C.J. is a 27-year-old male who started to present crusty and yellowish discharged on his eyes 24 hours ago. At the beginning he thought that washing his eyes vigorously the discharge will go away but by the contrary increased producing a blurry vision specially in the morning. Once he clears his eyes of the sticky discharge her visual acuity was normal again. Also, he has been feeling throbbing pain on his left ear. His eyes became red today, so he decided to consult to get evaluated. On his physical assessment you found a yellowish discharge and bilateral conjunctival erythema. His throat and lungs are normal, his left ear canal is within normal limits, but the tympanic membrane is opaque, bulging and red.
Case Study Questions
Based on the clinical manifestations presented on the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rational.
With no further information would you be able to name the probable etiology of the eye affection presented? Viral, bacterial, allergic, gonococcal, trachoma. Why and why not.
Based on your answer to the previous question regarding the etiology of the eye affection, which would be the best therapeutic approach to C.J problem.
Full Answer Section
Therapeutic Approach
Given the likely bacterial etiology, the best therapeutic approach would be:
- Topical Antibiotics: Antibiotic eye drops or ointments are the mainstay of treatment for bacterial conjunctivitis. Common options include fluoroquinolones (e.g., moxifloxacin), trimethoprim/polymyxin B, or bacitracin/gentamicin.
- Hygiene:
- Clean the eyelids gently with a clean, wet cloth to remove discharge.
- Wash hands frequently to prevent the spread of infection.
- Avoid touching the eyes.
- Do not share towels or washcloths.
- Avoid Contact Lenses: If C.J. wears contact lenses, he should discontinue use until the infection has cleared and consult his eye care professional about proper cleaning or disposal of the lenses.
- Pain Relief: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be used for any discomfort.
Regarding the ear symptoms (throbbing pain, opaque, bulging, and red tympanic membrane), this strongly suggests acute otitis media (AOM) or a middle ear infection. It's important to address this concurrently, as it could be related to the conjunctivitis.
- Treatment for Otitis Media:
- Antibiotics: Oral amoxicillin is often the first-line treatment for bacterial AOM.
- Pain Management: Ibuprofen or acetaminophen for pain relief.
- Decongestants: May help to relieve ear pressure.
It's crucial for C.J. to be evaluated by a doctor for both his eye and ear symptoms to confirm the diagnoses and receive appropriate prescriptions.
Sample Answer
Okay, let's analyze C.J.'s case.
1. Eye Diagnosis and Rationale
Based on the clinical manifestations, the most likely eye diagnosis for C.J. is bacterial conjunctivitis.
Here's the rationale:
- Yellowish discharge: This is a key indicator of bacterial conjunctivitis. While viral conjunctivitis typically presents with a watery discharge, bacterial conjunctivitis is characterized by a thick, purulent, yellow or greenish discharge.
- Bilateral conjunctival erythema: The redness in both eyes also supports conjunctivitis.
- Symptoms worsening in the morning: Bacterial conjunctivitis often causes the eyelids to stick together due to the discharge, making it difficult to open the eyes in the morning.
- Normal visual acuity after clearing discharge: This suggests that the infection is primarily affecting the conjunctiva and not causing significant corneal involvement or other serious complications that would affect vision.
2. Probable Etiology of the Eye Affection
With the information provided, the most probable etiology is bacterial.
- Bacterial: The yellowish discharge strongly points towards a bacterial infection.
- Viral: While viral conjunctivitis is a possibility, it typically presents with a watery discharge, not a thick, yellowish one.
- Allergic: Allergic conjunctivitis usually involves itching, which is not mentioned in the case. The discharge is also typically watery and may be accompanied by other allergy symptoms.
- Gonococcal/Trachoma: These are less likely without further information. Gonococcal conjunctivitis usually presents with a hyperacute onset and profuse purulent discharge. Trachoma is less common and is associated with specific geographic regions.