Differential Diagnosis for 44M with UC on Immunotherapy
Single most likely diagnosis
- Allergic conjunctivitis: This is the most likely diagnosis given the symptoms of bilateral red eyes, itching, and mild photophobia, especially with a concurrent viral upper respiratory tract infection (URTI) which can exacerbate allergic reactions.
Other Likely diagnoses
- Viral conjunctivitis: Given the concurrent viral URTI, viral conjunctivitis is a plausible diagnosis. It often presents with redness, itching, and discharge.
- Dry eye syndrome: Patients on immunotherapy may experience dry eye syndrome due to the medication's side effects, which could contribute to the symptoms of red eyes and mild photophobia.
- Blepharitis: This condition, characterized by inflammation of the eyelids, can cause redness, itching, and photophobia, and is common in adults.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Uveitis: Although less common, uveitis is a serious condition that can be associated with ulcerative colitis (UC) and immunotherapy. It requires prompt treatment to prevent vision loss.
- Scleritis: This is a severe inflammatory disease that can cause redness, pain, and photophobia. It is less common but can lead to serious complications if not treated promptly.
- Endophthalmitis: A rare but potentially devastating infection within the eye that can occur in patients on immunotherapy, presenting with severe eye pain, redness, and vision loss.
Rare diagnoses
- Ocular cicatricial pemphigoid: A rare autoimmune condition that can cause chronic conjunctivitis and scarring.
- Sjögren's syndrome: An autoimmune disorder that can cause dry eyes and other systemic symptoms, though it's less directly related to the acute presentation described.
- Atopic keratoconjunctivitis: A condition associated with atopic diseases, presenting with severe itching, redness, and potential for corneal complications.