NR 511 Case Study Week 3 Part 1
Gail-Marie Stewart
NR 511
Week 3 – Case Study Part 1
1. Case Summary
• 19 yo male presents with a CC of bilateral mild to moderate eye discomfort onset 2-3
days. Reports discomfort is constant and feels “gritty” “like sand” in his eyes and rates it
2/10. Patient does not report any aggravating or relieving factors, however, has tried
OTC visine gtts 1x yesterday. Gtts reduced redness in eyes but did not reduce gritty
sensation, tearing or itching.
• Patient does not wear glasses or contact lenses, denies eye injury, trauma, or
dryness. Denies any mucoid or purulent drainage from eyes or crusting of lids
• Upon physical exam visual acuity is 20/20 (uncorrected) OU, PERRLA, slight light
sensitivity bilaterally. Diffuse redness to conjunctiva present but no FB present
bilaterally. Fundoscopic exam unremarkable with flat retinal discs and sharp
margins.
Retinal background WNL w/o presence of hemorrhages. Nasal turbinate’s mild and
boggy bilaterally with mild to mod. swelling and clear drainage. ENT negative for
soreness or enlarged tonsils or exudate.
• Currently prescribed Loratidine 10mg daily for seasonal allergies; fluticasone nasal
spray daily (only during Spring when allergies flare up) – Patient is not taking either
medication at the moment.
2. Differential Diagnoses
• Allergic Conjunctivitis
o Caused by the body’s response to an allergic stimulus that is most often
environmental which cause a “systemic humoral or local histaminic response”
(Dunphy, 2019, p. 273). There are three main types of non-severe allergic
conjunctivitis; seasonal (typically spring), perennial (year-round caused by dust
and other environmental factors), and acute allergic conjunctivitis (Marais 2017)
• Corneal Abrasion
o Caused by trauma (physical or chemical) to the cornea. When the epithelial layer
of the cornea is damaged, the healing process in response to the limbal epithelium
can cause mild to moderate discomfort. The epithelium conjunctiva can also
cause signs and symptoms consistent with excessive tearing, itching and burning
(Verum, 2019).
• Dry Eye (kerato-conjunctivitis sicca)
o Caused by decreased tear production or inadequate tear quality. Dunphy (2019)
indicates that dry eye disease is also caused by release of cytokines which initiate
an inflammatory response along with “lymphocytic infiltration (CD4 T cells and
B cells) of [both the] lacrimal and salivary glands” (p. 267). Androgen and
estrogen receptors are also located in the lacrimal and Meibomian glands which
when decreased can cause decrease lacrimal duct function and decreased tear
production. Autoimmune diseases such as Sjögren is also possible but is most
prevalent in females (Dunphy, 2019).
3. Analyze the Differential
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, NR 511 Case Study Week 3 Part 1
Diagnosis #1 Allergic conjunctivitis
Allergic conjunctivitis is at the top of my differential as evidenced by
• Pertinent positive findings:
o Objective findings:
▪ Diffuse redness to conjunctiva relieved with visine ggts
▪ Boggy nasal turbinates with mild to moderate swelling and clear drainage
o Subjective findings:
▪ Report of seasonal allergies
▪ Itching, burning, and gritty sensation in eyes bilaterally
▪ Mild to moderate discomfort 2/10
• Pertinent negative findings:
o Lack of purulent or mucoid drainage
o Negative crusting of eye lids
Diagnosis #2 Dry Eye (kerato-conjunctivitis sicca)
The next possible differential would be dry eye as evidenced by
• Pertinent positive findings:
o Subjective findings
▪ Feeling of sand in eyes
▪ Feeling of grit in eyes
▪ Itching and tearing of eyes
o Objective findings
▪ Redness to conjunctiva
▪ light sensitivity
• Pertinent negative findings
o Normal visual acuity 20/20
o Negative mucoid or purulent drainage
Diagnosis #3 Corneal Abrasion
Lastly, the third differential that I would choose is corneal abrasion. This is a least likely
differential because the patient reports that he does not wear contact lenses and denies any
trauma to his eyes, however, could be possible due to a microscopic abrasion caused by dirt or
other miniscule foreign body, if all others are ruled out. This diagnosis is evidenced by:
• Pertinent positive findings:
o Subjective findings
▪ Feeling of sand in eyes
▪ Feeling of grit in eyes
▪ tearing
o Objective findings
▪ Redness to conjunctiva
• Pertinent negative findings
o Normal visual acuity 20/20
o No foreign body present bilaterally
This study source was downloaded by 100000832558064 from CourseHero.com on 03-30-2022 02:44:03 GMT -05:00
https://www.coursehero.com/file/69544398/NR-511-Case-Study-Week-3-Part-1-091420docx/
Gail-Marie Stewart
NR 511
Week 3 – Case Study Part 1
1. Case Summary
• 19 yo male presents with a CC of bilateral mild to moderate eye discomfort onset 2-3
days. Reports discomfort is constant and feels “gritty” “like sand” in his eyes and rates it
2/10. Patient does not report any aggravating or relieving factors, however, has tried
OTC visine gtts 1x yesterday. Gtts reduced redness in eyes but did not reduce gritty
sensation, tearing or itching.
