My, what beautiful eyes you have

by chelseajin

I identified my first atopic kid today, all by myself! Pretty silly, but still.

The kid comes in with somewhat scary sounding symptoms. She said she couldn’t breathe the night before because her nose was all blocked up, but she didn’t have any cold/flu symptoms before and no one around her was sick. She also had some irritation and swelling on the lower lid of one eye.

I saw that eye and thought, man that really looks like an allergic shiner. They’re supposed to be bilateral, on both eyes, and I’m thinking that one of them was more puffy because she was rubbing it. I wish I could call her in a week and ask if it went away on its own, unfortunately, you can only really follow-up if they come back and if you’re feeling fine, why would you come back to the doctor?

Those “shiners” look a lot like this, and resemble bags under the eye or dark circles like you might get if you don’t sleep well. These are due to increased blood flow in the sinuses.

Everything checked out ok on physical exam except for one of her ears which looked like it was getting an infection. Apparently this was a common thing for her, and most probably unrelated to her other complaints since she wasn’t exhibiting anything but a nasal-voice. No redness in the throat, lungs clear.

Mom didn’t have her taking anything, so Betty and I recommended Zyrtec (Cetirizine) 10 mg QD (maybe I’ll impress a peds attending one day in the near future) and some eyedrops and saline spray.

So that was a neat little case.

Sometimes, I look at my notes and they’re a total mess. I need a way to make them more streamlined. How have I not figured this out after 5 months?