Differential Diagnosis for Upper Eyelid/Lash Line Irritation

• Single Most Likely Diagnosis
  • Blepharitis: This is the most common cause of upper eyelid and lash line irritation, often due to a combination of bacterial overgrowth, meibomian gland dysfunction, and Demodex mites. Symptoms include redness, itching, and crusting around the eyelashes.
• Other Likely Diagnoses
  • Dry Eye Syndrome: Can cause irritation and discomfort in the eyes, including the eyelids, due to insufficient tear production or poor tear quality.
  • Allergic Conjunctivitis: An allergic reaction to substances like pollen, dust, or makeup can lead to itching, redness, and irritation of the eyelids and conjunctiva.
  • Demodex Infestation: A higher concentration of Demodex mites than usual can cause irritation, itching, and inflammation around the eyelashes.
  • Seborrheic Dermatitis: A skin condition that can affect the eyelids, causing redness, itching, and flaking.
• Do Not Miss Diagnoses
  • Orbital Cellulitis: A serious infection of the tissues surrounding the eye, which can cause eyelid swelling, redness, and pain. It requires prompt medical attention to prevent serious complications.
  • Herpes Zoster (Shingles): When it affects the ophthalmic division of the trigeminal nerve, it can cause severe pain, blistering, and potentially lead to serious eye complications if not treated promptly.
• Rare Diagnoses
  • Lacrimal Gland Dysfunction: Abnormalities in the lacrimal gland can lead to various symptoms, including eyelid irritation, though this is less common.
  • Sarcoidosis: A systemic disease that can affect the eyes, including the eyelids, causing inflammation and irritation, though it is relatively rare.
  • Leukemic Infiltration: In rare cases, leukemia can cause infiltration of the eyelids, leading to swelling, redness, and irritation, especially in patients with a known history of leukemia.