FIGURE 123.7 Patient with right epidemic keratoconjunctivitis infection Note the lid swelling, red eye, and absence of purulent discharge Patient also has right preauricular adenopathy (not visible) Note the early injection of left eye, representing sequential involvement Clinical Assessment No child should be diagnosed or treated for conjunctivitis without a careful examination Although conjunctivitis is characterized by ocular erythema, not all patients with a red eye have conjunctivitis Various ophthalmic conditions, as well as many systemic processes, can be associated with a red eye One should also be weary of making this diagnosis in a patient with recent ocular trauma Chapter 114 Ocular Trauma outlines the evaluation and differential diagnosis of this finding Signs and symptoms not typically associated with conjunctivitis that should prompt a search for a more serious condition include reduced visual acuity, significant ocular pain and/or photophobia, corneal opacities, and significant foreign-body sensations Fluorescein instillation is recommended to fully evaluate the ocular surface in these cases Characteristic dendritic staining patterns can be seen on the cornea or conjunctiva in herpetic infections ( Fig 123.11 ) Ophthalmic consultation is indicated in suspected HSV ocular disease The clinician should also be wary of making the diagnosis of conjunctivitis in contact lens wearers These patients are at risk for inflammation and ulceration of the cornea known as bacterial keratitis A bacterial corneal ulcer will appear as a white spot in the normally clear cornea associated with conjunctival injection, foreign body sensation or pain, photophobia, and decreased vision (see Chapter 27 Eye: Red Eye ) This is a rapidly progressing