Differential Diagnosis for a Baby Born at Home with Bilateral Chemosis, Eyelid Swelling, and Purulent Drainage

• Single Most Likely Diagnosis
  • Neonatal Conjunctivitis (Ophthalmia Neonatorum): This condition is highly likely due to the lack of erythromycin ointment prophylaxis at birth, which is commonly used to prevent gonococcal and chlamydial conjunctivitis. The symptoms of bilateral chemosis, eyelid swelling, and purulent drainage are classic for this condition.
• Other Likely Diagnoses
  • Chemical Conjunctivitis: Although less likely than infectious causes given the presence of purulent drainage, chemical conjunctivitis could occur due to the lack of prophylactic antibiotic ointment and exposure to the birth canal's flora. However, it typically presents earlier and with less severe symptoms.
  • Viral Conjunctivitis: Herpes simplex virus (HSV) or other viral infections could cause similar symptoms, though they might be less common in this context compared to bacterial causes.
• Do Not Miss Diagnoses
  • Gonococcal Conjunctivitis: This is a critical diagnosis to consider because it can lead to severe consequences, including corneal perforation and blindness, if not promptly treated. The absence of erythromycin ointment prophylaxis increases the risk.
  • Chlamydial Conjunctivitis: Similar to gonococcal conjunctivitis, chlamydial infection is a significant concern due to its potential for causing long-term ocular and systemic complications if left untreated.
• Rare Diagnoses
  • Congenital Dacryocystitis: Although rare, this condition involves an infection of the nasolacrimal sac and could present with similar symptoms. It's less likely given the bilateral nature and the context of the birth.
  • Other Infectious Causes: Less common pathogens could be responsible, especially in areas with high prevalence of specific infectious diseases. However, these would be less likely without specific risk factors or exposures.