Allergic conjunctivitis differential diagnosis: Difference between revisions
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{{Allergic conjunctivitis}} | {{Allergic conjunctivitis}} | ||
==Overview== | |||
The [[differential]] [[diagnoses]] of [[allergic]] [[conjunctivitis]] include: | |||
* '''[[Infective]] [[conjunctivitis]]''' : [[Bacterial]] and [[viral]] [[conjunctivitis]] are the most important [[clinical]] entities to differentiate from [[allergic]] [[conjunctivitis]]. They present with classical [[systemic]] [[symptoms]] of infection long with some [[characteristic]] [[ocular]] features | |||
* '''[[Autoimmune]] [[eye]] [[disease]]''': Characterised by [[episcleritis]], [[scleritis]] from a wide range of diseases including [[rheumatoid]] [[arthritis]], [[ankylosing]] [[spondylitis]] etc. | |||
* '''[[Acne]] [[rosacea]]''': Manifests as [[facial]] [[papules]] and [[pustules]] with [[flushing]] and [[photosensitivity]]. | |||
==Differentiation from other [[diseases]]== | |||
{| class="wikitable" | |||
|+ Differential diagnosis of [[allergic]] [[conjunctivitis]] | |||
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! Diseases !! Clinical manifestations !! Para-clinical findings !! Gold standard !! Additional findings | |||
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| [[Bacterial]] [[conjunctivitis]] ||Bilateral [[matting]] of the [[eyelids]] in the morning, [[Mucopurulent]] [[discharge]], [[conjunctival]] [[hyperemia]], no previous history of [[conjunctivitis]]<ref name="pmid15201195">{{cite journal| author=Rietveld RP, ter Riet G, Bindels PJ, Sloos JH, van Weert HC| title=Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. | journal=BMJ | year= 2004 | volume= 329 | issue= 7459 | pages= 206-10 | pmid=15201195 | doi=10.1136/bmj.38128.631319.AE | pmc=487734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15201195 }} </ref> ||Normal [[visual]] [[acuity]]; [[corneal]] involvement may be detected by a [[slit-lamp]] examination<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468 }} </ref>; [[otoscopy]] may detect concurrent [[otitis]] [[media]] in children with [[ear]] [[symptoms]]<ref name="pmid20724317">{{cite journal| author=Pichichero ME| title=Bacterial conjunctivitis in children: antibacterial treatment options in an era of increasing drug resistance. | journal=Clin Pediatr (Phila) | year= 2011 | volume= 50 | issue= 1 | pages= 7-13 | pmid=20724317 | doi=10.1177/0009922810379045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20724317 }} </ref>||[[Conjunctival]] [[cultures]] || [[Itching]] , [[burning]], [[serous]] or no [[discharge]]<ref name="pmid15201195">{{cite journal| author=Rietveld RP, ter Riet G, Bindels PJ, Sloos JH, van Weert HC| title=Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms. | journal=BMJ | year= 2004 | volume= 329 | issue= 7459 | pages= 206-10 | pmid=15201195 | doi=10.1136/bmj.38128.631319.AE | pmc=487734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15201195 }} </ref> | |||
|- | |||
| [[Viral]] [[conjunctivitis]] || Thin, watery [[discharge]] with intensely [[hyperemic]] response<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468 }} </ref>, [[periauricular]] [[lymphadenopathy]]<ref name="pmid18249256">{{cite journal| author=Mahmood AR, Narang AT| title=Diagnosis and management of the acute red eye. | journal=Emerg Med Clin North Am | year= 2008 | volume= 26 | issue= 1 | pages= 35-55, vi | pmid=18249256 | doi=10.1016/j.emc.2007.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18249256 }} </ref> || Significant only in cases of suspected [[chlamydia]] or [[gonorrhoea]], [[immunocompromise]] or excess [[ocular]] [[discharge]]<ref name="pmid19357422">{{cite journal| author=Sethuraman U, Kamat D| title=The red eye: evaluation and management. | journal=Clin Pediatr (Phila) | year= 2009 | volume= 48 | issue= 6 | pages= 588-600 | pmid=19357422 | doi=10.1177/0009922809333094 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19357422 }} </ref> || [[Viral]] [[cell]] [[cultures]], [[PCR]] for [[viral]] [[DNA]] detection<ref name="pmid10845603">{{cite journal| author=Elnifro EM, Cooper RJ, Klapper PE, Yeo AC, Tullo AB| title=Multiplex polymerase chain reaction for diagnosis of viral and chlamydial keratoconjunctivitis. | journal=Invest Ophthalmol Vis Sci | year= 2000 | volume= 41 | issue= 7 | pages= 1818-22 | pmid=10845603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10845603 }} </ref> || [[Fever]], [[malaise]], [[fatigue]], [[symblepharon]]<ref name="pmid20735288">{{cite journal| author=Chintakuntlawar AV, Chodosh J| title=Cellular and tissue architecture of conjunctival membranes in epidemic keratoconjunctivitis. | journal=Ocul Immunol Inflamm | year= 2010 | volume= 18 | issue= 5 | pages= 341-5 | pmid=20735288 | doi=10.3109/09273948.2010.498658 | pmc=2974573 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20735288 }} </ref>, [[conjunctival]] [[follicles]] and [[papillae]]<ref name="pmid31300283">{{cite journal| author=Marinos E, Cabrera-Aguas M, Watson SL| title=Viral conjunctivitis: a retrospective study in an Australian hospital. | journal=Cont Lens Anterior Eye | year= 2019 | volume= 42 | issue= 6 | pages= 679-684 | pmid=31300283 | doi=10.1016/j.clae.2019.07.