Differential Diagnosis for Eye Irritation and Redness

The patient presents with symptoms of eye irritation, redness, goopiness, and crusting, primarily affecting one eye initially but now involving the other. The use of over-the-counter eye drops has not provided significant relief. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Viral Conjunctivitis: This is the most likely diagnosis given the symptoms of redness, goopiness, and crusting, especially with the initial involvement of one eye and subsequent spread to the other. The lack of significant improvement with over-the-counter eye drops also supports this diagnosis, as viral conjunctivitis often does not respond to topical antibiotics or simple lubricants.

• Other Likely Diagnoses

  • Bacterial Conjunctivitis: This could be considered if the discharge is more purulent and the symptoms are more severe. However, the initial presentation and the spread from one eye to the other might lean more towards a viral etiology.
  • Allergic Conjunctivitis: Given the time of year (if it's during allergy season) and the presence of irritation and redness, allergic conjunctivitis could be a consideration, especially if the patient has a history of allergies.
  • Dry Eye Syndrome: Although less likely given the acute presentation, dry eye could cause irritation and redness, especially if the patient has been using computers or has been in a dry environment.

• Do Not Miss Diagnoses

  • Acute Angle-Closure Glaucoma: This is a medical emergency that can present with eye pain, redness, and decreased vision. Although the symptoms described do not fully align with glaucoma, any condition that could lead to permanent vision loss if not promptly treated should be considered.
  • Herpes Simplex Keratitis: This condition can cause significant morbidity, including vision loss, if not treated properly. It often presents with pain, redness, and a dendritic ulcer on the cornea.
  • Gonococcal Conjunctivitis: In adults, this condition is usually seen in those who are sexually active and can present with severe, purulent conjunctivitis. It's a critical diagnosis to consider due to its potential for rapid progression and the need for systemic antibiotic treatment.

• Rare Diagnoses

  • Keratoconjunctivitis Sicca (Sjögren's Syndrome): An autoimmune disorder that can cause dry eyes among other symptoms. It's less likely given the acute presentation but could be considered in the differential for chronic cases.
  • Episcleritis or Scleritis: Inflammatory conditions of the episclera or sclera that can cause redness and pain. These are less common and usually present with more severe pain and deeper inflammation.