| Catherine Bailey is a 32 YO woman who comes to your office on a lovely spring day with a concern about her left eye which looks like this: |
 |
Question 1: If you could only ask whether or not she had
two symptoms, which two would be the most important to know?
Answer to Question 1
Question 2: What does the presence of pain tell you? Blurry
or Changed Vision?
Answer to Question 2
Mrs. Bailey denied any pain or change in vision.
Question 3: What other things do you want to know about her
history?
Answer to Question 3
Mrs. Bailey says that this has been going on for 3 days. It seems to have increased
slightly during the last 2 days. She denied any photophobia, halos, and itching but does
acknowledge significant eye watering and small amount of discharge. She said that it is
also starting up in her other eye.
You ask her the standard questions about:
- whether there is anyone else sick at home or work
- whether she has symptoms of anything else
- has she tried anything for it
- does anything make it better or worse.
She responds that she has had a bit of a runny nose and headache, as have some of the
children at the day care center at which she works. She tried Tylenol and some OTC
artificial tears with no effect.
Using that information, you can get a good idea about the diagnosis. Again, your history
is the most important tool:
| Cause | Picture/Description | Blurred Vision | Pain | Photo- phobia | Colored Halos | Exudates | Itching |
| Keratitis: eg herpes simplex keratitis |
 |
3 |
2 |
3 |
0-3 |
||
| Conjunctivitis: Inflammation of the conjunctiva |
 |
Bacterial: 3 |
Allergic: 2-3 |
||||
| Iritis |
 |
1-2 |
2 |
3 |
|||
| Angle Closure Glaucoma |
 |
3 |
2- 3 |
1 |
2 |
||
| Referral Advisable if Present | Yes |
Yes |
Yes |
Yes |
No |
No |
At this point, conjunctivitis is likely, but you need to confirm this with the exam.
Question 4: If you could only check two things on the eye
exam, what would you choose?
Answer to Question 4
On exam, you find no pupillary abnormalities, no ciliary flush and a small amount of dried
discharge on her eye lashes. You also note palpable preauricular nodes. The remainder of
the exam is unremarkable.
Question 5: Scleritis, Episcleritis and Conjunctivitis are
very similar appearing. They have neither ciliary flush, nor pupillary abnormalities. What
helps you to differentiate them?
Answer to Question 5
Question 6: Based on the present evidence, what is your
general diagnosis?
Answer to Question 6
Question 7: What are the 2 anatomically/locational different
types of conjunctiva?
Answer to Question 7
Question 8: Now that you have a diagnosis, how do you
determine the TYPE of conjunctivitis?
Answer to Question 8
Question 9: What type of conjunctivitis does she have?
Answer to Question 9
Question 10: What types of therapy and prognosis can you
offer her?
Answer to Question 10
Question 11: What is the expected course/duration of other
types of conjunctivitis?
Answer to Question 11
End of Case 2
Start Case 3
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