Differentials
Red eye
SIGNS / SYMPTOMS
Specific symptoms/signs of causes of red eye may help in the differential diagnosis.
Viral/bacterial conjunctivitis: watery/mucopurulent/purulent discharge
Allergic conjunctivitis: itch is the hallmark feature
Giant papillary conjunctivitis: associated with trauma to upper tarsal plate (e.g., contact lens wear, exposed suture, foreign body). Large upper tarsal papillae is the main feature.
INVESTIGATIONS
Dry eye should always be considered in the differential diagnosis of red eye.
Conjunctival swabs for adenovirus, herpes simplex virus, herpes zoster virus, bacteria, and chlamydia may aid in the diagnosis of infective conjunctivitis.
Sjögren syndrome
SIGNS / SYMPTOMS
Symptomatic dry eye, mouth, or both.
Patients with DED related to Sjögren syndrome usually have more severe DED compared with patients with non-Sjögren syndrome-related DED.[36]
May be associated with other autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, and extraglandular manifestations affecting thyroid, liver, or kidney, and lymphoma.[36]
Oral symptoms can be determined with positive responses to at least one of the following questions: Have you had a daily feeling of dry mouth for more than 3 months? Have you had recurrently or persistently swollen salivary glands as an adult? Do you frequently drink liquids to aid in swallowing dry food?[3]
INVESTIGATIONS
At least two of the following three criteria must be met:[36]
Positive serum anti-Sjögren syndrome A antigen (anti-Ro) and/or anti-Sjögren syndrome B antigen (anti-La), or positive rheumatoid factor and antinuclear antibody titer ≥1:320
Keratoconjunctivitis sicca with ocular staining score ≥3 (assuming the individual is not using daily glaucoma eye drops, and has not had corneal surgery or cosmetic eyelid surgery over past 5 years)
Labial salivary gland biopsy showing focal lymphocytic sialadenitis, with a focus score ≥1 focus/4 mm².
Meibomian gland dysfunction
SIGNS / SYMPTOMS
Past ocular and/or medical history may indicate meibomian gland dysfunction.
Scalp changes including seborrheic dermatitis and/or flaking/greasy skin may be present.
Patients with rosacea often have meibomian gland dysfunction/blepharitis.
INVESTIGATIONS
Slit-lamp tests reveal unstable tear film with rapid tear breakup time.
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