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A 22-year-old man presents to his primary care physician with itchy eyes. The patient recently moved to the northern US and states that he has experienced bilateral itching and watering of his eyes. He states that it is very distracting and is making it hard for him to work. The patient denies any recent sick contacts and lives alone. He works as a machinist and is currently struggling with his finances. The patient has a past medical history of asthma, and his current medications include albuterol, fluticasone, fish oil, and whey protein supplements. His temperature is 99.5°F (37.5°C), blood pressure is 100/65 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 99% on room air. Cardiopulmonary exam is within normal limits. You notice the bilateral findings seen in Figure A. Otoscopy reveals bilateral clear tympanic membranes. The rest of the patient's physical exam is within normal limits. Which of the following is the most likely diagnosis?
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A 6-year-old boy is brought to the pediatrician complaining of itchy eyes. The mother states that she has noted that he has been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. She notices that his symptoms seem to improve in the evening after he showers. His temperature is 97.0°F (36.1°C), blood pressure is 100/66 mmHg, pulse is 90/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is the most likely diagnosis?
A 45-year-old truck driver complains of itchy eyes. He states his symptoms are worse when he goes outside and better when he takes a shower. His past medical history is significant for hypercholesterolemia, type II diabetes mellitus, and hypertension for which he takes atorvastatin, metformin, and lisinopril. His temperature is 98.1°F (36.7°C), blood pressure is 174/104 mmHg, pulse is 82/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man with the findings in Figure A which are seen in both eyes. Which of the following is the most appropriate next step in management?