Differential Diagnosis for 45 yo Female with Painful Crack Corner of Mouth, Watery Left Eye, and Globus Sensation

• Single Most Likely Diagnosis
  • Angular cheilitis: This condition is characterized by inflammation of the corners of the mouth, often causing pain and cracks. The combination of a painful crack in the corner of the mouth, along with other symptoms like a watery eye and globus sensation, could be related to an underlying condition such as a vitamin deficiency or an autoimmune disorder, but the primary symptom points towards angular cheilitis.
• Other Likely Diagnoses
  • Sjögren's syndrome: An autoimmune disorder that can cause dry eyes (which might not directly correlate with a watery eye but could be part of a broader symptom complex including oral and ocular manifestations) and dry mouth, potentially leading to difficulties with swallowing or a sensation of a lump in the throat (globus sensation).
  • Dental issues (e.g., ill-fitting dentures, gum disease): These could cause discomfort while eating, potentially leading to a globus sensation, and if there's an infection, it could theoretically cause eye symptoms through systemic infection or direct spread, though this is less common.
  • Allergies or sinusitis: Could cause watery eyes and potentially contribute to oral symptoms if there's significant postnasal drip or if the allergies affect the oral mucosa.
• Do Not Miss Diagnoses
  • Oral or pharyngeal cancer: Although less likely, any persistent or unexplained oral symptoms, including painful areas in the mouth or difficulty swallowing, necessitate a thorough evaluation to rule out malignancy.
  • Lyme disease: In endemic areas, Lyme disease can cause a wide range of symptoms including facial palsy (which might lead to a watery eye due to inability to close the eye properly), and systemic symptoms could potentially contribute to the other complaints.
  • Multiple sclerosis or other neurological disorders: Could potentially cause a variety of symptoms including vision changes (leading to a watery eye), swallowing difficulties, and oral sensory changes.
• Rare Diagnoses
  • Sarcoidosis: A systemic disease that can affect multiple parts of the body, including the eyes (causing uveitis or other ocular symptoms), skin (including the corners of the mouth), and potentially the nervous system, leading to a wide array of symptoms.
  • Relapsing polychondritis: An autoimmune disorder that can affect cartilaginous structures, including those in the eyes and ears, potentially leading to symptoms like a watery eye, and could also affect the oral and pharyngeal areas, though this is less common.