Keratitis Diagnosis Differential
Single Most Likely Diagnosis
- Herpes Simplex Keratitis: This is often the most common cause of keratitis, especially in patients with a history of cold sores or previous episodes of keratitis. The presentation typically includes a dendritic ulcer on the cornea.
Other Likely Diagnoses
- Bacterial Keratitis: Common in contact lens wearers or following trauma, bacterial keratitis can present with significant pain, redness, and discharge. Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae are common pathogens.
- Fungal Keratitis: More likely in agricultural workers or after trauma with organic matter, fungal keratitis tends to have a slower onset and may present with feathery or irregular borders of the ulcer.
- Acanthamoeba Keratitis: Typically seen in contact lens wearers, especially those who swim or shower while wearing lenses, acanthamoeba keratitis can cause severe pain out of proportion to the clinical appearance.
Do Not Miss Diagnoses
- Syphilis: Although less common, syphilitic keratitis can occur and is crucial to diagnose due to its systemic implications and the need for treatment to prevent long-term complications.
- Lyme Disease: Can cause keratitis, especially in endemic areas, and is important to consider due to its potential for systemic involvement and the need for appropriate antibiotic treatment.
- Varicella-Zoster Virus (VZV) Keratitis: Similar to herpes simplex, VZV can cause keratitis, particularly in older adults or immunocompromised individuals, and requires antiviral treatment.
Rare Diagnoses
- Cytomegalovirus (CMV) Keratitis: Primarily seen in immunocompromised patients, such as those with HIV/AIDS or post-transplant patients, CMV keratitis requires specific antiviral therapy.
- Mycobacterial Keratitis: Can occur, especially after trauma or surgery, and may require prolonged antibiotic treatment.
- Onchocercal Keratitis: Associated with onchocerciasis (river blindness), this is rare outside of endemic areas but can cause significant ocular morbidity if not treated appropriately.