Five-year-old girl with redness and light sensitivity of the right eye of 2 days' duration. She denied any significant pain or decreased vision. She initially presented to an urgent care clinic, where application of polymyxin B/trimethoprim eye drops 4 times a day was prescribed. Her symptoms had persisted despite this treatment. The mother was concerned because her daughter had kept the right eye closed since she awoke that morning. She also had noticed minimal clear discharge from the eye.
Otherwise healthy child with no chronic medical conditions. She was given no medications other than the eye drops. She had no fevers, headaches, or difficulty in swallowing;
no history of recent travel or travel abroad; and no pets. Family was unaware of any other children (in day care or neighborhood) with “pink eye.”
Alert, active child in slight distress related to her right eye. She was afebrile. Vital signs appropriate for her age. She had no preauricular lymph node enlargement. Systemic examination findings within normal limits.
Visual acuity 20/40 in right eye, 20/30 in left eye. Pupils equal and reactive to light, eyes aligned, and extraocular movements full. Right lower lid slightly edematous and erythematous; no vesicular or pustular lesions noted on the lid margin or periorbital skin. Conjunctiva significantly injected with diffuse tiny gelatinous bumps (A). Corneal light reflex slightly irregular in some areas; cornea otherwise clear. Anterior chamber and red reflex also clear. Left eye completely normal.
Right eye viewed by Wood lamp after application of fluorescein dye as shown (B).
WHAT'S YOUR DIAGNOSIS?
1. Wishart PK, James C, Wishart MS, Darougar S. Prevalence of acute conjunctivitis caused by chlamydia, adenovirus, and herpes simplex virus in an ophthalmic casualty department. Br J Ophthalmol. 1984;68:653-655.
2. Uchio E, Takeuchi S, Itoh N, et al. Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1. Br J Ophthalmol. 2000;84:968-972.
3. Wilhelmus KR. Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis. Cochrane Database Syst Rev. 2010;12:CD002898.
4. Young RC, Hodge DO, Liesegang TJ, Baratz KH. Incidence, recurrence, and outcomes of herpes simplex virus eye disease in Olmsted County, Minnesota, 1976-2007: the effect of oral antiviral prophylaxis. Arch Ophthalmol. 2010;128:1178-1183.