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FIGURE 123.7 Patient with right epidemic keratoconjunctivitis infection. Note the lid
swelling, red eye, and absence of purulent discharge. Patient also has right preauricular
adenopathy (not visible). Note the early injection of left eye, representing sequential
involvement.

Clinical Assessment. No child should be diagnosed or treated for conjunctivitis
without a careful examination. Although conjunctivitis is characterized by ocular
erythema, not all patients with a red eye have conjunctivitis. Various ophthalmic
conditions, as well as many systemic processes, can be associated with a red eye.
One should also be weary of making this diagnosis in a patient with recent ocular
trauma. Chapter 114 Ocular Trauma outlines the evaluation and differential
diagnosis of this finding. Signs and symptoms not typically associated with
conjunctivitis that should prompt a search for a more serious condition include
reduced visual acuity, significant ocular pain and/or photophobia, corneal
opacities, and significant foreign-body sensations. Fluorescein instillation is
recommended to fully evaluate the ocular surface in these cases. Characteristic
dendritic staining patterns can be seen on the cornea or conjunctiva in herpetic
infections ( Fig. 123.11 ). Ophthalmic consultation is indicated in suspected HSV
ocular disease. The clinician should also be wary of making the diagnosis of
conjunctivitis in contact lens wearers. These patients are at risk for inflammation
and ulceration of the cornea known as bacterial keratitis. A bacterial corneal ulcer
will appear as a white spot in the normally clear cornea associated with
conjunctival injection, foreign body sensation or pain, photophobia, and
decreased vision (see Chapter 27 Eye: Red Eye ). This is a rapidly progressing