Sticky, Red Eye — Free SCA Practice Case
Mother of a newborn with a sticky, red eye
Station Timer
12:00
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
12:00
Golden MinuteMaterials for Candidate
Please review before starting the consultation
Patient Profile
Full Name
Alfie Merton
Age
12 years
Consultation Type
TelephoneAge
12 days
Situation
Telephone Consultation. The baby's mother is calling.
Reason for Encounter
"My newborn's eyes have been sticky and a bit red for a few days, and now there's yellow discharge and some swelling. I'm worried."
Medical Records (Alfie Merton)
- ●PMH: Born at term by vaginal delivery 12 days ago; no complications. Bottle fed.
- ●Medications: None.
- ●Allergies: NKDA.
- ●Recent notes: No prior consultations.
Patient Script
For the friend playing the patient role
Character Overview: You are Sophie, a 29-year-old first-time mother of Alfie, who is 12 days old. For about three days his eyes have been sticky with a yellow discharge, and now both eyes look red and the lids are a bit swollen. He is otherwise feeding well, has normal wet nappies, is not floppy or unusually sleepy, and has no fever. You are anxious as a new mum and want to know whether it is serious and what to do. You will follow clear advice.
Opening Sentence: "Hello Doctor. My little boy is 12 days old, and for about three days his eyes have been sticky with yellow gunk. Now both eyes are red and his eyelids look a bit puffy. He's feeding okay, but I'm really worried — is this serious? What should I do?"
History if Asked (Data Gathering Phase)
- ●The eyes: "Both eyes. Sticky yellow discharge for about three days, and now they're red and the lids are a bit swollen. He keeps them a bit gummed up, especially after sleep."
- ●Onset: "It started around three days ago and seems to be getting worse, not better."
- ●How he is otherwise: "He's feeding well, plenty of wet nappies, not floppy, not unusually sleepy, and no temperature that I can tell."
- ●Birth: "He was born normally, at term, no problems. He's bottle fed."
- ●What she wants: "To know if it's serious and what I should do — should I be worried?"
ICE — Ideas, Concerns, Expectations
The mother does not volunteer this information unprompted. These responses surface only when the candidate explores her perspective.
- ●Ideas: Sophie thinks it is probably an eye infection but is not sure how serious it is in a newborn. "I think it's an eye infection, but I don't know how worried to be with him being so tiny."
- ●Concerns: As a first-time mum she is anxious it could be something serious or affect his eyes/sight. "I'm scared it's something serious, or that it could damage his eyes."
- ●Expectations: She wants to know how serious it is and what to do, and would follow clear advice including going to be seen if needed. "I want to know how serious it is and exactly what to do."
If Asked — Ophthalmia Neonatorum and Sepsis Screen
The mother answers these only when directly asked.
- ●If asked about one or both eyes: "Both eyes."
- ●If asked about the discharge (amount, colour, purulent): "Yellow, sticky, and there's more of it now — quite a lot."
- ●If asked about lid swelling and redness (severity): "The lids are a bit swollen and the eyes look red — it's getting worse."
- ●If asked about timing of onset (days of life): "It started at about nine days old and has built up over three days." (Onset in the first weeks — within the ophthalmia neonatorum window.)
- ●If asked about very early onset / hyperacute profuse discharge (gonococcal): "It wasn't there in the first day or two — it came on later, and it's yellow rather than gushing." (Less suggestive of hyperacute gonococcal, but the candidate must ask.)
- ●If asked about fever, poor feeding, floppiness, drowsiness, irritability, reduced wet nappies (neonatal sepsis red flags): "No — he's feeding well, plenty of wet nappies, alert, not floppy, no temperature." (Systemically well.)
- ●If asked about whether the baby seems to see/eyes otherwise (excessive tearing, cloudiness): "His eyes look normal apart from the redness and discharge — no cloudiness."
- ●If asked (sensitively) about the pregnancy/maternal health or infections in pregnancy: "The pregnancy was fine, no infections that I know of." (Kept proportionate.)
