Case 3

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Case 3
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Presentation History

• Teacher Female 23 with 1 unilateral sore ,red
  eye for 3weeks.
• Given Guttae Chlorsig 4 times a day for 1 week
  by GP.
• No response saw a partner and given Guttae
  Soframycin for another week.
• Attended optometrist as no better and told she
  needed Guttae Maxidex and GP prescribed this on
  optometrical advice!
• No better and given Guttae Neosporin.
• No response.Patient very angry and annoyed with
  the irritation and feels she has been mucked
  around.

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First thoughts

• Likely causes?

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• Viral infection?
• Resistant microbe?
• Wrong diagnosis?
• ? Iritis
• Ulcer?
• Iatrogenic?

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Further History?
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Suggested Further history

• Family members with sore eyes?
• Occupation?
• Injury?
• Discharge ?

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Further history

• No mucous discharge/ watery.
• No injury.
• No family members affected.

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Examination ? general

• List

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Suggestions

• Glands.
• Fauces.
• Rash.

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Ocular exam.

• List.

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Suggestions

• VA
• Stain.
• Evert lids.
• Glands.

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Findings

• Va 6/5 RL.
• No stain.
• Upper lid see slide.
• Pre auricular lymphadenopathy.

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Path.?

• List

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Suggested

• Micro.
• Viral.( culture, PCR Herpes)
• Chlamydia.( PCR)

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D.Diagnosis

• Viral keratoconjuntivitis.
• Chlamydia.

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Results

• All ive except PCR Chlamydia ive.

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Management

• ?

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Suggested

• 1 gm azithromycin orally statim.
• Contacts.( all negative)
• No sexual contact by 12/12
• ? The cause.

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Defect in history!! Worked in Arnhem Land for
12/12 as a teacher TRACHOMA!!