Differential Diagnosis for "Sand in the Eye" Complaint

The patient's complaint of feeling like she has "sand in her eye" is a common description for a condition affecting the eye. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Keratitis sicca (Dry Eye Syndrome): This condition is characterized by a lack of sufficient lubrication on the surface of the eye, leading to discomfort, irritation, and the sensation of having sand or grit in the eye. It's a common condition that matches the patient's symptoms closely.

• Other Likely Diagnoses

  • Blepharitis: Inflammation of the eyelids can cause irritation, itchiness, and a gritty sensation in the eyes, similar to the complaint of having sand in the eye.
  • Conjunctivitis: Whether allergic, viral, or bacterial, conjunctivitis can cause eye irritation, redness, and a sensation of foreign bodies in the eye.
  • Corneal abrasion: A scratch on the cornea can cause significant discomfort, including pain, redness, and the sensation of having something in the eye.

• Do Not Miss Diagnoses

  • Acute Angle-Closure Glaucoma: Although less common, this condition is an emergency. It can cause severe eye pain, blurred vision, and sometimes a sensation of having something in the eye, along with nausea and vomiting. Missing this diagnosis can lead to permanent vision loss.
  • Uveitis: Inflammation of the uvea can cause eye pain, sensitivity to light, and vision problems. It's less likely to cause a "sand in the eye" sensation but is critical to diagnose due to potential complications.

• Rare Diagnoses

  • Sjögren's Syndrome: An autoimmune disorder that can cause dry eyes (keratitis sicca) among other symptoms. While it could explain the sensation of sand in the eye, it's less common and typically associated with other systemic symptoms.
  • Foreign body in the eye: Actual presence of a foreign object in the eye, which could be anything from dust to a metal shard, depending on the context of the injury. This would be an obvious cause of the sensation but is less likely without a history of trauma or exposure to potential foreign bodies.