Dear KY sunshine,After reading your case history, I could make out that your boy friend is suffering from atopic keratoconjuctivitis.The clinical symptoms of itching , burning and watering and signs of puffing ,crusting and discharge are pointing towards allergy(atopic keratoconjuctivitis).It may be associated with eczema of eyelids that is puffiness and swelling along with crusting of lids and may be associated with atopic dermatitis
.A proper history of asthma, allergic rhinitis
, atopic dermatitis,seasonal or exposure related exacerbation of some of the triggering factors should be ruled out.Since his scratch test is positive he may be suffering from some allergy.Naphcon A ( nephazoline+pheniramine
).Nephazoline is a decongestant and pheniramine is an antihistamine which may help upto some extent.Looking at yours boyfriend present condition I would definitely like to evaluate completely.He needs a proper eye evaluation to look for eczema, blepheritis, meibomitis, subepithelial fibrosis,papillae, follicles, puctate epithelial erosions, superficial punctate keratitis
etc.Increased serum Ig E level and Eosinophils in Geimsa stain of Conjuvtival scrapping may help in diagnosing atopic keraticonjuctivitis.The treatment is multifaceted and needs environmental control as well as topical and systemic medications.He may require topical steroids like prednisolone
acetate, and mast cell stabilizer like azelastine
, olaptadine etc.He may require oral antihistaminic like cetrizine.Since he is having yellowish and bloody discharge there are chances of staphylococcal blepheritis and secondary infection.He may require antibiotics too.So it's better to re-evalute him properly with an ophthalmologist and dermatologist
....Visit as soon as possible....TC ..Dr Ajay Shankar Kar,cornea consultant, Sankar foundation Eye Hospital,Visakhapatnam.