Differential Diagnosis for Sharp Eye Pain

The patient's symptoms of sharp eye pain, inability to keep the eye open, and constant clear discharge suggest several potential diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Dry Eye Syndrome: This condition is characterized by insufficient lubrication of the eye, leading to pain, discomfort, and excessive tearing (which can be clear in nature). The sharp pain and inability to keep the eye open could be due to severe dryness, especially if the patient has been experiencing environmental factors like dry air or has a condition that affects tear production.

• Other Likely Diagnoses

  • Conjunctivitis (Viral or Allergic): Both viral and allergic conjunctivitis can cause significant discomfort, redness, and a watery discharge. The sharp pain could be due to irritation of the conjunctiva.
  • Corneal Abrasion: A scratch on the cornea can cause severe pain, tearing, and sensitivity to light. The pain can be sharp and is often described as feeling like something is in the eye.
  • Blepharitis: Inflammation of the eyelids can cause eye pain, burning sensations, and excessive tearing. It might not fully explain the sharp pain but could contribute to the overall discomfort.

• Do Not Miss Diagnoses

  • Acute Angle-Closure Glaucoma: Although less common, this is a medical emergency. Symptoms include severe eye pain, blurred vision, headache, nausea, and vomiting, along with a red, inflamed eye. The pain can be sharp and is accompanied by decreased vision and possibly seeing halos around lights.
  • Endophthalmitis: An infection within the eye, usually following surgery or trauma. Symptoms include severe eye pain, redness, decreased vision, and swelling. It's a rare but potentially devastating condition if not promptly treated.
  • Keratitis (Corneal Ulcer): An infection of the cornea that can cause severe pain, redness, and discharge. It's more common in contact lens wearers but can occur in anyone.

• Rare Diagnoses

  • Scleritis: Inflammation of the sclera (the white part of the eye), which can cause severe, deep pain and tenderness to the touch. It's less common than other conditions like conjunctivitis or dry eye but should be considered in cases of severe, unexplained eye pain.
  • Uveitis: Inflammation of the uvea, the middle layer of the eye, which can cause pain, sensitivity to light, and vision problems. It's less common and might not initially present with sharp pain but could be considered if other symptoms are present.

Each of these diagnoses requires a thorough eye examination, and some may necessitate further testing, such as a slit-lamp examination or imaging studies, to confirm the diagnosis and guide appropriate treatment.