Red eye, mucopurulent discharge, and foreign body sensation.

• Cat-scratch disease from Bartonella henselae (most common cause): Often a history of being scratched or licked by a kitten within 2 weeks of symptoms.
• Tularemia: History of contact with rabbits, other small wild animals, or ticks. Patients have severe headache, fever, and other systemic manifestations.
• Tuberculosis and other mycobacteria.
• Rare causes: Syphilis, leukemia, lymphoma, mumps, Epstein–Barr virus, HSV, fungi, sarcoidosis, listeria, typhus, and others.

1. Warm compresses for tender lymph nodes.
2. Antipyretics as needed.
3. Disease specific:
   • Cat-scratch disease: Generally resolves spontaneously in 6 weeks. Consider azithromycin 500 mg p.o. q.i.d., then 250 mg daily for four doses (for children, 10 mg/kg q.i.d., then 5 mg/kg daily for four doses); alternatives include trimethoprim/sulfamethoxazole (160/800 mg b.i.d.) or ciprofloxacin 500 mg p.o. b.i.d. Duration should be individualized. Use a topical antibiotic (e.g., bacitracin/polymyxin B ointment or gentamicin drops q.i.d.). The cat does not need to be removed.
   • Tularemia: Recommended therapy is gentamicin 5 mg/kg once daily i.m. or i.v. for 10 days. For mild illness, alternative therapies include ciprofloxacin 500 mg p.o. b.i.d. for 10 to 14 days or doxycycline 100 mg p.o. b.i.d. for 14 to 21 days. Systemic medication should coincide with gentamicin 0.3% drops q2h for 1 week and then five times per day until resolved. Often patients are systemically ill and under the care of a medical internist for tularemia; if not, refer to a medical internist for systemic management.
   • Tuberculosis: Refer to an internist for antituberculosis medication.
   • Syphilis: Systemic penicillin (dose depends on the stage of syphilis) and topical tetracycline ointment (see 12.12, SYPHILIS).

Repeat the ocular examination in 1 to 2 weeks. Conjunctival granulomas and lymphadenopathy can take 4 to 6 weeks to resolve for the cat-scratch disease.