Differential Diagnosis
The patient presents with progressive watering, redness, grittiness, and stringy white discharge in one eye, followed by similar symptoms in the other eye. Here's a differential diagnosis based on the provided symptoms:
Single Most Likely Diagnosis
- Viral Conjunctivitis: This is the most likely diagnosis given the symptoms of watering, redness, grittiness, and the presence of stringy white discharge. The fact that it started in one eye and then affected the other eye is also consistent with viral conjunctivitis, which can be highly contagious.
Other Likely Diagnoses
- Bacterial Conjunctivitis: This could also present with similar symptoms, including discharge, although the discharge in bacterial conjunctivitis is often thicker and more purulent than in viral conjunctivitis.
- Allergic Conjunctivitis: This condition can cause watering, redness, and a sensation of grittiness, often with a clear or slightly stringy discharge. It typically occurs in both eyes simultaneously and can be seasonal or perennial, depending on the allergen.
- Irritant Conjunctivitis: Exposure to an irritant (chemical, environmental) could cause similar symptoms, but the history would typically include an exposure to a potential irritant.
Do Not Miss Diagnoses
- Gonococcal Conjunctivitis: Although less common, this condition can present with severe, purulent discharge and is a medical emergency, especially in newborns (as a result of maternal transmission during birth) or in adults who may have contracted it through sexual contact. Prompt treatment is necessary to prevent complications.
- Herpes Simplex Keratitis: This condition can cause eye pain, redness, and discharge, and can lead to serious complications, including vision loss, if not properly treated.
- Acute Angle-Closure Glaucoma: While this condition typically presents with severe eye pain, blurred vision, headache, nausea, and vomiting, in some cases, it can cause redness and watering of the eye. It is a medical emergency requiring immediate treatment.
Rare Diagnoses
- Chlamydial Conjunctivitis: This can cause chronic conjunctivitis and is often associated with a history of chlamydial infection. It's less common but should be considered, especially in sexually active individuals.
- Fungal Conjunctivitis: This is rare and usually occurs after an injury to the eye, especially if the injury involved plant material. It can cause severe inflammation and requires specific antifungal treatment.
Treatment
The treatment will depend on the final diagnosis:
- Viral Conjunctivitis: Supportive care, including frequent hand washing, avoiding touching the eyes, using warm compresses to loosen discharge, and over-the-counter lubricants for comfort. Antiviral medication may be prescribed if the cause is identified as herpes simplex.
- Bacterial Conjunctivitis: Antibiotic eye drops or ointment.
- Allergic Conjunctivitis: Avoiding the allergen, using antihistamine or mast cell stabilizer eye drops.
- Irritant Conjunctivitis: Removing the irritant and using lubricating eye drops.
- Gonococcal Conjunctivitis, Herpes Simplex Keratitis, Acute Angle-Closure Glaucoma, and other serious conditions require immediate medical attention and specific treatments that may include antibiotics, antivirals, or emergency surgical intervention.