A 27-year-old female presents to your clinic complaining of a red right eye with watery discharge over the past three days. She has some photophobia but otherwise appears well, with no exposure to infectious contacts. Visual acuity measures 20/20 OU and anterior segment examination of the right eye reveals 2+ conjunctival injection, 3+ follicles, a small pseudodendrite, and several small subepithelial infiltrates with overlying epithelial defects at the superior temporal limbus. There is also slight inflammation of the right eyelid and you palpate swollen, tender preauricular lymph nodes on the same side. You diagnose your patient with herpetic keratoconjunctivitis and prescribe her with combination oral antiviral and topical antibiotic therapy.1
You wipe down all surfaces with alcohol wipes before seeing your next consult—a 14-year-old boy and his 9-year-old sister, both of whom you see annually as part of their regular eye exams. “Everything looks great; both children are doing very well!” you tell their mother after performing a complete optometric exam and dispensing new eyeglass prescriptions. She wants to look at some of the new frames available in your clinic, so you redirect her to your eyewear selection.
The children begin trying on new frames, and you call your next patient —a 61-year-old gentleman whom you follow for regular diabetic eye exams. He coughs dryly into his sleeve and seems out of breath walking toward the clinic room. You are surprised to see him appearing lethargic and under the weather since he is normally very energetic. “Doc, I don’t feel so good: it really hurts to breathe, and I feel my heart beating out of my chest,” he remarks as he falls into the exam chair. Concerned that he may be systemically unwell, you take his temperature which comes out to 39°C (102°F). You are unsure whether it is safe for your patient, clinic staff, and yourself to proceed with the appointment.