Differential Diagnosis for a 2-Week-Old Male with Eye Discharge
Single Most Likely Diagnosis
- Nasolacrimal Duct Obstruction (NLDO): This condition is common in newborns due to the incomplete canalization of the nasolacrimal duct. The presentation of eye discharge that is easily cleaned and the absence of other significant symptoms support this diagnosis. The fluorescein dye test showing equal distribution on the cornea and conjunctiva but not specifically mentioning drainage into the nose suggests a possible obstruction.
Other Likely Diagnoses
- Conjunctivitis: Although the conjunctivae are clear bilaterally, mild conjunctivitis could still be present, especially given the increased tears on the left. However, the lack of other symptoms such as redness or purulent discharge makes this less likely.
- Allergic Rhinitis: The mild nasal congestion could suggest an allergic component, but in a 2-week-old, this would be unusual and not typically associated with eye discharge as a primary symptom.
Do Not Miss Diagnoses
- Gonococcal Ophthalmia Neonatorum: This is a serious condition that can lead to blindness if not treated promptly. It's less likely given the clinical presentation and the fact that the discharge is easily cleaned, but it must be considered, especially if there's any suspicion of maternal gonococcal infection.
- Chlamydial Conjunctivitis: Similar to gonococcal ophthalmia, chlamydial conjunctivitis is a significant condition that requires prompt treatment to prevent long-term consequences. The presentation can be similar to NLDO, but it's crucial to consider this diagnosis due to its potential impact.
Rare Diagnoses
- Dacryocystitis: This is an infection of the lacrimal sac and is less common in newborns. It could present with eye discharge, but typically, there would be more significant signs of infection or a palpable lacrimal sac mass.
- Congenital Glaucoma: Although this condition can cause tearing and eye discharge, it is typically associated with other signs such as photophobia, blepharospasm, and corneal clouding, which are not mentioned in the case.