Differential Diagnosis for Acute Onset of Eye Symptoms

The patient presents with acute onset of eye swelling, tearing, discomfort, and mild periorbital swelling without a history of trauma or foreign body exposure. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Allergic Conjunctivitis: This is the most likely diagnosis given the acute onset of symptoms, including tearing, discomfort, and swelling, without a history of trauma or foreign body exposure. Allergic conjunctivitis is a common condition that can be triggered by various allergens, leading to the release of histamine and other mediators, which cause the observed symptoms.
• Other Likely Diagnoses
  • Viral Conjunctivitis: This condition is characterized by redness, tearing, and discharge, which can be clear or purulent. It is highly contagious and can be caused by various viruses, including adenovirus.
  • Blepharitis: This is an inflammation of the eyelids that can cause swelling, redness, and discomfort. It can be associated with a clear discharge and is often related to poor eyelid hygiene or meibomian gland dysfunction.
• Do Not Miss Diagnoses
  • Acute Angle-Closure Glaucoma: Although less likely, this is a medical emergency that requires immediate attention. It can present with acute eye pain, redness, and blurred vision, but the absence of visual disturbances in this patient makes it less likely. However, it is crucial not to miss this diagnosis due to its potential for permanent vision loss.
  • Orbital Cellulitis: This is an infection of the orbital tissues that can cause swelling, redness, and pain. It is more severe than preseptal cellulitis and can lead to serious complications, including vision loss and intracranial infection.
• Rare Diagnoses
  • Thyroid-Associated Orbitopathy: This condition is associated with thyroid disease and can cause swelling of the tissues around the eye, including the eyelids and orbit. It is less common and typically presents with other symptoms of thyroid disease.
  • Sarcoidosis: This is a systemic disease that can affect various parts of the body, including the eyes. It can cause uveitis, conjunctivitis, and other ocular symptoms, but it is relatively rare and usually presents with systemic symptoms.

Treatment

The treatment will depend on the final diagnosis. For allergic conjunctivitis, antihistamines and mast cell stabilizers can be effective. For viral conjunctivitis, supportive care with artificial tears and good hygiene practices is recommended. Blepharitis may require eyelid hygiene practices and possibly antibiotics. Acute angle-closure glaucoma and orbital cellulitis require immediate medical attention and potentially surgical intervention. Thyroid-associated orbitopathy and sarcoidosis require management of the underlying condition.