Taylor’s Case: Red Right Eye (7-Year-Old)

Week 3 Discussion Part I

 

Table 1

Red Eye

 

Please complete the differential diagnosis table for cc: red eye
  Clinical Findings Diagnosis Treatment/Management
Ophthalmia neonatorum      
Bacterial conjunctivitis      
Viral conjunctivitis      
Allergic conjunctivitis      
Corneal abrasion, foreign body      
Periorbital Cellulitis      
Blepharitis      
Hordeolum (Stye)      
Chalazion      

 

 

Table 2

Abnormal Ophthalmologic Finings

 

Complete the table
  Strabismus Amblyopia Esotropia
Description      
Management/Treatment      

 

  Red Reflex Light Reflex Test/Corneal Light Reflex/Hirschberg Test)
Describe how to perform the procedure    
What is an expected finding?    
Screening for?    

 

 

Table 3

Dental Health

 

Fill in the Blank
 
1. When should a child’s first dental appointment occur?
 
2. When do the first primary teeth erupt?
 
3. A child usually has 6-8 primary teeth by _____ (what age?)
 
4.A child has a complete set of 20 primary teeth, including second molars by ______(what age?)

 

Table 4

Ear Pain

 

Complete the table.
Common Differentials Description Causative Agents Clinical Findings Treatment/
Management
Prevention/
Education
Otitis Externa          
Acute Otitis Media (AOM)          
Otitis Media w/ Effusion          
List 5 other Differentials for er pain Description Clinical Findings Management
1.      
2.      
3.      
4.      
5.      

 

Taylor is 7-year-old who is brought to the clinic by her aunt because she has had redness in her right eye for 3 days. Today when she woke up, her right eye was swollen, red, and tender. She denies fever.

  • What should you ask Taylor about her eye?
  • What type of exam(s) should be performed?
  • What would be your management for this patient?

SOLUTION

Taylor’s Case: Red Right Eye (7-Year-Old)


Questions to Ask Taylor About Her Eye:

  • When did the redness start?

  • Was there any injury or trauma to the eye?

  • Is there any discharge? If yes, what color is it?

  • Does the eye itch or feel gritty?

  • Is the vision blurry?

  • Is there any sensitivity to light?

  • Has she had any recent upper respiratory infection or allergies?

  • Does she wear contact lenses?

  • Has this happened before?


Exams to Perform:

  • Visual acuity test

  • Inspection of eye for discharge, swelling, conjunctival injection, and eyelid involvement

  • Eversion of eyelid to check for foreign bodies

  • Fluorescein stain with Wood’s lamp to rule out corneal abrasion

  • Palpation of periorbital area for tenderness or cellulitis

  • Ophthalmoscope exam for red reflex and internal eye structures

  • Pupil reaction test for photophobia or afferent pupillary defect


Likely Diagnosis:

Hordeolum (Stye) or Periorbital Cellulitis (differential).


Management:

  • Warm compresses 4–6 times daily if it’s a hordeolum

  • Topical antibiotics (e.g., erythromycin ointment) if mild bacterial conjunctivitis

  • Oral antibiotics (e.g., Augmentin) if periorbital cellulitis is suspected

  • Refer to ophthalmology if not improving in 24–48 hours or if worsening

  • Educate on hand hygiene, avoid rubbing eyes, and avoid school until discharge clears


📘 Table 1: Differential Diagnosis of Red Eye

Clinical Findings Diagnosis Treatment/Management
Redness in neonate within days of birth; purulent discharge Ophthalmia Neonatorum Depends on cause: erythromycin ointment prophylactically; systemic antibiotics for gonorrhea/chlamydia
Mucopurulent discharge, unilateral/bilateral, stuck eyelids Bacterial Conjunctivitis Topical antibiotics (e.g., polymyxin B/trimethoprim, erythromycin ointment)
Watery discharge, bilateral, preauricular node swelling Viral Conjunctivitis Supportive care, hand hygiene, cool compress
Itchy eyes, watery discharge, bilateral, allergic history Allergic Conjunctivitis Oral antihistamines, antihistamine eye drops (e.g., olopatadine), avoid allergens
Pain, foreign body sensation, fluorescein uptake Corneal Abrasion/Foreign Body Remove FB if present, topical antibiotic ointment, avoid contact lenses
Redness, eyelid swelling, tenderness, no vision changes Periorbital Cellulitis Oral antibiotics, warm compresses; refer if orbital cellulitis suspected
Red, itchy, scaly lid margins, crusting Blepharitis Lid hygiene, warm compresses, topical antibiotics if infected
Localized painful nodule on eyelid margin Hordeolum (Stye) Warm compresses, possible topical antibiotics
Firm, painless bump on eyelid (meibomian gland) Chalazion Warm compresses, ophthalmology referral if persistent

📘 Table 2: Abnormal Ophthalmologic Findings

Strabismus Amblyopia Esotropia
Description Misalignment of eyes Decreased vision due to poor visual stimulation Inward turning of one or both eyes
Management/Treatment Refer to ophthalmology, patching, surgery Patching stronger eye, corrective lenses Eye patching, surgery, glasses

Vision Screening Techniques

Red Reflex Corneal Light Reflex (Hirschberg Test)
Procedure Shine ophthalmoscope light into eyes from 12–18 inches Shine light at eyes, observe light reflection location
Expected Finding Equal red reflex in both eyes Light reflection centered and symmetrical
Screening for Cataracts, retinoblastoma Strabismus, ocular misalignment

🦷 Table 3: Dental Health

  1. First dental appointment: By 12 months of age or within 6 months of first tooth eruption

  2. First primary teeth eruption: Around 6 months

  3. 6–8 primary teeth by: 12 months of age

  4. Complete set of 20 primary teeth by: 2.5 to 3 years of age


👂 Table 4: Ear Pain

Common Differentials

Description Causative Agents Clinical Findings Treatment/Management Prevention/Education
Otitis Externa Infection of ear canal Pseudomonas, S. aureus Pain with ear tugging, canal edema, discharge Antibiotic ear drops, avoid moisture Keep ears dry, avoid trauma
Acute Otitis Media Infection of middle ear Viral, S. pneumoniae, H. influenzae Fever, ear pain, bulging TM Amoxicillin first-line Vaccination, avoid smoke
Otitis Media w/Effusion Fluid without infection Post-infection Hearing loss, fullness, no fever Observation, possible ENT referral Hearing screening, monitor speech delay

5 Other Differentials for Ear Pain

Description Clinical Findings Management
1. Foreign Body Object in ear canal Pain, hearing loss, visible object Removal in office or ENT
2. TM Perforation Hole in eardrum Sudden pain relief, drainage Keep ear dry, ENT follow-up
3. Mastoiditis Infection of mastoid Post-AOM, swelling behind ear IV antibiotics, possible surgery
4. Dental Abscess Tooth infection referring pain Tooth tenderness, swelling Dental referral, antibiotics
5. Temporomandibular Joint (TMJ) Dysfunction Jaw-related pain Clicking, pain on chewing Rest jaw, warm compress, refer if persistent

 

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