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31300283 }} </ref> | |||
|- | |||
| [[Autoimmune]] [[eye]] [[disease]] || Dry or red [[eyes]], [[foreign-body]] sensation, [[pruritus]], [[photophobia]]<ref name="pmid12358224">{{cite journal| author=Patel SJ, Lundy DC| title=Ocular manifestations of autoimmune disease. | journal=Am Fam Physician | year= 2002 | volume= 66 | issue= 6 | pages= 991-8 | pmid=12358224 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12358224 }} </ref> || Abnormal [[Schirmer's]] test, deranged [[visual]] [[acuity]], [[proptosis]], [[exposure keratitis]]<ref name="pmid12358224">{{cite journal| author=Patel SJ, Lundy DC| title=Ocular manifestations of autoimmune disease. | journal=Am Fam Physician | year= 2002 | volume= 66 | issue= 6 | pages= 991-8 | pmid=12358224 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12358224 }} </ref> || [[Autoimmune]] panel of [[blood]] || [[Pain]], [[visual]] changes, complete loss of [[vision]]<ref name="pmid12358224">{{cite journal| author=Patel SJ, Lundy DC| title=Ocular manifestations of autoimmune disease. | journal=Am Fam Physician | year= 2002 | volume= 66 | issue= 6 | pages= 991-8 | pmid=12358224 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12358224 }} </ref> | |||
|- | |||
| [[Acne]] [[rosacea]]<ref name="pmid12658088">{{cite journal| author=Ghanem VC, Mehra N, Wong S, Mannis MJ| title=The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics. | journal=Cornea | year= 2003 | volume= 22 | issue= 3 | pages= 230-3 | pmid=12658088 | doi=10.1097/00003226-200304000-00009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12658088 }} </ref> <ref name="pmid34727263">{{cite journal| author=Ozturk T, Kayabasi M, Ozbagcivan O, Ayhan Z, Utine CA| title=Common ocular findings in patients with acne rosacea. | journal=Int Ophthalmol | year= 2022 | volume= 42 | issue= 4 | pages= 1077-1084 | pmid=34727263 | doi=10.1007/s10792-021-02093-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34727263 }} </ref> ||Minor irritation, gritty sensation, dryness, blurry vision, [[blepharitis]] and [[conjunctivitis]] ||Magnifying glass or a [[microscopic]] slide for [[blanching]] [[skin]], [[dermatoscopy]] for [[skin]] [[telangiectasia]]<ref name="pmid30240779">{{cite journal| author=Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC| title=Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. | journal=J Am Acad Dermatol | year= 2019 | volume= 80 | issue= 6 | pages= 1722-1729.e7 | pmid=30240779 | doi=10.1016/j.jaad.2018.08.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30240779 }} </ref> || [[Skin]] [[biopsy]]<ref name="pmid30240779">{{cite journal| author=Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC| title=Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. | journal=J Am Acad Dermatol | year= 2019 | volume= 80 | issue= 6 | pages= 1722-1729.e7 | pmid=30240779 | doi=10.1016/j.jaad.2018.08.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30240779 }} </ref> ||[[Lid]] margin and [[conjunctival]] [[telangiectasias]], [[eyelid]] thickening, [[eyelid]] crusts and scales, [[chalazion]], [[hordeolum]], punctate [[epithelial]] erosions, [[corneal]] infiltrates, [[corneal]] [[ulcers]], [[corneal]] scars, and [[vascularization]] | |||
|-} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 19:00, 8 September 2022
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Overview
The differential diagnoses of allergic conjunctivitis include:
- Infective conjunctivitis : Bacterial and viral conjunctivitis are the most important clinical entities to differentiate from allergic conjunctivitis. They present with classical systemic symptoms of infection long with some characteristic ocular features
- Autoimmune eye disease: Characterised by episcleritis, scleritis from a wide range of diseases including rheumatoid arthritis, ankylosing spondylitis etc.
