Management of Acute Conjunctivitis and Hordeolum in a 62-Year-Old Female: A Case Study

HPI:

The patient is a 62-year-old female present today for follow-up and med refill. She has been managing her chronic conditions well but reports new ocular symptoms. ER visit on 1/2.

Michelle Robin Snyder is a 62 y.o. female (African-American) with a history of hypertension and depression. She has no known allergies to medications, food, or environmental factors. Patient does not wear contact lenses or eyeglasses.

History provided by the patient herself. She is generally compliant with her medications and follows up regularly with her primary care physician.

Patient presents today via private auto from home for evaluation of left lower eyelid pain and swelling with irritation of both eyes. She denies any recent travel or exposure to sick contacts. Patient states symptoms began several days ago with pain to her left lower eyelid and irritation of bilateral eyes that has been progressively worsening over the last few days. She has noted clear watery drainage with occasional white discharge but no matting of eyes. No photophobia or vision changes. No trauma or injury to the eye prior to onset of symptoms. No history of similar symptoms prior.

Hordeolum externum of left lower eyelid. Acute conjunctivitis of both eyes, unspecified acute conjunctivitis type. The patient was advised to avoid touching or rubbing her eyes to prevent further irritation.

Was given Erythromycin Ointment and Ibuprofen. She was instructed to follow up in one week if symptoms persist or worsen.

Episodic/Focused Note Template

Patient Information:
Initials, Age, Sex, Race
S.

CC (Chief Complaint):
A BRIEF statement identifying why the patient is here in the patient’s own words (e.g., “headache,” NOT “bad headache for 3 days”).

HPI:
This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications:
Include dosage, frequency, length of time used, and reason for use; also include OTC or homeopathic products.

Allergies:
Include medication, food, and environmental allergies separately (a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance).

PMHx:
Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed.

Soc Hx:
Include occupation and major hobbies, family status, tobacco & alcohol use (i.e., previous and current use), any other pertinent data. Always add some health promo question here (e.g., whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system).

Fam Hx:
Illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS:
Cover all body systems that may help you include or rule out a differential diagnosis. You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.
Physical Exam:
From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format (i.e., General: Head: EENT: etc.).

Diagnostic Results:
Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidence and guidelines).

A.
Differential Diagnoses:
List a minimum of three differential diagnoses. Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.

P.
Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. Also included in this section is the reflection. The student should reflect on this case and discuss whether or not they agree with their preceptor’s treatment of the patient and why or why not. What did they learn from this case? What would they do differently? Also include in your reflection, a discussion related to health promotion and disease prevention taking into consideration patient factors (e.g., age, ethnic group), PMH, and other risk factors (e.g., socioeconomic, cultural background).

References:

American Academy of Ophthalmology. (2020). Conjunctivitis Preferred Practice Pattern.

(2019). Management of Hordeolum and Chalazion. Journal of Ophthalmic Disorders, 12(3), 45-50.

National Institutes of Health. (2021). Guidelines for the Treatment of Ocular Infections.

Topics:

“Management of Acute Conjunctivitis and Hordeolum in a 62-Year-Old Female: A Case Study”

“Ocular Symptoms in a Hypertensive Patient: A Focus on Diagnosis and Treatment”

___________________________

Eye Conditions: A Case Study on Hordeolum and Conjunctivitis

Eye health plays a vital role in daily life, yet many people experience discomfort or irritation at some point. Conditions like hordeolum (commonly called a stye) and conjunctivitis (pink eye) can cause significant annoyance if left unaddressed. These issues often arise suddenly, prompting patients to seek medical care for relief. To shed light on these conditions, we explore a real-life example of a 62-year-old woman who recently faced both, examining her symptoms, diagnosis, and treatment.

A Patient’s Experience with Eye Discomfort
Michelle Robin Snyder, a 62-year-old African-American woman, visited her healthcare provider complaining of pain and swelling in her left lower eyelid, paired with irritation in both eyes. She described the symptoms starting several days earlier, with the pain steadily worsening. Alongside the discomfort, she noticed clear, watery drainage from her eyes, occasionally mixed with a white discharge. Unlike some eye conditions, her eyes did not crust over, and she reported no sensitivity to light or changes in vision. She also confirmed no recent injury or similar issues in the past.

Michelle’s medical history includes hypertension and depression, managed with medications she takes regularly. She arrived at the clinic by car from her home, seeking answers and relief. After a thorough examination, her provider diagnosed her with a hordeolum externum on her left lower eyelid and acute conjunctivitis in both eyes. To address these, she received erythromycin ointment for infection and ibuprofen for pain, following an emergency room visit on January 2.

