricular lymphadenopathy, fever, pharyngitis, and/or URI. Monocytes are found on stained scrapings/exudates. Adenovirus is most commonly responsible and is highly contagious (through direct contact with secretions or contaminated objects/surfaces). Treatment of viral conjunctivitis is symptomatic (saline drops, antihistamine-decongestants) and should resolve over two weeks.
Conjunctivitis secondary to an allergic response is associated with bilateral redness, watery/stringy discharge, moderate tearing, and severe itchiness (which distinguish it from viral conjunctivitis). On stained scrapings/exudates, eosinophils can be found. A history of seasonal allergies or specific allergies is usually elicited. Treatment consists of topical anti-histamines and (in severe cases) topical steroids.
When symptoms comprise of an injected, painful eye, tenderness to palpation, vision loss/blurred vision, photophobia, corneal opacity, non-reactive pupil, severe headache with nausea, severe profusely purulent exudate, poor extraocular movement, ciliary flush (ring of red or purple around the cornea) and/or trauma, other ocular diagnosis should be considered. The differential for these etiologies include but are not limited to acute angle closure glaucoma, hyphema, hypopion, iritis/uveitis, cellulitis, infectious keratitis, gonococcal conjunctivitis, trachoma (secondary to C trachomatis A - C)/inclusion conjunctivitis (secondary to C trachomatis D- K), and herpes conjunctivitis.