Differential Diagnosis for a 2-week-old with Yellow Drainage and Crusted Lid Shut
- Single Most Likely Diagnosis
- Neonatal Conjunctivitis (Ophthalmia Neonatorum): This condition is highly likely due to the age of the patient and the symptoms presented. It is commonly caused by bacterial (e.g., Neisseria gonorrhoeae, Chlamydia trachomatis) or viral infections acquired during birth. The yellow drainage and crusted eyelid are classic signs.
- Other Likely Diagnoses
- Blepharitis: Inflammation of the eyelids can cause crusting and discharge, though it's less common in neonates.
- Keratitis: Inflammation of the cornea can present with discharge and crusting, especially if there's an associated infection.
- Dacryocystitis: Infection or blockage of the tear duct can cause discharge and crusting, particularly if the lacrimal duct is obstructed.
- Do Not Miss Diagnoses
- Gonococcal Conjunctivitis: Although less common, this condition can lead to severe consequences, including corneal perforation and blindness if not promptly treated. It presents similarly to other forms of conjunctivitis but requires specific and immediate antibiotic treatment.
- Herpes Simplex Virus (HSV) Keratoconjunctivitis: HSV infection in the neonate can be severe and sight-threatening. Early recognition and antiviral treatment are crucial.
- Rare Diagnoses
- Congenital Glaucoma: While not typically presenting with discharge, congenital glaucoma can cause tearing and crusting due to corneal edema and breakdown. It's a rare condition but critical to diagnose early to preserve vision.
- Tear Duct Atresia with Secondary Infection: While tear duct atresia itself is not rare, a secondary infection presenting with the described symptoms in a neonate is less common but should be considered, especially if other diagnoses are ruled out.