Differential Diagnosis for Swollen Eyes

The patient presents with swollen eyes since the previous night, unresponsive to Benadryl, and a reported new allergy to cherries causing throat itch. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Allergic Reaction: Given the patient's reported new allergy to cherries and the symptoms of throat itch, an allergic reaction could be the cause of the swollen eyes, especially if the patient consumed cherries recently. The lack of response to Benadryl might indicate a more severe reaction or another underlying cause.

• Other Likely Diagnoses

  • Angioedema: This condition can cause swelling of the eyes, lips, and throat, and can be triggered by allergic reactions. The patient's throat itch and eye swelling could be indicative of angioedema, especially if the reaction to cherries is severe.
  • Conjunctivitis (Allergic): This is an inflammation of the conjunctiva due to an allergic reaction, which could cause eye swelling. The new allergy to cherries might be the culprit, although conjunctivitis typically presents with other symptoms like redness and discharge.
  • Contact Dermatitis or Irritant Contact Dermatitis: If the patient came into contact with an irritant or allergen (possibly related to cherries or another substance), this could cause eye swelling.

• Do Not Miss Diagnoses

  • Anaphylaxis: Although the patient's symptoms seem localized, anaphylaxis is a life-threatening condition that can present with a variety of symptoms, including swelling, and can be triggered by a severe allergic reaction. The fact that Benadryl had no effect increases the concern for a more severe reaction.
  • Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN): These are severe skin and mucous membrane disorders, usually a reaction to medication or infection. They can cause eye swelling among other symptoms and are medical emergencies.

• Rare Diagnoses

  • Hereditary Angioedema (HAE): A rare genetic disorder that causes recurring episodes of severe swelling, typically in the limbs, face, intestines, and airways. It could be considered if the patient has a family history or if other diagnoses are ruled out.
  • Erythema Multiforme: A skin condition characterized by target lesions, which can sometimes involve the eyes and be triggered by infections or medications. It's less likely but should be considered if other symptoms are present.