Differential Diagnosis for Pink Painful Eye after Sleeping in Contacts

• Single most likely diagnosis
  • Contact lens-related microbial keratitis: This condition is highly likely due to the practice of sleeping in contact lenses, which increases the risk of microbial infection. The symptoms of a pink, painful eye are consistent with this diagnosis.
• Other Likely diagnoses
  • Contact lens-induced acute red eye (CLARE): This condition is an inflammatory response to the contact lens itself, which can cause pain, redness, and discomfort, especially after sleeping in lenses.
  • Giant papillary conjunctivitis: This is an allergic reaction to the contact lenses, which can cause inflammation, discomfort, and a pink appearance of the eye.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Endophthalmitis: Although less common, this is a severe, sight-threatening infection within the eye that can occur after trauma, including from a contact lens. It requires immediate medical attention.
  • Corneal ulcer: A serious infection of the cornea that can lead to vision loss if not promptly treated. It's crucial to differentiate it from less severe conditions.
• Rare diagnoses
  • Acanthamoeba keratitis: A rare but serious infection of the cornea caused by a parasite, often associated with poor hygiene and swimming in contaminated water while wearing contact lenses.
  • Fungal keratitis: A rare fungal infection of the cornea, which can be more common in warm, humid climates and in individuals who have compromised corneal integrity, such as from trauma or contact lens use.