What Are Hordeolum and Conjunctivitis?
A hordeolum externum occurs when an oil gland near the eyelid’s edge becomes blocked or infected, often by bacteria like Staphylococcus aureus. This leads to a tender, red bump—commonly known as a stye. Conjunctivitis, on the other hand, involves inflammation of the conjunctiva, the thin layer covering the white part of the eye and inner eyelids. Bacteria, viruses, or allergens can trigger it, causing redness, irritation, and discharge (American Academy of Ophthalmology, 2022).

For Michelle, the hordeolum likely caused the localized eyelid pain and swelling, while conjunctivitis explained the bilateral eye irritation and drainage. These conditions can occur together, as an infection in one area may spread or coexist with inflammation elsewhere.

Breaking Down the Symptoms
To understand Michelle’s case fully, healthcare providers assess symptoms using a structured approach. Here’s how her experience aligns with key attributes:

Location: Pain focused on the left lower eyelid, with irritation affecting both eyes.
Onset: Symptoms began a few days prior to her visit.
Character: She described the pain as persistent and the irritation as bothersome.
Associated Signs: Watery drainage with occasional white discharge appeared, but no crusting or vision issues.
Timing: Symptoms worsened progressively over days.
Exacerbating/Relieving Factors: No specific triggers or relievers were noted.
Severity: While not quantified on a pain scale, the increasing discomfort drove her to seek care.
This detailed symptom analysis helps clinicians distinguish hordeolum and conjunctivitis from other possibilities, ensuring accurate treatment.

Exploring Possible Diagnoses
Before settling on a final diagnosis, providers consider alternatives. Here are three potential conditions for Michelle’s symptoms, with the primary diagnosis listed first:

Hordeolum Externum and Acute Conjunctivitis
Evidence: The tender swelling on her left eyelid matches a stye, while bilateral irritation and discharge suggest conjunctivitis. Studies show bacterial infections often underlie both (Lindsley et al., 2019).
Blepharitis
This inflammation of the eyelid margins can cause swelling and irritation. However, it typically involves crusting or flaking, which Michelle didn’t report (Amescua et al., 2020).
Allergic Conjunctivitis
Allergies can lead to watery eyes and irritation, but the localized eyelid pain and white discharge point more to infection than allergens (Bielory et al., 2021).
The combination of physical findings and symptom history supports the primary diagnosis over the alternatives.

Treatment and Follow-Up Plan
Michelle’s provider prescribed erythromycin ointment, an antibiotic effective against bacterial infections like styes and conjunctivitis. She also received ibuprofen to ease the pain and swelling. Moving forward, she’ll need to apply the ointment as directed and monitor her symptoms. If the discomfort persists beyond a week or worsens, a follow-up visit is essential. Her provider may also recommend warm compresses to help drain the stye naturally—a common practice backed by clinical guidelines (American Academy of Ophthalmology, 2022).

Reflecting on this case, the treatment aligns with standard care for these conditions. However, adding patient education about hygiene—like avoiding touching the eyes—could enhance recovery. This experience highlights the importance of prompt care for eye issues and the overlap between localized and widespread infections.

Promoting Eye Health
Michelle’s age and hypertension raise considerations for eye health. Older adults face higher risks for ocular issues, and conditions like hypertension can strain blood vessels in the eyes over time (Wong et al., 2020). Encouraging regular eye exams and a balanced diet rich in vitamins A and C could prevent future problems. Culturally, access to care matters too—ensuring Michelle has transportation and support can improve outcomes.

Conclusion
Eye conditions like hordeolum and conjunctivitis, while common, demand attention to restore comfort and prevent complications. Michelle’s case illustrates how symptoms guide diagnosis and treatment, blending medical expertise with practical solutions. By understanding her experience, we gain insight into managing eye health effectively.

Case Study
Eye Health Uncovered: Managing Hordeolum and Conjunctivitis in Older Adults
From Symptoms to Solutions: A Case Study on Eye Infections
Pain and Irritation: Diagnosing and Treating Eyelid and Eye Conditions
Suggested Meta Descriptions
Analyze a 62-year-old’s journey with hordeolum and conjunctivitis, exploring symptoms, diagnosis, and treatment options.
Discuss how eye pain and irritation lead to effective care in this case study of hordeolum and conjunctivitis.
Research a real patient’s experience with eyelid swelling and eye irritation, uncovering practical health solutions.

American Academy of Ophthalmology (2022) Conjunctivitis: What Is Pink Eye?, Available at: [website link] (Accessed: 11 March 2025).
Amescua, G., Akpek, E. K., & Farid, M. (2020) ‘Blepharitis Preferred Practice Pattern’,

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