Differential Diagnosis for a 44-year-old Female with Redness, Pain, Burning Sensation, Itchiness, and a White Ring around the Iris
- Single most likely diagnosis:
- Arcus senilis or Arcus juvenilis: This condition is characterized by a white, grey, or blue opaque ring in the corneal margin (peripheral cornea) and is often associated with aging, high cholesterol, or familial hyperlipidemia. However, given the patient's symptoms of redness, pain, and burning sensation, this diagnosis might not fully explain all symptoms but could be a contributing factor or an incidental finding.
- Other Likely diagnoses:
- Vernal keratoconjunctivitis (VKC): This is a seasonal allergic disorder that can cause redness, pain, burning sensation, and itchiness, especially in younger individuals, but can persist into adulthood. The presence of a white ring could be related to the formation of Horner-Trantas dots or other signs associated with VKC.
- Phlyctenular keratoconjunctivitis: An allergic type of conjunctivitis that can cause redness, pain, and a sensation of burning, often associated with a small, white or yellowish nodule (phlycten) on the conjunctiva or cornea.
- Scleritis or Episcleritis: Inflammation of the sclera or episclera, respectively, which can cause severe pain, redness, and sensitivity to light. While these conditions might not directly cause a white ring around the iris, they could be associated with changes in the appearance of the eye that might be perceived as such.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Acute Angle-Closure Glaucoma: A medical emergency that can cause severe eye pain, redness, blurred vision, and sometimes a haloes appearance around lights due to corneal edema. The white ring could potentially be confused with the appearance of a fixed, mid-dilated pupil or other signs associated with increased intraocular pressure.
- Uveitis: Inflammation of the uvea, which can cause pain, redness, sensitivity to light, and changes in vision. While not typically associated with a white ring around the iris, certain types of uveitis (like Fuchs heterochromic iridocyclitis) could present with unusual findings.
- Rare diagnoses:
- Siderosis or Chalcosis: Conditions resulting from the deposition of iron or copper in the eye tissues, respectively, often due to a retained intraocular foreign body. These could potentially cause a range of symptoms including vision changes, pain, and alterations in the appearance of the eye, though a white ring around the iris would be an unusual presentation.
- Intraocular lymphoma: A rare malignancy that can cause a variety of ocular symptoms, including floaters, blurred vision, and pain. While not typically associated with a white ring around the iris, the diverse presentations of lymphoma mean that it should be considered in cases with unexplained or complex symptoms.