Management of Conjunctival Redness and Watery Discharge
For a patient presenting with conjunctival redness and watery discharge, the appropriate management is B. Artificial tears, as this presentation is most consistent with viral conjunctivitis, which is self-limited and requires only supportive care. 1
Clinical Reasoning
Distinguishing Features of Viral Conjunctivitis
The combination of watery discharge with conjunctival redness strongly suggests viral rather than bacterial etiology 1, 2. Key distinguishing features include:
- Watery (not purulent) discharge is the hallmark of viral conjunctivitis 1, 2
- Bacterial conjunctivitis typically presents with mucopurulent discharge and matted eyelids, which is absent in this case 2, 3
- The absence of itching makes allergic conjunctivitis less likely 4
Why Artificial Tears (Option B) is Correct
Viral conjunctivitis is self-limited and does not benefit from antibiotics or routine antiviral therapy 1. The American Academy of Ophthalmology recommends supportive care as initial management 5, 1:
- Artificial tears provide symptomatic relief and help dilute inflammatory mediators 5, 1
- Cold compresses reduce inflammation and discomfort 5, 1
- The condition typically resolves within 2-3 weeks without specific treatment 5
Why Other Options Are Incorrect
Option D (Topical antibiotics) should be avoided:
- Antibiotics are not indicated for viral conjunctivitis and only shorten bacterial conjunctivitis duration by approximately 1 day 1
- Indiscriminate use of topical antibiotics should be avoided as they can induce toxicity and promote resistance 5
- Bacterial conjunctivitis presents with purulent discharge and matted eyelids, not watery discharge 2, 3
Option C (Topical acyclovir) is not routinely indicated:
- Topical antivirals are reserved for herpes simplex virus (HSV) conjunctivitis with distinctive signs such as vesicular lid lesions or dendritic corneal lesions 1, 6
- Simple viral conjunctivitis (likely adenoviral) does not require antiviral treatment 5, 1
Option A (Refer to ophthalmology) is not immediately necessary:
- Urgent ophthalmology referral is indicated only for specific red flags 1, 2:
- Decreased vision
- Severe pain (not just irritation)
- Corneal involvement
- Recent ocular surgery
- Vesicular rash on eyelids or nose
- Immunocompromised state
- Simple viral conjunctivitis with watery discharge does not meet these criteria 1
Important Caveats
When to Reconsider and Refer
Patients should be instructed to return if symptoms persist beyond 2-3 weeks or if they develop 5:
- Pain or decreased vision (suggests corneal involvement)
- Photophobia (indicates possible keratitis)
- Worsening symptoms despite supportive care
Infection Control
Viral conjunctivitis is highly contagious 1. Counsel patients on:
- Frequent handwashing and avoiding eye touching 1
- Avoiding sharing towels, pillowcases, or eye cosmetics 1
- Staying home from work/school during the contagious period (typically 10-14 days) 5
Follow-up Considerations
If symptoms include photosensitivity and pain (not just watery discharge), this suggests corneal involvement and warrants closer monitoring for adenoviral keratoconjunctivitis or HSV 1. However, the question presents only redness and watery discharge, making simple supportive care with artificial tears the appropriate initial management 1.