DR WILLIAM BOOTHE!!!!!!!!!!

Clinical suspicion may be present at first presentation or upon treatment failure of an unsuspected case. It is probably desirable to have the nurse or other office-related personnel take the sexual history to avoid a sense of inappropriateness. It is better to ask the patient if friends or family members should leave the room for this aspect of the evaluation. Duration of the disease and previous attempts at therapy should be documented. It is usual for symptoms to be present for several days or weeks at the time of presentation. An uncommonly long duration or a frequent recurrence suggests that other factors or conditions may be present. For instance, a molluscum lesion at the lid margin may be shedding virus into the eye. Chlamydial infection or viral keratoconjunctivitis may be present. A history of resistance to therapy may prompt the practitioner to obtain a culture. History of recent exposure to other cases is helpful. An exposure to a case that healed uneventfully would be comforting, whereas exposure to someone with known epidemic keratoconjunctivitis or herpes simplex would raise concern. A brief history to assess possible occupational exposure may be appropriate. A brief history of systemic illness should be obtained to determine if a recent viral upper respiratory tract infection has occurred or if there are any major known systemic illnesses, such as AIDS or diabetes. A medication history is important to document what already has been tried and to rule out medicamentosa or other drug causes for the condition. Ocular redness and irritation may occur due to an antibacterial eye drop solution or the preservatives in the solution. Systemic chemotherapeutic agents can cause an irritative conjunctivitis.

A history of allergies to medications should be established for avoidance purposes and recorded in the medical record prominently since this is often the only medical encounter with an otherwise healthy individual. Patients with typical bacterial conjunctivitis do not complain of photophobia. Sensitivity to light is a symptom of intraocular inflammation as in iritis or corneal lesions, such as those found in viral keratitis. A history of contact lens wear opens up an array of possibilities in the setting of a red eye. Corneal ulcers, which are infections within the stroma of the cornea, may occur with contact lens wear. Improper contact lens care and/or contaminated solutions can lead to corneal infections with bacteria, Acanthamoeba, or fungi. In early 2006, an outbreak of fungal infections with Fusarium species occurred due to a contact lens solution. In these cases, the infection involves the cornea and may be associated with a red eye.

Dr. William Boothe - Dr. Boothe