Which is the most appropriate next step in the management of this patient?

No further treatment

Answer and Critique Key Point Viral conjunctivitis is characterized by subacute appearance of a red eye without ocular pain or change in visual acuity. This patient with a red eye and tearing most likely has viral conjunctivitis. This is a self-limited process that is expected to resolve spontaneously. No further treatment is required. The key aspects of the history that are used to establish this patients diagnosis are the presence of a red eye, the absence of ocular pain, and the absence of visual changes. The patient can be reassured but told that the process may spread to the other eye and could be contagious for 2 weeks. The absence of purulent discharge indicates that this is not bacterial conjunctivitis, and, therefore, topical antibiotics are not needed. Allergic conjunctivitis is an unlikely diagnosis in this patient given the absence of pruritus and the unilateral distribution of symptoms. Therefore, topical antihistamines are not indicated. An urgent referral to an ophthalmologist for red eye is needed only in patients who have ocular pain and visual loss, symptoms of which may be suggestive of scleritis, acute angle-closure glaucoma, anterior uveitis, or viral or bacterial keratitis. Treatment with topical corticosteroids is indicated in the case of anterior uveitis, which is characterized by red eye but is also associated with ocular pain and visual loss, symptoms not found in this patient. Topical corticosteroids are generally not recommended without an evaluation by an ophthalmologist because they may worsen some types of eye conditions, specifically herpes keratitis. Patients with signs suspicious for anterior uveitis require urgent referral to an ophthalmologist. Bibliography 1.