Conjunctivitis and red eye — formative SAQs

SAQ 1 (10 marks)

A 4-year-old is brought to the general practice with a two-day history of bilateral red, gritty, watery eyes, follicles on the tarsal conjunctiva and a tender preauricular lymph node. The child had a runny nose and mild fever last week. Vision is normal, and there is no pain or photophobia. A classmate has similar symptoms. ^[6]

Question: (a) What is the diagnosis and how do you confirm it? (b) Outline the management and the school advice. (c) State the red-flag features that would change your management to urgent ophthalmology referral. (10 marks) ^[1]

Model answer

(a) Diagnosis and confirmation (3 marks). The most likely diagnosis is viral conjunctivitis, most often adenoviral, suggested by the clear watery discharge, follicles on the tarsal conjunctiva, the tender preauricular lymph node, the accompanying upper-respiratory infection and the sick classmate. The diagnosis is clinical, built on the discharge type, the follicular conjunctival reaction and the preauricular node; routine swabs are not needed for uncomplicated disease. The vision is normal and there is no pain or photophobia, which excludes keratitis here. ^{[6] [1]}

(b) Management and school advice (4 marks). Viral conjunctivitis is self-limiting, resolving over one to two weeks, and the management is supportive: lubricating drops and cold compresses for comfort, with strict hygiene to limit spread — frequent hand washing, not sharing towels or pillows, avoiding eye rubbing. Because adenoviral conjunctivitis is highly contagious, advise exclusion from school, childcare and swimming pools until the discharge has settled. Topical antibiotics do not help a viral cause and should not be prescribed. Advise the family to return if pain, photophobia or reduced vision develops. ^[6]

(c) Red-flag features for urgent referral (3 marks). The red-eye red flags that move the child out of the conjunctivitis basket and into urgent ophthalmology are pain, photophobia, reduced vision, a foreign-body sensation, contact-lens use, trauma, ciliary flush (a ring of redness concentrated around the cornea), a corneal opacity or ulcer, and an abnormal pupil. Each points to keratitis, iritis (uveitis), acute glaucoma, corneal abrasion or a retained foreign body, and each mandates fluorescein staining and urgent referral rather than a topical drop. Conjunctivitis causes discomfort and grittiness, not true pain or visual loss. ^{[5] [1]}