Keratoconjunctivitis Sicca, Viral, and Bacterial Conjunctivitis

Eye Diseases
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1 What other subjective data would you obtain?
In the subjective data, it is essential to fill out the general data and ask for the history of present illness, which will include the onset of the symptoms, provoking factors or palliation, quality of pain or itchiness, radiation, severity, and timing (Bickley & Szilagyi, 2012). The general data will show the patient’s risks. Studies have shown that it is highly associated with the female sex and with increasing age. Generally, it is more common in Asians than Westerns, but the prevalence varies with the geographical location and other vital characteristics (Golden et al., 2021).
The history of present illness may reveal eye redness, burning, stinging, sandy or foreign body sensation, itchiness, epiphora, dryness, blurred vision, and increased sensitivity to light. These can progress to punctate erosions on the eye, pressure sensation, or increased eye discharges (Messmer, 2015; Bowling, 2016; Denniston & Murray, 2014).
The past medical history should also be thoroughly asked since this may identify the etiologic factors for the disease. Consequently, identifying the etiology will determine the management (Bickley & Szilagyi, 2012). The causes can be local eye diseases or previous disorders, systemic illnesses, or iatrogenic causes (i.e., topical medications, surgeries). Specifically, local eye problems may include previous conjunctival exposure to thermal or chemical burns, eye allergies, eye strain secondary to prolonged radiation exposure (i.e., prolonged use of mobile phones or computers), meibomian gland dysfunction, leading to the increased thickness of the eyelids due to the lack of lubrication, and long-term use of contact lenses, resulting to the decreased corneal sensation that also diminishes the protective mechanisms of the eye. Examples of systemic diseases include eczema, Sjogren syndrome, systemic lupus erythematosus, rheumatoid arthritis, graft-versus-host disease, maintenance drugs, or use of systemic drugs such as antihypertensives, antihistamines, benzodiazepines, systemic hormones, diuretics, corticosteroids, isotretinoin, anticholinergics, nonsteroidal anti-inflammatory drugs, and antidepressants. The patient might also have Vitamin A deficiency, resulting in excessive dryness of the conjunctivae and cornea. The review of systems could also provide information about these comorbidities (Golden et al., 2021).
Family history should also be evaluated due to systemic diseases that increase the risk of having the disease. For example, Younis and Al-Quzweeni (2019) noted that rheumatoid arthritis and dry eye have genetic predispositions. Berg et al. (2020) also explained the significance of knowing the environmental factors, such as increased exposure to humidity and airborne pollutants.
2 What other objective findings would you look for?
Eyelid evaluation is crucial as it will dictate how the treatment should proceed. The elements that must be evaluated are as follows: 1) Blepharitis, specifically anterior and Demodex blepharitis, places the patient at high risk for dry eye syndrome. This is secondary to the clogging of the eyelids, resulting in inflammation. Without proper treatment, this may lead to chronic presentations such as the presence of chalazion, corneal injury, sty, and others (Mayo Clinic, 2020). 2) Lid wiper epitheliopathy should be evaluated because this causes increased contact between the ocular surface and the lid, leading to a rise in friction due to the reduction in the spreading of the tear film. 3) Inspecting the meibomian gland orifices is critical in identifying external obstructions leading to viscous discharge excretion. 4) Eyelid blink closure was only briefly evaluated in the objective part. Frankly, the assessment sounded more like a subjective rather than an objective result. This must be performed using a video recording to demonstrate the presence or absence of incomplete blinking to identify lagophthalmos (Golden et al., 2021).
3 What diagnostic exams do you want to order?
Diagnostic examinations include evaluating the tear film stability, tear volume, visual surface assessment, tear film assays, and the meibomian glands. Tear film break-up time can be used to assess tear film stability. The clinician examines the patient under the slit lamp microscope and applies sodium flu...