Acute painful red eye in a teenage girl

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).