A 30-year-old woman presents to the office with a 3-day history of a unilateral red eye. Her vision is decreased and she has significant photo-phobia. She has a mucus-like discharge. She reports having had ‘flu’ with fever 2 weeks earlier. There is no history of exposure to an individual with a red eye, no history of contact lens wear, and no other associated non-ocular findings. Past medical history is positive for a recent ‘cold sore’ and a history of ‘hay fever.’ The patient is currently taking multivitamins and oral contraceptive pills. Based on the history presented, what is the best course of action?
- Gentamicin ophthalmic solution four times a day for presumed bacterial conjunctivitis
- Cool compresses and observation for presumed viral conjunctivitis
- Ophthalmologic referral for presumed acute angle closure glaucoma
- Ophthalmologic referral for presumed herpes simplex virus-related ocular disease
- Observation and topical antihistamines for presumed allergic conjunctivitis
When dealing with an ‘acute red eye’, it is imperative to establish a history of the present illness. One should explore the course of development, the presence of a discharge (bacterial infections produce more than viral), pain, recent upper respiratory infection (suggesting viral conjunctivitis), photophobia (suggesting iritis), foreign body sensation, itching (suggesting allergic conjunctivitis), burning, associated fever or rash, or decreased visual acuity. Elements of the past ocular history may be relevant, including glaucoma and contact lens wear. A. history of atopic disease may be important in the diagnosis of allergic conjunctivitis. A. history of herpes simplex virus labialis may be significant. In this patient, the history of herpes labialis and significant photophobia are suggestive for herpes simplex virus-related ocular disease.
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