DIAGNOSTIC QUIZ

Recalcitrant Itching, Redness
Pose Clinical Quandary

by Andrew S. Gurwood, O.D.

A 47-year-old white male had a chief complaint of itchy, red eyes for two months. His general physician had given him an antibiotic ointment. He had also been seen by two other eye doctors. Each doctor recommended treatment (eye drops or ointment), but that helped only slightly. The signs and symptoms would return whenever he discontinued the regimen.

A 47-year-old white male complaining of red, itchy eyes for the last two months had already seen three other doctors before the present visit. Previous antibiotic treatments helped only marginally, and each time the condition would relapse once the regimens were discontinued. The vision was unaffected.

How would you approach this case? Read on for details about the exam. Then check your diagnostic skills by calling the "Diagnostic Quiz" phone line or by clicking on "Diagnostic Quiz Answers" at the bottom of this article.

Best corrected visual acuities were 20/20 O.U. at distance and near. The external exam was normal with no evidence of afferent defect.  Refraction revealed hyperopia with presbyopia. The slit lamp exam disclosed the presentation seen in the accompanying photograph. The dilated fundus exam revealed normal, healthy optic nerve heads and no peripheral pathology in either eye.

What is the diagnosis? Are there any additional tests you would perform to confirm the diagnosis? How would you manage this patient?

The editors welcome Dr. Gurwood as the author of this column. He is a prolific contributor to these pages and an associate professor of clinical sciences at The Eye Institute of the Pennsylvania College of Optometry.

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