Patient Profile: Saman, a 28-year-old school teacher from Matara, presents to the outpatient eye clinic.

History of Presenting Complaint:

Saman reports that over the past week, he has been experiencing a constant, irritating sensation of grittiness and discomfort in his eyes, describing it as feeling like there is sand trapped under his eyelids. He notes that the irritation initially began in his right eye five days ago but has since spread to involve both eyes.

Unlike the thick, sticky crust he has seen in the past with other eye infections, Saman is experiencing a steady, watery and clear discharge. He mentions that several children in his classroom have been sent home recently with “pink eye” during a local epidemic. Furthermore, he has been battling a mild upper respiratory tract infection, accompanied by a persistent cold and cough that started just before his eye symptoms appeared.

Today, Saman’s condition has worsened. He reports severe discomfort and photophobia, wearing sunglasses into the clinic because the standard room lighting is causing him significant pain. He expresses frustration, noting that this issue seems to be dragging on much longer than a typical eye infection.

Clinical Examination:

:● Gross Appearance: Both of Saman’s eyes display marked redness with diffuse
injection (engorged blood vessels) across the conjunctiva.
● Lymph Node Palpation: Examination of the head and neck reveals marked
pre-auricular lymphadenopathy, with tender, swollen nodes situated just in front of his ears.
● Eyelid Eversion: Inspection of the conjunctiva reveals the presence of follicles,
appearing as small, white lymphoid aggregations.
● Slit-Lamp Examination: Under high magnification, the cornea shows small, focal areas of inflammation. Discrete corneal erosions and opacities are present, which
correspond with his recent onset of severe photophobia and discomfort.