What could be causing a swollen and irritated outer corner of my left eye with a slight yellow discharge that lasted 45 minutes?

Acute Chemosis with Transient Yellow Discharge

This presentation is most consistent with viral conjunctivitis, likely adenoviral, which is self-limited and requires only supportive care with close monitoring for complications. 1

Clinical Assessment

The key features described—swollen white part of the eye (chemosis), irritation, brief 45-minute duration, and slight yellow coloring—align with several diagnostic possibilities that require differentiation:

Most Likely Diagnosis: Viral Conjunctivitis

Adenoviral conjunctivitis presents with bulbar conjunctival injection, watery discharge (which can have slight mucoid component appearing yellowish), chemosis, and eyelid swelling. 1 The abrupt onset, unilateral presentation, and self-limited nature (symptoms improving within 45 minutes suggests mild case) are characteristic. 1

• The natural history is self-limited with improvement within 5-14 days 1
• Most cases require no treatment beyond supportive care 1
• The slight yellow coloring likely represents minimal mucoid component rather than purulent discharge 1

Critical Red Flags to Exclude

Bacterial conjunctivitis must be considered if discharge becomes frankly purulent or symptoms worsen. 1

• Gonococcal conjunctivitis presents with marked purulent discharge and rapid progression, requiring emergency treatment to prevent corneal perforation 1
• However, the brief duration and minimal discharge make this unlikely 1

Allergic or irritant causes can produce chemosis but typically have clear watery discharge without yellow coloring 1

Management Approach

Immediate Actions

No specific treatment is required for presumed viral conjunctivitis beyond supportive measures. 1

• Cool compresses for comfort 1
• Artificial tears to alleviate irritation 1
• Strict hand hygiene to prevent transmission 1

When to Escalate Care

Urgent ophthalmology referral is indicated if any of the following develop: 1, 2

• Vision changes or decreased visual acuity 2, 3
• Severe eye pain (beyond mild irritation) 4
• Corneal involvement (detected by fluorescein staining showing epithelial defects) 1
• Progression to marked purulent discharge suggesting bacterial superinfection 1
• Symptoms persisting beyond 14 days 1
• Development of photophobia suggesting keratitis 1

Follow-up Monitoring

The patient should be instructed to monitor for worsening symptoms over the next 5-14 days. 1

• If symptoms completely resolved within 45 minutes and do not recur, this may represent transient chemical irritation or allergic reaction 1
• If symptoms recur or worsen, re-evaluation is needed 1
• Subepithelial corneal infiltrates can develop weeks after initial infection in epidemic keratoconjunctivitis, causing decreased vision 1

Common Pitfalls

Do not prescribe topical antibiotics empirically for presumed viral conjunctivitis. 5, 6

• Antibiotics like bacitracin or erythromycin are indicated only for bacterial infections 5, 6
• Inappropriate antibiotic use can cause medication-induced keratoconjunctivitis with chronic irritation 1
• The slight yellow coloring alone does not mandate antibiotic treatment if other features suggest viral etiology 1

Do not dismiss brief symptoms as insignificant without proper assessment. 2, 4

• Even transient chemosis can herald more serious conditions 2
• Chemical exposure requires immediate and prolonged irrigation (30 minutes minimum) 2
• High-velocity trauma can cause occult globe injury requiring eye shield protection 2