C.J. is a 27-year-old male who started to present crusty and yellowish discharge on his eyes 24 hours ago. In the beginning, he thought that by washing his eyes vigorously the discharge would go away but on the contrary, it increased causing blurry vision, especially in the morning. Once he clears his eyes of the sticky discharge his visual acuity is normal again. Also, he has been feeling a throbbing pain in his left ear. His eyes became red today, so he decided to consult to get evaluated. On his physical assessment, you found a yellowish discharge and bilateral conjunctival erythema. His throat and lungs are normal, and his left ear canal is within normal limits, but the tympanic membrane is opaque, bulging, and red.

Case Study 2 Questions:

Based on the clinical manifestations presented in the case above, what would be your diagnosis for C.J. Please name why you got to this diagnosis and document your rationale.

Any additional diagnosis or complication noted? Explain.

With no further information would you be able to name the probable etiology of the eye affection presented? Viral, bacterial, allergic, gonococcal, trachoma. Why and why not?

Based on your answer to the previous question regarding the etiology of eye affection, which would be the best therapeutic approach to C.J.’s problem? Include any additional treatment or approach to any other diagnosis or complication present in this case.

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Diagnosis: C.J.’s clinical presentation suggests a probable diagnosis of bacterial conjunctivitis and otitis media with effusion (OME). The presence of crusty and yellowish discharge from the eyes, accompanied by redness, blurry vision, and bilateral conjunctival erythema, are characteristic features of bacterial conjunctivitis (Azari & Barney, 2013). Additionally, the opaque, bulging, and red tympanic membrane observed during the physical assessment indicates inflammation and fluid accumulation in the middle ear, consistent with OME (Rosenfeld et al., 2016).

Rationale: Bacterial conjunctivitis typically presents with purulent discharge, conjunctival erythema, and ocular irritation, as seen in C.J.’s case (Azari & Barney, 2013). The worsening symptoms despite vigorous eye washing suggest a bacterial etiology, as viral conjunctivitis usually resolves spontaneously within a few days. The association of ear pain and findings of otoscopic examination indicative of OME suggest a concurrent middle ear infection, which can commonly accompany bacterial conjunctivitis (Kliegman et al., 2020).

2. Additional Diagnosis or Complication: A possible complication noted in C.J.’s case is the potential for the spread of infection from the eyes to the ears, resulting in concurrent bacterial conjunctivitis and otitis media. Additionally, the bulging and opaque tympanic membrane raise concerns for acute otitis media (AOM) with effusion, which may require further evaluation and management (Rosenfeld et al., 2016).
3. Probable Etiology of Eye Affection: Given the clinical presentation of crusty discharge, ocular irritation, and worsening symptoms, bacterial conjunctivitis is the most likely etiology. While viral conjunctivitis can also present with similar symptoms, the persistence of symptoms and presence of purulent discharge favor a bacterial etiology (Azari & Barney, 2013).

Therapeutic Approach: The best therapeutic approach for C.J.’s bacterial conjunctivitis involves topical antibiotic treatment, such as fluoroquinolones or polymyxin B/trimethoprim, to target the bacterial infection (Azari & Barney, 2013). Additionally, supportive measures such as warm compresses and lubricating eye drops can help alleviate symptoms and promote ocular comfort (Azari & Barney, 2013).

For the concurrent otitis media, management may include pain relief with analgesics and observation for spontaneous resolution, given the presence of OME without signs of acute inflammation (Rosenfeld et al., 2016). However, if symptoms persist or worsen, further evaluation for acute otitis media with possible consideration of antibiotic therapy may be necessary (Rosenfeld et al., 2016).

In summary, C.J. likely presents with bacterial conjunctivitis and otitis media with effusion, warranting prompt initiation of topical antibiotic treatment for the eyes and close monitoring of ear symptoms for potential progression to acute otitis media.

References:

Azari, A. A., & Barney, N. P. (2013). Conjunctivitis: A systematic review of diagnosis and treatment. JAMA, 310(16), 1721–1729. https://doi.org/10.1001/jama.2013.280318

Kliegman, R. M., St. Geme, J. W., Blum, N. J., & Shah, S. S. (Eds.). (2020). Nelson textbook of pediatrics (21st ed.). Elsevier.

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., … Grundfast, K. M. (2016). Clinical practice guideline: Otitis media with effusion (update). Otolaryngology–Head and Neck Surgery, 154(1 Suppl), S1–S41. https://doi.org/10.1177/0194599815623467

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