What is the diagnosis and treatment for a 66-year-old male with left eye swelling, discharge, and pain for 3 days following trauma, with a negative wood lamp exam for foreign body or corneal abrasion?

Diagnosis and Management of Viral Conjunctivitis with Suspected Trauma

The most likely diagnosis for this 66-year-old male with left eye swelling, discharge, and pain for 3 days following trauma is viral conjunctivitis, which should be treated with topical antibiotics to prevent secondary bacterial infection.

Clinical Assessment

History and Physical Findings

• 66-year-old male with left eye swelling, discharge, and pain for 3 days 1
• History of trauma to the eye 3 days ago (unspecified object) 1
• Wood lamp examination negative for foreign body or corneal abrasion 1

Diagnostic Considerations

• Viral conjunctivitis is the most likely diagnosis given the presentation of:

  • Unilateral eye involvement with abrupt onset 1
  • Conjunctival swelling and discharge 1
  • Recent history of trauma which may have introduced viral pathogens 1
  • Absence of corneal abrasion on Wood lamp examination 1

• Differential diagnoses to consider:

  • Bacterial conjunctivitis (less likely given the negative Wood lamp exam) 1, 2
  • Herpes simplex virus keratitis (would typically show dendritic lesions on exam) 1
  • Allergic conjunctivitis (less likely with acute onset after trauma) 1

Treatment Plan

Immediate Management

• Topical broad-spectrum antibiotic to prevent secondary bacterial infection 3, 4, 5

  • Options include:
    • Bacitracin ophthalmic ointment 3-4 times daily 4
    • Erythromycin ophthalmic ointment 3-4 times daily 5

• Pain management:

  • Topical nonsteroidal anti-inflammatory drops may help reduce pain and inflammation 6
  • Oral analgesics as needed for discomfort 6

Follow-up Recommendations

• Patient should be reevaluated in 24 hours if symptoms worsen or fail to improve 6
• Signs requiring immediate referral to ophthalmology:
  • Development of corneal infiltrate or ulcer 6, 7
  • Significant vision loss 6
  • Increasing pain or redness 6, 8

Important Considerations

Potential Complications

• Secondary bacterial infection can occur, especially with viral conjunctivitis 1, 2
• Corneal scarring may develop if epithelial damage occurs 1
• Subepithelial corneal infiltrates may develop in cases of adenoviral conjunctivitis 1

Patient Education

• Avoid touching or rubbing the eye to prevent further irritation 6
• Wash hands frequently to prevent spread to the other eye or to other individuals 1, 6
• Discard contact lenses if worn during the injury or infection 3, 6
• Discontinue contact lens wear until complete resolution 3

Treatment Pitfalls to Avoid

• Patching the eye is not recommended as it does not improve pain and may delay healing 3, 6
• Topical steroids should be avoided initially as they may worsen viral infections and mask signs of bacterial infection 1
• Chronic use of prophylactic antibiotics should be avoided to prevent development of resistant organisms 3, 9

By following this treatment approach, the patient should experience symptom improvement within 5-14 days, which is the typical course for viral conjunctivitis 1.