Key distinguishing features of the most common diagnoses
|Allergic Conjunctivitis||Infective Conjunctivitis||Dry Eyes||Blepharitis||Blocked Tear Duct|
Possible:Swab, Schirmer’s test.
Small Print:TFT, thyroid autoantibodies, MRI orbits, biopsy.
- Swab: May be necessary in persistent discharge; essential in neonates who’ve had sticky eyes since birth.
- Schirmer’s test: To assess for dry eye – may be performed by the optician.
- TFT, thyroid autoantibodies, MRI orbits – may be required in suspected thyroid eye disease.
- Biopsy: Rarely, if sebaceous gland carcinoma suspected.
- Diagnosis can be difficult and an optician’s input may be invaluable.
- Enquire about the use of OTC drops and their effect: This may give clues to the underlying problem. Sometimes, the drops themselves may be the cause.
- It can be easy to overlook entropion – ask the patient to squeeze the eyes shut, then suddenly open them, in which case a subtle entropion should be revealed.
- Bear in mind that patients with dry eyes sometimes paradoxically complain of a stringy discharge.
- Remember that thyroid eye disease can present before biochemical dysfunction – if in doubt, refer.
- Do not overlook a foreign body as a possible cause, especially if the history is vague and the symptoms unilateral.
- Chlamydia and gonorrhoea must be excluded in the neonate with a sticky eye or eyes from birth.
- The rare sebaceous gland carcinoma causes blepharitis-type symptoms, but with localised inflammation and localised loss of lashes.