Online Photo Diagnosis

By William Townsend, OD, FAAO

This photo shows the cornea of a 19-year-old female who initially presented with binocular ocular pain and photophobia that was more severe in the right eye. Her accompanying signs included bilateral pre-auricular adenopathy, follicular hypertrophy, multiple corneal infiltrates, and conjunctival injection. All of these presentations were more pronounced in the right eye. We diagnosed viral keratoconjunctivitis and instructed the patient to discontinue contact lens wear, initiate a treatment regimen of tapering topical steroid therapy, and return in one week for evaluation.

The patient did not keep her subsequent appointment, but three weeks later she again presented with similar symptoms. Visual acuity was reduced to 20/30 in the right eye and her clinical presentation was as it appears in this photo.

Noncompliance is a very common and annoying phenomenon in health care, including eye care. Once symptoms respond to treatment, many patients simply fail to return for subsequent visits; they may elect (as did this individual) to discontinue treatment and to begin contact lens wear against medical advice. This individual developed corneal infiltrates and signs that were actually more severe than those at the initial presentation. We instructed her to stop all lens wear and began a slow tapering dose of topical steroids. We continue to follow her on a regular basis as her corneas gradually clear.

Patients who fail to follow guidelines and treatment regimens are at risk for the multiple adverse affects of their actions. It is essential that practitioners properly record treatment instructions for all patients in their clinical records so that if a patient develops vision loss or physical changes in the eye and adnexae, the records plainly show that medically sound instruction was provided to the patient and that they elected not to comply. We also find it useful for medico-legal and compliance purposes to record our findings with a digital biomicroscopic image and then show the image to the patient. This reinforces the gravity of the condition and helps promote better compliance.