Differential Diagnosis for 79 YO Female with Redness in One Eye
Single Most Likely Diagnosis
- Blepharitis or Dry Eye Syndrome: The patient's symptoms of redness, mild soreness with light, and lack of response to chloramphenicol (chlorsig) drops suggest a superficial ocular condition. The absence of visual acuity problems, systemic symptoms, and normal intraocular pressure (IOP) also point towards a benign, superficial condition.
Other Likely Diagnoses
- Conjunctivitis: Given the redness and soreness, conjunctivitis (either viral or bacterial) is a plausible diagnosis, especially since the patient has not responded to antibiotic drops, which might indicate a viral etiology or a condition not responsive to antibiotics.
- Keratitis: Inflammation of the cornea could cause redness and soreness, especially with light (photophobia). The lack of visual acuity problems does not rule out keratitis, as some forms may not significantly impact vision initially.
- Uveitis: Although less likely given the lack of systemic symptoms and normal vision, uveitis could present with eye redness and photophobia. However, it typically causes more significant visual disturbances and is often associated with systemic diseases or other ocular findings.
Do Not Miss Diagnoses
- Acute Angle-Closure Glaucoma: Despite normal IOP at presentation, this condition can be a medical emergency. The patient's symptoms of redness and photophobia, although mild, necessitate consideration of this diagnosis, especially in the context of her background of hypertension and cardiovascular disease, which might increase the risk of vascular occlusions.
- Endophthalmitis: An intraocular infection, usually following surgery or trauma, which can present with severe vision loss, pain, and redness. Although the patient's vision is unaffected, and there's no mention of recent ocular surgery or trauma, this diagnosis is critical to consider due to its severe consequences.
- Ocular Malignancy (e.g., Lymphoma): In an elderly patient, even with mild symptoms, ocular malignancies can present subtly and should not be overlooked, especially given the patient's background of systemic diseases.
Rare Diagnoses
- Scleritis: Inflammation of the sclera, which can cause severe pain, redness, and tenderness to the touch. It's less common and often associated with systemic autoimmune diseases.
- Corneal Ulcer: An open sore on the cornea, usually resulting from infection, which can cause redness, pain, and vision problems. The patient's lack of significant vision issues makes this less likely but still a consideration, especially if there's a history of contact lens use or trauma.