A child with itchy eyes

Case presentation

A 7-year-old boy presented with a two-week history of itchy eyes. He had been rubbing the eyes constantly, and his mother said they had been red for some months, becoming more itchy, watery and swollen over the last few weeks and having an occasional stringy discharge. The boy was photophobic and very reluctant to remove his baseball cap because of the glare of the room lights; he wore sunglasses constantly when outside. He was otherwise well and was taking no topical, ocular or systemic medications. Further questioning revealed a history of childhood asthma and mild eczema. He had no known allergies.

The patient’s family history included an older brother who was diagnosed at the age of 14 years with keratoconus (a slowly progressing conical protrusion of the cornea with central thinning) and wore contact lenses to improve his vision. He also had an older sister who suffered from severe eczema and asthma and had developed a cataract at 18 years of age.