Possible blepharitis

Patient is 25-year-old female, who is having an acute reaction around her eyes currently. She has in both eyes very red, swollen and irritated skin that is painful and itchy. She has seen Ryan Burke at primary health for this. He has prescribed her an erythromycin ointment to use on the corners of her eyes for this. He also prescribed her a Pataday eye drop. The erythromycin does seem to help with the irritation, but does not seem to help resolve the reaction. She does take Zyrtec as needed for this reaction. She took one this morning and it did not seem to help with the swelling. She has had this a few times in the past about two to three times per year. She knows her eyes are sensitive although this is the worse it has ever been. She does not know what exactly is causing it. She did switch it to a new face wash a couple of weeks ago and it bothered her skin. So, she stopped using it and return to the face wash she usually uses and woke up this morning with this eye irritation. She does use mascaras and eyeliners regularly and it does seem to bother her eyes slightly although does not seem to cause reaction such as this all the time and she also uses nail polishes, but has not changed her nail polish recently.

She denies any problems with seasonal allergies or nasal symptoms at all including sneezing, itching of the nose, clear nasal discharge, or nasal stuffiness. She does state that she is a strep throat carrier and has frequent strep throat. She denies sinus infections, frequent bad colds, nasal polyps, aspirin-induced nasal symptoms, nasal surgeries, TMJ, or frequent headaches. She states that she gets these frequent tonsillitis infections about two to three times per year and needs antibiotics.

She denies any ear infection, dizziness, lightheadedness, or hearing impairment.

She does admit to eye itching, redness, tearing, dryness, burning, eyelid swelling, and eyelid irritation. She denies light hurting her eyes or yellow discharge from eyes. She states that this occurs two to three times per year. Although the most recent reaction is the worst it has been.

She denies any wheezing or lung problems.

She denies any allergic skin problems. She has never been evaluated for allergies in the past.

ASSESSMENT:
1. Allergic contact dermatitis.
2. Allergic conjunctivitis.
3. Possible blepharitis.
4. History of penicillin allergy.

PLAN:
1. At this time, I would like to prescribe prednisone 30 mg daily until the swelling resolves. I have given her 2.5% hydrocortisone ointment to apply two to three times per day around her eyes to help with this irritation. It does appear to be an allergic contact dermatitis. I encouraged her to not use any mascaras or eyeliner at this time. I also discussed with her that nail polish tends to be a frequent trigger of this as well.
2. If she continues to have troubles with controlling these symptoms or having flares of this irritation, I recommended a patch testing so she can discover what exact chemical she may be reacting to so she can do a better job at avoidance. We did discuss that if she tries new products, to first place the product on flexor surface for two days’ time and then wait to see if she gets dermatitis reaction from it before applying on the face or we will followup as needed. She will keep in touch and let me know if she is maintaining good control of her allergic contact dermatitis and if she wants to purse more testing.

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