Ease Into Prep with a PANCE^® Question of the Day

The correct answer is A. This is viral conjunctivitis, an acute conjunctival inflammation most often caused by adenovirus. Most patients with this condition have had a recent exposure to someone with viral conjunctivitis or have had a recent viral upper respiratory infection. The presentation illustrated here is typical. Severe cases additionally have photophobia and a foreign body sensation. Pseudomembranes of fibrin and inflammatory cells on the conjunctival surfaces can occur. Corneal involvement can leave residual scarring visible by slit lamp for up to 2 years after a severe case. Cases are self-limited but tend to be extremely contagious, so care should be taken to have both the patient and health care provider wash their hands very thoroughly after touching the face.

Herpes virus (choices B and C) can cause corneal ulceration, hyperkeratosis, or scarring. It is commonly identified on staining of the eye, which reveals a dendritic corneal lesion.

Neisseria gonorrhoeae (choice D) can cause conjunctivitis in both adults and neonates. It produces a purulent, rather than a watery discharge.

Staphylococcus aureus (choice E) is a common cause of bacterial conjunctivitis. It produces a purulent, rather than a watery discharge.

PEARL: Viral conjunctivitis is a benign self-limiting condition. The most common causative organism is adenovirus. Viral conjunctivitis typically is associated with a watery discharge. Both bacterial and viral conjunctivitis may cause a matting of the eyelids together. Preauricular lymph node involvement is much more commonly seen with viral conjunctivitis. Adenoviral conjunctivitis is the typical cause of epidemic keratoconjunctivitis and follicular conjunctivitis. Viral conjunctivitis is more commonly seen in children. It is highly contagious and spreads by both direct contact with people or by touching contaminated surfaces that contain these secretions.