• Patient does not wear glasses or contact lenses, denies eye injury, trauma, or
dryness. Denies any mucoid or purulent drainage from eyes or crusting of lids
• Upon physical exam visual acuity is 20/20 (uncorrected) OU, PERRLA, slight light
sensitivity bilaterally. Diffuse redness to conjunctiva present but no FB present
bilaterally. Fundoscopic exam unremarkable with flat retinal discs and sharp
margins.
Retinal background WNL w/o presence of hemorrhages. Nasal turbinate’s mild and
boggy bilaterally with mild to mod. swelling and clear drainage. ENT negative for
soreness or enlarged tonsils or exudate.
• Currently prescribed Loratidine 10mg daily for seasonal allergies; fluticasone nasal
spray daily (only during Spring when allergies flare up) – Patient is not taking either
medication at the moment.
2. Differential Diagnoses
• Allergic Conjunctivitis
o Caused by the body’s response to an allergic stimulus that is most often
environmental which cause a “systemic humoral or local histaminic response”
(Dunphy, 2019, p. 273). There are three main types of non-severe allergic
conjunctivitis; seasonal (typically spring), perennial (year-round caused by dust
and other environmental factors), and acute allergic conjunctivitis (Marais 2017)
• Corneal Abrasion
o Caused by trauma (physical or chemical) to the cornea. When the epithelial layer
of the cornea is damaged, the healing process in response to the limbal epithelium
can cause mild to moderate discomfort. The epithelium conjunctiva can also
cause signs and symptoms consistent with excessive tearing, itching and burning
(Verum, 2019).
• Dry Eye (kerato-conjunctivitis sicca)
o Caused by decreased tear production or inadequate tear quality. Dunphy (2019)
indicates that dry eye disease is also caused by release of cytokines which initiate
an inflammatory response along with “lymphocytic infiltration (CD4 T cells and
B cells) of [both the] lacrimal and salivary glands” (p. 267). Androgen and
estrogen receptors are also located in the lacrimal and Meibomian glands which
when decreased can cause decrease lacrimal duct function and decreased tear
production. Autoimmune diseases such as Sjögren is also possible but is most
prevalent in females (Dunphy, 2019).
3. Analyze the Differential
This study source was downloaded by 100000832558064 from CourseHero.com on 03-30-2022 02:44:03 GMT -05:00
https://www.coursehero.com/file/69544398/NR-511-Case-Study-Week-3-Part-1-091420docx/
, NR 511 Case Study Week 3 Part 1
Diagnosis #1 Allergic conjunctivitis
Allergic conjunctivitis is at the top of my differential as evidenced by
• Pertinent positive findings:
o Objective findings:
▪ Diffuse redness to conjunctiva relieved with visine ggts
▪ Boggy nasal turbinates with mild to moderate swelling and clear drainage
o Subjective findings:
▪ Report of seasonal allergies
▪ Itching, burning, and gritty sensation in eyes bilaterally
▪ Mild to moderate discomfort 2/10
• Pertinent negative findings:
o Lack of purulent or mucoid drainage
o Negative crusting of eye lids
Diagnosis #2 Dry Eye (kerato-conjunctivitis sicca)
The next possible differential would be dry eye as evidenced by
• Pertinent positive findings:
o Subjective findings
▪ Feeling of sand in eyes
▪ Feeling of grit in eyes
▪ Itching and tearing of eyes
o Objective findings
▪ Redness to conjunctiva
▪ light sensitivity
• Pertinent negative findings
o Normal visual acuity 20/20
o Negative mucoid or purulent drainage
Diagnosis #3 Corneal Abrasion
Lastly, the third differential that I would choose is corneal abrasion. This is a least likely
differential because the patient reports that he does not wear contact lenses and denies any
trauma to his eyes, however, could be possible due to a microscopic abrasion caused by dirt or
other miniscule foreign body, if all others are ruled out. This diagnosis is evidenced by:
• Pertinent positive findings:
o Subjective findings
▪ Feeling of sand in eyes
▪ Feeling of grit in eyes
▪ tearing
o Objective findings
▪ Redness to conjunctiva
• Pertinent negative findings
o Normal visual acuity 20/20
o No foreign body present bilaterally
This study source was downloaded by 100000832558064 from CourseHero.com on 03-30-2022 02:44:03 GMT -05:00
https://www.coursehero.com/file/69544398/NR-511-Case-Study-Week-3-Part-1-091420docx/
