Allergic conjunctivitis differential diagnosis

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.

Differential diagnosis of allergic conjunctivitis
Diseases	Clinical manifestations	Para-clinical findings	Gold standard	Additional findings
Bacterial conjunctivitis	Bilateral matting of the eyelids in the morning, Mucopurulent discharge, conjunctival hyperemia, no previous history of conjunctivitis^[1]	Normal visual acuity; corneal involvement may be detected by a slit-lamp examination^[2]; otoscopy may detect concurrent otitis media in children with ear symptoms^[3]	Conjunctival cultures	Itching , burning, serous or no discharge^[1]
Viral conjunctivitis	Thin, watery discharge with intensely hyperemic response^[2], periauricular lymphadenopathy^[4]	Significant only in cases of suspected chlamydia or gonorrhoea, immunocompromise or excess ocular discharge^[5]	Viral cell cultures, PCR for viral DNA detection^[6]	Fever, malaise, fatigue, symblepharon^[7], conjunctival follicles and papillae^[8]
Autoimmune eye disease	Dry or red eyes, foreign-body sensation, pruritus, photophobia^[9]	Abnormal Schirmer’s test, deranged visual acuity, proptosis, exposure keratitis^[9]	Autoimmune panel of blood	Pain, visual changes, complete loss of vision^[9]
Acne rosacea^[10] ^[11]	Minor irritation, gritty sensation, dryness, blurry vision, blepharitis and conjunctivitis	Magnifying glass or a microscopic slide for blanching skin, dermatoscopy for skin telangiectasia^[12]	Skin biopsy^[12]	Lid margin and conjunctival telangiectasias, eyelid thickening, eyelid crusts and scales, chalazion, hordeolum, punctate epithelial erosions, corneal infiltrates, corneal ulcers, corneal scars, and vascularization

[pmid15201195-1] 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.

[pmid24150468-2] 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.

[pmid20724317-3] 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.

[pmid18249256-4] 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.

[pmid19357422-5] Sethuraman U, Kamat D (2009). “The red eye: evaluation and management”. Clin Pediatr (Phila). 48 (6): 588–600. doi:10.1177/0009922809333094. PMID 19357422.

[pmid10845603-6] 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.

[pmid20735288-7] 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.

[pmid31300283-8] 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.

[pmid12358224-9] 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.

[pmid12658088-10] 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.

[pmid34727263-11] 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).

[pmid30240779-12] 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.

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