A 24-year-old woman presents with a sudden onset of left-sided acute follicular conjunctivitis. She complains of severe pain in the eye, and she has blurred vision with copious watery discharge evident. On examination, you note the presence of pseudomembrane formation in the eye, and she has left-sided preauricular lymphadenopathy present.

1. What is the most likely diagnosis?
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This patient has a diagnosis of epidemic keratoconjunctivitis, which is a viral conjunctivitis that is highly contagious and has a tendency to occur in epidemics.

It is one of the most common causes of acute conjunctivitis, and has very characteristic clinical features, including:

  • Sudden onset of acute follicular conjunctivitis
  • Severe pain in affected eye
  • Copious watery discharge
  • Subconjunctival haemorrhages
  • Visual changes can occur
  • Hyperemia and chemosis
  • Membranes and pseudomembranes can occur
  • Ipsilateral preauricular lymphadenopathy
  1. What is the most likely causative organism?
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Epidemic keratoconjunctivitis is usually caused by adenoviruses.

3. What are the indications for urgent referral to an ophthalmologist in patients with conjunctivitis?
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An urgent referral to ophthalmology should be arranged if a patient with conjunctivitis has:

  • A red flag indicating a serious cause of red eye
  • Ophthalmia neonatorum
  • Suspected gonococcal or chlamydial conjunctivitis
  • Possible herpes infection
  • Suspected periorbital or orbital cellulitis
  • Severe disease, for example, corneal ulceration, significant keratitis or presence of a pseudomembrane
  • Had recent intraocular surgery
  • Conjunctivitis associated with a severe systemic condition such as rheumatoid arthritis or is immunocompromised
  • Corneal involvement associated with soft contact lens use.



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