Differential Diagnosis for a 12-year-old Boy with Itchy, Red Eyes
- Single most likely diagnosis:
- Allergic conjunctivitis: This is the most likely diagnosis given the patient's history of eczema, itchy eyes, and the presence of mild, clear eye drainage without pain or photophobia. The symptoms worsen with eye rubbing, which is common in allergic conjunctivitis.
- Other Likely diagnoses:
- Viral conjunctivitis: The patient's sister has symptoms of a viral upper respiratory infection, which could suggest a viral etiology for the patient's conjunctivitis. However, the lack of pain, photophobia, and the presence of itching make this less likely.
- Blepharitis: This condition can cause itchy, red eyes and is often associated with eczema. However, it typically presents with more eyelid margin inflammation and crusting.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Gonococcal conjunctivitis: Although unlikely in this age group and clinical presentation, gonococcal conjunctivitis can cause severe, vision-threatening infection and must be considered, especially if there's any suspicion of sexual abuse.
- Herpes simplex keratitis: This condition can present with redness, itching, and blurred vision. It's essential to consider this diagnosis, as it can lead to serious complications, including vision loss, if not treated promptly.
- Rare diagnoses:
- Vernal keratoconjunctivitis: This is a rare, severe form of allergic conjunctivitis that can cause significant discomfort, photophobia, and vision problems. It's more common in boys and young men, especially those with a history of eczema.
- Phlyctenular keratoconjunctivitis: This condition is an allergic reaction to staphylococcal antigens and can cause redness, itching, and vision problems. It's often associated with eczema and blepharitis.