Eyes, Ears, Nose & Throat

Thick, purulent (mucopurulent) discharge with eyelids matted shut, especially on waking, points to bacterial conjunctivitis; viral causes watery discharge.

Viral conjunctivitis (most often adenovirus) — watery discharge, often follows/accompanies an upper respiratory infection, highly contagious, with tender preauricular node.

Bilateral itching (the hallmark) with watery discharge, chemosis, and stringy mucus; treat with topical antihistamine/mast-cell stabilizer (e.g., olopatadine) and allergen avoidance.

Severe pain, true photophobia, vision loss, ciliary (perilimbal) flush, fixed/irregular pupil, corneal opacity, or contact-lens wearer with infiltrate — these point away from simple conjunctivitis toward keratitis, uveitis, angle-closure glaucoma, or scleritis.

Neisseria gonorrhoeae — copious purulent discharge developing over 12-24 h; sight-threatening (corneal perforation). Treat with IM/IV ceftriaxone plus saline irrigation; treat for chlamydia co-infection.

Open-angle glaucoma is painless with insidious peripheral vision loss; acute angle-closure presents with a painful red eye, halos around lights, headache/nausea, and a fixed mid-dilated pupil — an emergency.