- Acne rosacea: Manifests as facial papules and pustules with flushing and photosensitivity.
Differentiation from other diseases
References
- ↑ 1.0 1.1 Rietveld RP, ter Riet G, Bindels PJ, Sloos JH, van Weert HC (2004). "Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms". BMJ. 329 (7459): 206–10. doi:10.1136/bmj.38128.631319.AE. PMC 487734. PMID 15201195.
- ↑ 2.0 2.1 Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
- ↑ Pichichero ME (2011). "Bacterial conjunctivitis in children: antibacterial treatment options in an era of increasing drug resistance". Clin Pediatr (Phila). 50 (1): 7–13. doi:10.1177/0009922810379045. PMID 20724317.
- ↑ Mahmood AR, Narang AT (2008). "Diagnosis and management of the acute red eye". Emerg Med Clin North Am. 26 (1): 35–55, vi. doi:10.1016/j.emc.2007.10.002. PMID 18249256.
- ↑ Sethuraman U, Kamat D (2009). "The red eye: evaluation and management". Clin Pediatr (Phila). 48 (6): 588–600. doi:10.1177/0009922809333094. PMID 19357422.
- ↑ Elnifro EM, Cooper RJ, Klapper PE, Yeo AC, Tullo AB (2000). "Multiplex polymerase chain reaction for diagnosis of viral and chlamydial keratoconjunctivitis". Invest Ophthalmol Vis Sci. 41 (7): 1818–22. PMID 10845603.
- ↑ Chintakuntlawar AV, Chodosh J (2010). "Cellular and tissue architecture of conjunctival membranes in epidemic keratoconjunctivitis". Ocul Immunol Inflamm. 18 (5): 341–5. doi:10.3109/09273948.2010.498658. PMC 2974573. PMID 20735288.
- ↑ Marinos E, Cabrera-Aguas M, Watson SL (2019). "Viral conjunctivitis: a retrospective study in an Australian hospital". Cont Lens Anterior Eye. 42 (6): 679–684. doi:10.1016/j.clae.2019.07.001. PMID 31300283.
- ↑ 9.0 9.1 9.2 Patel SJ, Lundy DC (2002). "Ocular manifestations of autoimmune disease". Am Fam Physician. 66 (6): 991–8. PMID 12358224.
- ↑ Ghanem VC, Mehra N, Wong S, Mannis MJ (2003). "The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics". Cornea. 22 (3): 230–3. doi:10.1097/00003226-200304000-00009. PMID 12658088.
- ↑ Ozturk T, Kayabasi M, Ozbagcivan O, Ayhan Z, Utine CA (2022). "Common ocular findings in patients with acne rosacea". Int Ophthalmol. 42 (4): 1077–1084. doi:10.1007/s10792-021-02093-5. PMID 34727263 Check
|pmid=value (help). - ↑ 12.0 12.1 Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC (2019). "Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience". J Am Acad Dermatol. 80 (6): 1722–1729.e7. doi:10.1016/j.jaad.2018.08.049. PMID 30240779.