Allergic Conjunctivitis
Who you are:
FY2 in the GP clinic.Who the patient is:
30 year old Hans Zimmer came to the clinic with some problems with his eyes.What you should do:
Talk to the patient, assess, and address his concerns
Conjunctivitis (Positive Findings):
● Conjunctivitis is also known as red or pink eye. It usually affects both eyes and
makes them:
❖ Red
❖ Burn or feel gritty
❖ Produce pus that sticks to lashes
❖ Itch
❖ Water
Presenting complaint (P1) (ODIPARA):
D: Hello I am one of the doctors in the GP. You must be Hans?
P: Yes.
D: Can I get your full name and D.O.B., please, before we begin the consultation?
P: (Confirms details.)
D: So, Mr, Zimmer, I can see that you have been having some problems with your eyes?
P: Yes, doctor.
D: Tell me more about it (Open question)
P: I have been having this itching in my eyes and they are red as well.
D: Which eye?
P: Both the eyes.
D: When exactly did it start?
P: Well, doctor, it has been going on for the past 3 days (Onset)
D: Is it continuous or does it come and go? (Duration)
P: It comes and goes.
D: Any discharge, bleeding, pain?
P: No, doctor, it’s itchy and is watering.
D: Have you noticed any fever along with it?
P: No, doctor.
D: Do you think it has been increasing since it started? (Progression)
P: No, doctor. It’s the same since it started.
D: Is there anything that you think makes it better or worse? (Aggravating and relieving factors)
P: No doctor, it comes and goes by itself.
D: You had any injury or has any foreign body fallen into your eyes?
P: No doctor.
D: Any headache?
P: No.
D: Any problem with your vision?
P: No, doctor.
D: Anything else?
D.Ds
● Allergic conjunctivitis
● Infective conjunctivitis (Pus)
● Acute glaucoma (Severe eye pain, Headache, Decreased visual acuity)
● Foreign body.
Concern
D: Apart from this, do you have anything else that’s concerning you?
P: No.
Past medical conditions (P2)
D: Has this ever happened to you before in the past?
P: No, doctor, I have never had anything like this before.
D: Do you have any medical conditions that I should be aware of?
P: Yes, doctor, I have hay fever.
D.E.S.A:
Do you smoke?
What about alcohol?
M.A.F.T.O.S.A
D: Are you on any long-term medication?
P: No, doctor.
D: Any allergies to any food or drugs other than hay fever?
P: I am not sure about that, doctor.
D: Anyone in the family with similar problems or other medical conditions?
P: No, doctor.
Expectation
D: Anything specific in your mind that you are expecting from us today?
P: Something to get rid of it, doctor.
Examination:
● Observations (Check vitals)
● General physical examination
● Eye examination
Idea
D: Do you have any idea what might be causing this?
P: No, doctor.
Suspected diagnosis:
D: Mr. Zimmer, as you have been having this redness in the eye along with itching and excessive watering and you also have a history of hay fever, I am suspecting it to be allergic conjunctivitis, which is an allergic response of the eye to an allergen.
Management:
- Senior
- Investigations
● Not normally required. - Symptomatic management
● Avoidance of allergens, for example dust mite, mould, and animal dander control, avoidance of pets and proper ventilation of home and office environments.
● Washing the hair before going to bed may help reduce allergen exposure.
● Avoidance of eye rubbing.
● Boil water and let it cool down before you gently wipe your eyelashes to clean off crusts with a clean cotton wool pad (1 piece for each eye).
● Hold a cold flannel on your eyes for a few minutes to cool them down.
● Do not wear contact lenses until your eyes are better.
● Application of saline solution or artificial tears (Advise not to drive or perform other skilled tasks until vision is clear).
Do
● Wash your hands regularly with warm soapy water.
● Wash your pillowcases and face cloths in hot water and detergent.
● Cover your mouth and nose when sneezing and put used tissues in the bin.
Don’t
● Do not share towels and pillows.
● Do not rub your eyes.
- Definitive management
● Topical antihistamine or dual action mast cell stabilisers/topical antihistamine.
● Mast cell stabilisers can be used if symptoms are recurrent or persistent. (Need to be applied routinely for at least 2 weeks to provide prophylactic benefit.)
● Topical ocular diclofenac can be prescribed as adjunctive therapy if further symptomatic relief is required. - Specialist
● Only required if suspecting a serious cause for red eye - Safety net
● Meningitis
● Decreased visual acuity
● Purulent discharge