History
Recent sick contacts, healthcare/daycare exposure, contact lens use, URI symptoms, preauricular lymphadenopathy, sexual history, immunocompromised state, prior episodes.
Case 02 - Cornea, external disease, and anterior segment
The Red, Uncomfortable Eye
31-year-old woman - Bilateral sequential red eyes - Discharge - Photophobia - Blurred vision
Case 02Epidemic Keratoconjunctivitis (EKC)
Clinical Presentation
A 31-year-old woman has had a red, uncomfortable eye with moderate discharge for 5 days in the right eye; symptoms spread to the left after 3 days. She experienced intense foreign body sensation, photophobia, and blurred vision.
Learner Questions
- What questions should be asked regarding this patient's history?
- What are the ocular findings?
- What is the differential diagnosis, and how does the clinical course inform it?
- How would you manage this patient?
Answer Framework
DDx
EKC (adenovirus 8/19/37) most likely - bilateral sequential involvement, pseudomembranes, SEIs. DDx: pharyngoconjunctival fever, bacterial, chlamydial, HSV primary, molluscum. Sequential bilateral progression is the key distinguishing feature.
Findings
Marked conjunctival injection/chemosis, pseudomembranes on palpebral conjunctiva (whitish fibrinous deposits), subconjunctival hemorrhage, mucopurulent discharge, punctate epithelial erosions. SEIs appear 1-2 weeks in.
Management
Supportive: cool compresses, artificial tears. Topical steroids ONLY for vision-threatening SEIs. Strict hygiene - highly contagious. Healthcare workers furloughed ~2 weeks. Remove pseudomembranes to prevent symblepharon.
Teaching Pearl
EKC hallmark: pseudomembranes + subepithelial infiltrates (SEIs) that persist for months, reducing vision. Never prescribe steroids early - prolongs viral shedding. Adenovirus survives on surfaces for weeks; hospital outbreaks are a serious risk.
Original answer transcript
History DDx Recent sick contacts, healthcare/daycare exposure, contact lens use, URI symptoms, EKC (adenovirus 8/19/37) most likely - bilateral sequential involvement, preauricular lymphadenopathy, sexual history, immunocompromised state, prior episodes. pseudomembranes, SEIs. DDx: pharyngoconjunctival fever, bacterial, chlamydial, HSV primary, molluscum. Sequential bilateral progression is the key distinguishing feature. Findings Management Marked conjunctival injection/chemosis, pseudomembranes on palpebral conjunctiva Supportive: cool compresses, artificial tears. Topical steroids ONLY for vision-threatening (whitish fibrinous deposits), subconjunctival hemorrhage, mucopurulent discharge, SEIs. Strict hygiene - highly contagious. Healthcare workers furloughed ~2 weeks. Remove punctate epithelial erosions. SEIs appear 1-2 weeks in. pseudomembranes to prevent symblepharon. TEACHING PEARL EKC hallmark: pseudomembranes + subepithelial infiltrates (SEIs) that persist for months, reducing vision. Never prescribe steroids early - prolongs viral shedding. Adenovirus survives on surfaces for weeks; hospital outbreaks are a serious risk.