Responses to Management (The Negotiation Phase)
- ●If the Doctor explains a newborn's eye needs different handling from an older child's: "So it's not the same as a normal eye infection you'd get an older child — a newborn's more serious?" (The tested point is recognising that conjunctivitis in a newborn — ophthalmia neonatorum — is handled differently and more urgently.)
- ●If the Doctor arranges urgent same-day assessment: "You want him seen today? Is it that urgent?" (The tested point is arranging urgent assessment and swabs rather than simply advising cleaning/over-the-counter drops.)
- ●If the Doctor explains swabs and the possible causes: "They'll take swabs? What sorts of infection are you checking for?" (The tested point is explaining the need for swabs, including for gonococcal and chlamydial causes.)
- ●If the Doctor gives eye-cleaning and interim advice: "Is there anything I should do in the meantime?"
- ●If the Doctor gives a clear safety-net: "What would mean I need to get him to hospital straight away?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
0 / 16 indicators checked+0−0
Positive (0/8)
Negative (0/8)
Domain 2: Clinical Management and Medical Complexity
0 / 18 indicators checked+0−0
Positive (0/9)
Negative (0/9)
Domain 3: Relating to Others
0 / 12 indicators checked+0−0
Positive (0/6)
Negative (0/6)
Clinical Learning Points
1
Ophthalmia Neonatorum
- ●Ophthalmia neonatorum is conjunctivitis in the first 28 days of life. It is not managed like conjunctivitis in older children — it needs urgent assessment and swabs, because causes include gonococcal and chlamydial infection (acquired at birth), which require specific systemic treatment.
2
Timing Helps Suggest the Cause
- ●Gonococcal ophthalmia is typically hyperacute and very early (first few days), with profuse purulent discharge and marked lid swelling — a sight-threatening emergency. Chlamydial conjunctivitis typically presents later (around days 5–14) with mucopurulent discharge. Other bacterial and viral causes occur; a benign sticky eye/blocked nasolacrimal duct (well baby, minimal redness) is common and benign.
3
Always Screen for Neonatal Sepsis
- ●In any unwell neonate, screen for sepsis red flags — fever (or low temperature), poor feeding, floppiness, drowsiness, irritability, and reduced wet nappies — which mandate emergency assessment.
4
Urgent Assessment and Swabs
- ●Arrange urgent same-day assessment with conjunctival swabs (Gram stain, culture, and NAAT for gonococcus and chlamydia) via the appropriate local pathway. Do not rely on simple cleaning or over-the-counter drops for suspected ophthalmia neonatorum.
5
Treatment Is Organism-Directed and Systemic
- ●Gonococcal and chlamydial ophthalmia require specific systemic antibiotic treatment (coordinated with specialists), not topical treatment alone. Suspected gonococcal disease is an ophthalmic emergency.
6
The Maternal/Partner Dimension
- ●If a sexually transmitted cause is confirmed, the mother and partner need assessment and treatment via sexual-health services — handled sensitively and proportionately.
7
Interim Care and Safety-Netting
- ●Advise gentle eye cleaning with cooled boiled water/saline and hand hygiene in the interim, and give a clear neonatal safety-net (sepsis red flags and worsening eye signs → 999/A&E).
8
Common Candidate Mistakes in This Case
- ●Treating it as a simple sticky eye: advising cleaning/over-the-counter drops instead of urgent assessment and swabs.
- ●Missing gonococcal ophthalmia: not recognising the hyperacute, sight-threatening emergency.
- ●Not screening for neonatal sepsis: omitting the systemic red-flag screen in a newborn.
- ●Topical-only thinking: not appreciating that treatment is organism-directed and systemic, and specialist-coordinated.
- ●Poor communication: panicking or under-informing an anxious new mother, or handling the maternal/STI dimension insensitively.
Free MRCGP SCA practice case for GP registrars covering Sticky, Red Eye — Ophthalmology. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.
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