Differential Diagnosis for 61-year-old Female with Respiratory and Ocular Symptoms
- Single most likely diagnosis:
- Viral upper respiratory infection (URI) with secondary bacterial conjunctivitis: The patient's symptoms of nasal congestion, rhinorrhea, mild cough, and the progression to eye irritation, redness, and thick yellow drainage are consistent with a viral URI complicated by bacterial conjunctivitis. The use of over-the-counter allergy medication and Sudafed suggests an initial attempt to manage symptoms that were thought to be allergic in nature, but the development of purulent eye discharge indicates a bacterial infection.
- Other Likely diagnoses:
- Allergic rhinitis with viral conjunctivitis: Although the patient has been taking allergy medication, the presence of thick green nasal drainage and the development of conjunctivitis could still be consistent with an allergic reaction complicated by a viral infection.
- Bacterial sinusitis: The symptoms of nasal congestion, green nasal drainage, and the development of conjunctivitis could suggest bacterial sinusitis, especially if the infection has spread to the eyes.
- Viral conjunctivitis: This could be a separate entity from the URI, given the direct involvement of the eye with symptoms of redness, irritation, and discharge.
- Do Not Miss diagnoses:
- Orbital cellulitis: Although less likely, this condition is a medical emergency that requires prompt diagnosis and treatment. The presence of eye redness, swelling, and purulent discharge, especially if accompanied by fever, severe pain, or vision changes, would necessitate immediate further evaluation.
- Endophthalmitis: This is a rare but serious infection of the inner eye that can result from bacterial or fungal infections. It is a medical emergency and would require immediate ophthalmologic evaluation.
- Rare diagnoses:
- Dacryocystitis: An infection of the lacrimal sac, which could present with eye redness, swelling, and purulent discharge, particularly if there is a history of nasolacrimal duct obstruction.
- Sjögren's syndrome: An autoimmune disorder that can cause dry eyes and dry mouth, but in some cases, can present with eye inflammation and discharge, although this would be less likely given the acute presentation.