Differential Diagnosis for Abnormal Corneal Uptake of Fluorescein
Single Most Likely Diagnosis
- Corneal Abrasion: This is the most common cause of abnormal corneal uptake of fluorescein. It occurs due to a scratch or injury to the corneal epithelium, allowing the fluorescein dye to penetrate and stain the damaged area. The history of trauma or eye rubbing, along with the presence of pain, redness, and a foreign body sensation, supports this diagnosis.
Other Likely Diagnoses
- Corneal Ulcer: A corneal ulcer, often caused by bacterial or fungal infections, can lead to fluorescein uptake due to the breakdown of the corneal epithelium. Symptoms include severe pain, redness, decreased vision, and discharge.
- Herpes Simplex Keratitis: This viral infection can cause corneal epithelial defects, leading to fluorescein uptake. It is characterized by a dendritic pattern of staining and is often accompanied by pain, redness, and blurred vision.
- Dry Eye Syndrome: Severe dry eye can cause micro-abrasions on the corneal surface, leading to fluorescein uptake. Patients typically complain of dryness, grittiness, and irritation.
Do Not Miss Diagnoses
- Corneal Perforation: Although less common, corneal perforation is a medical emergency that requires immediate attention. It can cause severe pain, vision loss, and may lead to endophthalmitis if not promptly treated. Fluorescein uptake in this context indicates a full-thickness defect in the cornea.
- Chemical Burn: Chemical injuries to the eye can cause significant damage to the cornea, leading to fluorescein uptake. The history of exposure to chemicals, along with symptoms of severe pain, redness, and vision loss, should raise suspicion for this condition.
Rare Diagnoses
- Map-Dot-Fingerprint Dystrophy: A rare, inherited condition characterized by the formation of small, dot-like opacities in the corneal epithelium and basement membrane. It can cause fluorescein uptake due to the disruption of the epithelial layer.
- Thygeson's Superficial Punctate Keratitis: A rare condition of unknown etiology, characterized by multiple small, punctate lesions on the corneal surface, which can stain with fluorescein. It is often asymptomatic but can cause blurred vision and eye irritation in some cases.