A 19-year-old college student presents to the clinic with bilateral eye redness and itching for the past 3 days. She reports clear, watery discharge and notes that her symptoms worsen when she is outdoors. She has a history of seasonal allergies and eczema. She denies eye pain, photophobia, or changes in vision. Physical examination reveals bilateral conjunctival injection and mild eyelid edema. Visual acuity is normal.
Which of the following is the most appropriate initial treatment for this patient’s condition?
The correct answer is:
A) Cold compresses and topical antihistamine eye drops
Allergic conjunctivitis is a type I hypersensitivity reaction mediated by IgE and mast cell degranulation in response to allergens such as pollen. It typically presents with bilateral eye itching, conjunctival injection, watery discharge, and eyelid edema, often in patients with a history of atopy. First-line treatment includes allergen avoidance, cold compresses, and topical antihistamine or mast cell–stabilizing eye drops. Symptoms are usually self-limited and vision is preserved.
Answer choice B: Oral acyclovir therapy, is incorrect. Acyclovir is used to treat herpes simplex virus infections, which typically present with unilateral eye pain, photophobia, and dendritic lesions on fluorescein staining.
Answer choice C: Topical broad-spectrum antibiotic eye drops, is incorrect. Bacterial conjunctivitis is characterized by purulent discharge and eyelid crusting. This patient’s watery discharge and prominent itching are more consistent with allergic conjunctivitis.
Answer choice D: Topical corticosteroid eye drops as monotherapy, is incorrect. Topical steroids may be used in severe or refractory allergic conjunctivitis but are not first-line due to the risk of increased intraocular pressure, cataracts, and infection.
Answer choice E: Urgent ophthalmology referral for slit-lamp examination, is incorrect. Referral is indicated for severe pain, vision loss, photophobia, or suspected keratitis, none of which are present in this patient.
Key Learning Point
Allergic conjunctivitis presents with bilateral eye itching, watery discharge, and a history of atopy. First-line treatment includes cold compresses and topical antihistamine or mast cell–stabilizing eye drops.
