Bacterial Conjunctivitis: Diagnostics and Treatment

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Table of Contents

Patient Background
Additional Questions
Physical Examination
Differential Diagnosis
Diagnostic Tests
Final Diagnosis
Management Plan
References

Patient Background

Based on the information gathered during the patient’s visit, the tentative diagnosis for Tom’s case is bacterial conjunctivitis. While several conditions can be attributed to the described symptoms, conjunctivitis (commonly known as pink eye) is an eye infection that is generally defined by redness, itchiness, and inflammation (Azari & Arabi, 2020). The patient’s and his mother’s narrative suggests a quick onset of the symptoms and the lack of progression or their natural improvement. These factors help establish that the inflammation is likely caused by an infection rather than other potential conditions.

Additional Questions

To help with the final diagnosis, it is necessary to ask Tom and Mrs. Bass some questions. First, one has to ask about other symptoms, especially ones connected to respiratory infections. Conjunctivitis can be a part of an infection or a common cold – thus, such symptoms as cough, nasal discharge, fever, sore throat need to be discussed with the patient (Azari & Arabi, 2020). Second, the patient may have allergies or a prior history of allergic reactions. If the patient wears contact lenses or has had any incidents involving touching or damaging his eyes, this information can affect the diagnosis (Azari & Arabi, 2020). Questions about coming into contact with other people with eye irritation are vital for establishing the infectious nature of the condition. Finally, one has to inquire about Tom’s hygiene habits – handwashing, touching one’s eyes with unwashed hands, using clean towels, and sharing personal objects.

Physical Examination

The examination of the patient’s respiratory system is needed to exclude infection or an allergic reaction. A dermatological exam focusing on the skin surrounding the eyes is necessary to record the irritation and note if any other issues are present (Azari & Arabi, 2020). The central part of the examination is the eyes, although it is helpful to inspect the ears, mouth, nose, and throat to add more data to the differential diagnosis (Azari & Arabi, 2020). For example, a throat exam can show the signs of a sore throat, suggesting an underlying respiratory infection. Finally, one should check the patient’s lymph nodes to exclude the viral infection (Azari & Arabi, 2020). Overall, physical examinations are focused on discovering signs of infection and allergic reactions.

Differential Diagnosis

The first potential diagnosis is bacterial conjunctivitis, a bacterial infection of one or both eyes. The condition is caused by several types of bacteria and is highly contagious (Leung et al., 2018). Its symptoms include itchiness, irritation, and redness in one or both eyes (Leung et al., 2018). The defining difference of a bacterial infection from other conjunctivitis types is a thick, opaque yellow discharge from the eyes (Leung et al., 2018). In Tom’s case, the discharge is described as dry and yellow, and Mrs. Bass also reports having to clean the affected eye several times per day. Combining these symptoms leads to diagnosing bacterial conjunctivitis as the most probable.

The second differential diagnosis is viral conjunctivitis, an infection with the same symptoms caused by a virus. This condition is similar to bacterial conjunctivitis in many ways. It can affect one or both eyes, and its symptoms include dryness, itchiness, and pain in the eye or eyes. However, the discharge in the case of a viral infection is usually liquid and transparent, which does not align with the patient’s symptoms (Azari & Arabi, 2020). Thus, while it is difficult to exclude this diagnosis without diagnostic tests completely, viral conjunctivitis is a less likely diagnosis for the patient.

Allergic conjunctivitis is the third potential diagnosis for the patient. Similar to other conjunctivitis cases, it is described as irritation of one’s eyes with redness and itching. Furthermore, tearing and other symptoms, such as nasal discharge, sneezing, or coughing, may be present (Bielory et al., 2020). From the gathered information, Tom does not exhibit other symptoms of an allergic reaction. Moreover, allergic conjunctivitis affects both eyes simultaneously, but in the patient’s case, only one eye is reported to be red and inflamed (Bielory et al., 2020). Based on the differences in presentation, the diagnosis of allergic conjunctivitis can be excluded.

Diagnostic Tests

The need for diagnostic tests can be established after a physical examination of the patient’s eyes. For example, if Tom has a foreign body in his eye or his case proves to be severe, then a culture of the discharge is necessary to confirm the infection and its cause (Leung et al., 2018). However, most cases of conjunctivitis do not require diagnostic tests as they pass on their own or with the help of medical treatment (Leung et al., 2018). Thus, if Tom’s condition is confirmed to be mild, the patient does not need to undergo any testing.

Final Diagnosis

Based on the subjective and objective data of the patient, the final diagnosis for the case is bacterial conjunctivitis. First of all, the patient describes the pain, irritation, redness, and itchiness in his eye. These symptoms are consistent with all types of conjunctivitis – an eye inflammation (Leung et al., 2018). Moreover, the patient does not seem to have any objects or foreign bodies that caused the pain. The discharge described by Tom and Mrs. Bass suggests that the cause of the infection is likely to be bacterial. It is yellow and dry, and it occurs several times a day, which is consistent with the presentation of a bacterial infection (Leung et al., 2018). To sum up, bacterial conjunctivitis fits the description given by the patient and can be supported by the physical examination.

Management Plan

Medications

The treatment of conjunctivitis can include over-the-counter (OTC) medications and prescribed drugs. In this case, bacterial conjunctivitis may pass on its own, but a prescription of antibiotics will shorten the diseases’ course (Leung et al., 2018). Therefore, the patient needs to use an ophthalmic solution – tobramycin ophthalmic – in a dose of one drop to the affected eye every four hours for seven days (Drugs.com, 2021). This antibiotic has several alternatives, including erythromycin or TobraDex (a combination of tobramycin and dexamethasone) (Drugs.com, 2021). However, tobramycin ophthalmic is a solution that may be easier to apply than an ointment, and it is widely available. Furthermore, the patient may benefit from OTC artificial tears to moisten the eyes (Drugs.com, 2021). This medication cannot replace the prescribed antibiotics as it will not treat the infection.

Teaching Plan and Follow-Up

First, the patient and his parent need to be reminded of hand hygiene basics. It is essential to wash one’s hands frequently and not touch the face and eyes with unwashed hands. Moreover, washcloths and towels need to be cleaned and changed often, as well as pillowcases. The teaching plan also includes the proper application of drops without touching the infected areas and keeping the container clean. Conjunctivitis is contagious; thus, Mrs. Bass has to be attentive to the patient’s use of personal items and hand hygiene during the treatment duration and after it to prevent reinfection. Generally, no follow-up appointment is necessary for cases of conjunctivitis (Azari & Arabi, 2020). However, if the patient’s symptoms do not lessen or disappear in seven days with the help of antibiotics or if other issues develop, a referral to an ophthalmologist is required.

References

Azari, A. A., & Arabi, A. (2020). Conjunctivitis: A systematic review. Journal of Ophthalmic & Vision Research, 15(3), 372. Web.

Bielory, L., Delgado, L., Katelaris, C. H., Leonardi, A., Rosario, N., & Vichyanoud, P. (2020). ICON: Diagnosis and management of allergic conjunctivitis.Annals of Allergy, Asthma & Immunology, 124(2), 118-134. Web.

Drugs.com. (2021). Tobramycin ophthalmic dosage. Web.

Leung, A. K., Hon, K. L., Wong, A. H., & Wong, A. S. (2018). Bacterial conjunctivitis in childhood: Etiology, clinical manifestations, diagnosis, and management.Recent Patents on Inflammation & Allergy Drug Discovery, 12(2), 120-127. Web.

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