FSU Assessments Need Objective Data and Diagnosis Discussion Response – Description
Please respond to discussion below:
Subjective Data
Patient is an 11-year-old female with unilateral red sclera with bilateral swelling of the eyelids. Patient describes a sensation of “sand in the eye”. To obtain additional helpful subjective information I would ask the mother and patient whether there has been any recent trauma to the eye. This would include any scratches or material that could’ve gotten into the eye in the past three days. Additionally, I would want to know if the child has encountered anyone with who is sick or with known conjunctivitis in the past 4-5 days. It would be helpful to know if the child has had any itching of the eye, light sensitivity, or mucopurulent discharge (Solano et al., 2023). I would want to know if the child has recently had any kind of upper respiratory infection and if it was treated. Finally, I would ask whether the patient is experiencing any symptoms of fatigue or malaise. This information will be helpful for the diagnostic differential.
Objective Data & Diagnostics
During assessment I would conduct a visual acuity test with the Snellen chart. Additionally, I would perform a thorough eye exam to look to evaluate for any physical changes to the eyes and eyelids. Physical exam would also include lymph node palpation to help rule out viral infection. Lab testing would not be indicated unless the symptoms fail to resolve with typically treatment modalities such as eye drops and compresses (Solano et al., 2023).
Differential Diagnoses
Potential diagnosis includes blepharitis, conjunctivitis (bacterial or viral) and keratitis (Bates, 2010). Blepharitis is an inflammation of the eyelids. It can present with itching, burning, and crusting of the eyelids (Eberhardt & Rammohan, 2023). The patient may feel a foreign body sensation in the eye and frequent tearing. Vision changes may be noted on exam. Patient may experience mattering of the eyelids upon waking and notice that symptoms are worse in the morning.
Conjunctivitis is an inflammation of the conjunctiva. The etiology of conjunctivitis can be bacterial, viral or allergic in nature. It is unlikely that the patient is experiencing allergic conjunctivitis since the mother reports no allergies. Viral and allergic conjunctivitis present similarly with excessive eyewatering, and reddened sclera (Solano et al., 2023). The treatment for these two subtypes is different though since allergic conjunctivitis will include treatment with an antihistamine. Distinguishing between viral and bacterial conjunctivitis can be difficult. Patients with viral conjunctivitis will present with a sudden onset of a foreign body sensation in the eye, accompanied by reddened sclera, itching, light sensitivity and watery eyes (Solano et al., 2023). Generally, bacterial conjunctivitis will be accompanied by exudate that can look and feel like sticky goo. This can dry on the eyelids and create a crust. The patient may notice that their eyelids are stuck together when they first awake in the morning. The current history presented favors bacterial conjunctivitis from reports of otherwise healthy child with crusty exudate and morning mattering of the eyelids (Solano et al., 2023).
Keratitis is included in the differential but is less common. Microbial keratitis is a serious and potentially vision-threatening condition that results from inflammation of the cornea (Al Otaibi et al., 2012). This disease process is most commonly a result of trauma to the eye. Symptoms of the condition include pain and redness in the eye with photophobia and watery eyes with discharge. The patient will likely be experiencing vision changes and may report feeling as if there is something foreign in the eye.
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