Differential Diagnosis for Bilateral Eye Pain in a 12-year-old Boy
- Single most likely diagnosis:
- Ultraviolet (UV) keratitis: This condition is highly likely given the patient's recent prolonged exposure to snow, which can reflect UV radiation and cause corneal damage. The symptoms of bilateral eye pain, erythematous conjunctivae, increased tearing, and diffuse punctate corneal staining are consistent with UV keratitis.
- Other Likely diagnoses:
- Dry eye syndrome: Prolonged exposure to cold, windy environments, such as those encountered during skiing, can exacerbate dry eye symptoms, including eye pain, erythema, and increased tearing.
- Conjunctivitis: Viral or allergic conjunctivitis could present with similar symptoms, including erythema, increased tearing, and discomfort, although the lack of discharge or tenderness to palpation makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Acute angle-closure glaucoma: Although the anterior chamber appears normal, and there's no mention of elevated intraocular pressure, this condition is an emergency that can cause severe eye pain, blurred vision, and erythema. Missing this diagnosis could lead to permanent vision loss.
- Corneal abrasion or ulcer: These conditions can present with pain, erythema, and tearing. A corneal ulcer, in particular, is a serious infection that requires prompt treatment to prevent vision loss.
- Rare diagnoses:
- Snow blindness (photokeratitis) due to other causes: While UV keratitis is the most common form of snow blindness, other forms of photokeratitis (e.g., due to welder's flash) could theoretically occur, although the context provided strongly suggests UV exposure as the cause.
- Ocular foreign body: A small foreign body in the eye could cause pain, erythema, and tearing, but the lack of tenderness to palpation and the bilateral nature of the symptoms make this less likely.