Conjunctivitis and red eye — branching viva

Opening question

Examiner: Take me through this child. What is the diagnosis, and what is your frame for managing it? ^[1]

Candidate: The most likely diagnosis is viral conjunctivitis, most often adenoviral. The clear watery discharge, follicles on the tarsal conjunctiva, the tender preauricular lymph node and the recent runny nose are the classic picture, and the sick classmate fits an outbreak. My frame is three-layered: first, confirm that this is conjunctivitis and not a dangerous red eye, by screening for pain, photophobia, reduced vision and the other red flags; second, match the treatment to the cause, which for a viral cause is supportive care and hygiene; and third, give clear safety-net and school advice. Because the child is well with normal vision and no pain, this is a community-managed case. ^{[1] [6]}

Examiner: How do you classify conjunctivitis, and which form is dangerous? ^[1]

Candidate: The three common forms are bacterial, viral and allergic. Bacterial conjunctivitis produces purulent or mucopurulent discharge with crusted lashes; viral conjunctivitis produces watery discharge with follicles and a preauricular node; and allergic conjunctivitis is dominated by itching, with cobblestone papillae in an atopic child. The dangerous forms are not these but the causes of a red eye that look like conjunctivitis and are not — bacterial keratitis in a contact-lens wearer, herpes simplex dendritic keratitis, iritis and acute glaucoma — plus, in the newborn, gonococcal ophthalmia neonatorum that can perforate the cornea within hours. ^{[1] [5]}