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Endgames Case Review

Acute painful red eye in a teenage girl

BMJ 2024; 385 doi: (Published 23 May 2024) Cite this as: BMJ 2024;385:e078598
  1. Lei Siew, medical student1,
  2. Nicholas Beng Hui Ng, consultant paediatrician2,
  3. Chris Hong Long Lim, associate consultant ophthalmologist3
  1. 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  2. 2National University Hospital, Khoo Teck Puat-National University Children’s Medical Institute, Singapore
  3. 3Department of Ophthalmology, National University Hospital, Singapore
  1. Correspondence to: N B H Ng nbhng{at}

A teenage girl presented with a four day history of worsening pain and redness of the left eye, eyelid swelling, and sensitivity to light. She had no preceding trauma or history of ocular procedures, and had no fever, coryzal symptoms, joint pains, rashes, weight loss, or lethargy. She wore contact lenses and reported that for the past three months she had been wearing monthly replacement lenses for more than 16 hours daily. She also wore the lenses while swimming.

On examination, the left eye showed conjunctival injection associated with lid swelling, and mucopurulent discharge. The right eye appeared normal. The patient could only perceive hand movements in the left eye, whereas her best corrected visual acuity was 6/9 on the right side. She had no relative afferent pupillary defect. Slit lamp examination showed the presence of a paracentral corneal infiltrate with an epithelial defect, and a fibrin clump inferiorly with no associated hypopyon. No satellite lesions or dendritic lesions were identified (fig 1).

Fig 1

Slit lamp examination of left eye showing conjunctival injection …

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