Explaining viral conjunctivitis, hygiene and the red flags — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in primary care. A 4-year-old has a two-day history of both eyes being red and gritty with a clear, watery discharge. On examination there are follicles on the tarsal conjunctiva and a tender preauricular lymph node, and the child had a runny nose last week; a classmate has similar symptoms. The child is otherwise well, with normal vision and no pain or photophobia. [6]

Your tasks are: [1]

1. Explain the diagnosis of viral conjunctivitis and what the illness will look like over the coming week, in plain language. [6]
2. Explain why a topical antibiotic is not needed for a viral cause, and the supportive care and hygiene measures that limit spread. [6]
3. Give the school and swimming advice for the contagious period. [1]
4. Tell the parent the red-flag features that would need urgent review. [5]

You are not expected to prescribe oral medication or refer to ophthalmology unless a red flag is present — the child is well and the vision is normal. [3]

Examiner prompt to the actor (parent)

"But the chemist said he probably needs antibiotic drops to clear it up, and I have to go to work — can he still go to school? His sister had the same thing last week, so surely he just caught it from her." [3]

Marking domains

• Frame and explanation (3): explains viral conjunctivitis as a common, contagious but self-limiting viral eye infection in plain, reassuring language; names that the child is well with normal vision and not in danger; sets the expectation that the watery redness settles over one to two weeks. [6]
• Antibiotic and hygiene plan (3): explains clearly that a topical antibiotic does not help a viral cause, so it is not needed; gives the supportive care (lubricating drops or cold compresses for comfort) and the hygiene measures — frequent hand washing, not sharing towels or pillows, avoiding eye rubbing — that limit spread to the rest of the family. [3] [6]
• School and swimming advice (2): explains that because adenoviral conjunctivitis is highly contagious the child should stay away from school, childcare and swimming pools until the discharge has settled, which is usually a few days; acknowledges the work and childcare pressure and frames it around protecting others. [6]
• Red flags (2): tells the parent to return immediately with pain, increased sensitivity to light, reduced or blurred vision, or a worsening of symptoms rather than settling — because these are the features that point to a more serious eye problem needing urgent review, not simple conjunctivitis. [5]

Model answer — the explanatory script

"Thank you for bringing him in. What you are describing is conjunctivitis, and from the story — the watery, gritty eyes, the clear discharge, the cold he had last week and the fact his classmate has it too — this is the viral form, which is very common in children and very contagious. The good news is it settles on its own, usually over a week or two, and because his vision is normal and he has no pain or light sensitivity, he is not in any danger." [6]

"Let me take you through four things — the antibiotic question, what to do at home, school, and what to watch for." [1]

"First, the drops. I know the chemist suggested antibiotic drops, but those help the bacterial form of conjunctivitis, not the viral kind he has. Antibiotics do nothing for a virus, so he does not need them, and giving them would not make him better any faster. What does help is keeping him comfortable — some lubricating drops or a cold, damp flannel over the closed eyes can soothe the grittiness." [3]

"Second, the spread. Because this virus is so contagious, the main thing is to stop it passing around the family. Wash his hands often and yours, do not share towels, flannels or pillows, and try to stop him rubbing his eyes, which is how it spreads from one eye to the other and to other people. His sister has already had it, so she is likely fine, but the rest of the household needs the same hygiene." [6]

"Third, school. I am afraid he does need to stay home from school and childcare, and away from swimming, until that watery discharge has dried up — usually a few days. I know that is hard with work, but the reason is that this spreads very easily between children, and a day or two at home now protects his classmates. Once the eyes are no longer weeping, he can go back." [6]

"Finally, what to watch for. Most viral conjunctivitis settles on its own, but I want you to bring him straight back if he develops real pain in the eye, if the light bothers him more than the grittiness, if his vision goes blurry or he cannot see as well, or if things are getting worse rather than better after a few days. Those are the signs that it might be something more serious than simple conjunctivitis, and we would want to see him and check the eye properly. Otherwise, with the hygiene and a bit of patience, this will settle." [5]