Review Question - QID 109561

This patient is presenting with bilateral itching and watering of his eyes with the absence of other symptoms/exposures suggesting allergic conjunctivitis as the most likely diagnosis.

Allergic conjunctivitis occurs when an individual is exposed to an antigen that leads to mast cell degranulation. Patients can present with bilateral tearing, pruritis, and hyperemia. The best treatment for allergic conjunctivitis is allergen avoidance as well as non-sedating anti-histamines such as loratadine or fexofenadine.

Figure A demonstrates the physical exam findings of hyperemia and tearing which are commonly seen in allergic conjunctivitis.

Incorrect Answers:
Answer 1: Viral conjunctivitis presents similarly to allergic conjunctivitis with bilateral tearing, pruritis, and hyperemia. However, given this patient's history of atopy, recent migration to a new location, lack of other physical exam findings, and absence of systemic symptoms, allergic conjunctivitis is a more likely diagnosis. Viral conjunctivitis is a strong possibility and should be on the differential.

Answer 2: Bacterial conjunctivitis presents with pain and a purulent discharge from the eye, in contrast to this patient's watery discharge and hyperemia.

Answer 4: Corneal abrasion presents with pain in the eye with or without visual disturbance. This patient's career as a machinist puts him at risk for corneal abrasion; however, his bilateral allergic symptoms suggest a diagnosis of allergic conjunctivitis.

Answer 5: Foreign body in the eye presents with eye pain and a chief complaint of a sensation of an object in the eye.

Bullet Summary:
Allergic conjunctivitis presents with bilateral tearing, pruritis, and hyperemia.