Differential Diagnosis for Acute Onset of Right Eye Symptoms

The patient's presentation of acute onset of right eye symptoms following removal of a contact lens, including clear tear-like drainage, mild swelling, photophobia, and increased watering, suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Allergic Reaction or Irritation: The symptoms of clear tear-like drainage, mild swelling, and photophobia without pain or purulent discharge are consistent with an allergic reaction or irritation, possibly due to the contact lens or lens care products. The absence of significant pain and the nature of the discharge further support this diagnosis.

• Other Likely Diagnoses

  • Dry Eye Syndrome: Although less likely given the acute onset, dry eye syndrome can cause increased watering (reflex tearing), mild irritation, and photophobia. However, it typically doesn't present as acutely.
  • Conjunctivitis (Viral or Allergic): The symptoms could also suggest a form of conjunctivitis, especially given the clear discharge and photophobia. However, the absence of crusting or purulent discharge makes this less likely.
  • Contact Lens-Related Infection (e.g., Giant Papillary Conjunctivitis): Given the recent removal of a contact lens, an infection related to the lens is possible, though the lack of significant pain or purulent discharge makes this less likely.

• Do Not Miss Diagnoses

  • Corneal Ulcer: Although the patient denies pain with eye movement, a corneal ulcer (possibly related to contact lens use) is a critical diagnosis not to miss due to its potential for serious complications, including vision loss. The presence of photophobia and increased watering could be indicative of this condition.
  • Acute Angle-Closure Glaucoma: This is a medical emergency that can present with acute onset of eye symptoms, including pain, blurred vision, and possibly increased watering. Although the patient denies significant pain, the possibility of this condition necessitates careful consideration.
  • Endophthalmitis: A severe, vision-threatening infection that can occur after trauma or surgery, or in association with contact lens use. The absence of significant pain or purulent discharge does not rule out this diagnosis, especially if the patient has been using contact lenses improperly.

• Rare Diagnoses

  • Sjögren's Syndrome: An autoimmune disorder that can cause dry eye symptoms, among others. While it's less likely given the acute presentation, it could be considered in the differential for chronic or recurrent symptoms.
  • Ocular Rosacea: Can cause eye irritation, redness, and increased tearing, but typically presents with other systemic symptoms of rosacea and is less likely given the acute onset described.