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Eye irritation in an adult

Louise Rowe comes to the pharmacy complaining of irritation in both her eyes for the last three to four months. Her predominant symptoms are intermittent itching and watery eyes. She has tried OTC chloramphenicol but the symptoms returned. On initial inspection both eyes appeared to be generally healthy but her eyelid margins were inflamed and sore.

Problem representation

A 37-year-old female with a four-month history of bilateral eye soreness involving the lid margins.

Hypothesis generation 

Louise appears to have some form of eyelid disorder that is apparently chronic in nature. Common causes of eyelid dysfunction can include blepharitis, hordeola (styes), dermatitis and chalazion. In this case hordeola and chalazion seem unlikely: the duration of symptoms would rule out hordeola and their bilateral nature tends to eliminate chalazion.

Likely diagnosis 

  • Blepharitis
  • Dermatitis.

Possible diagnosis  

  • Blocked tear duct/inflammation of the lacrimal sac
  • Chalazion
  • Ectropion or entropion
  • Hordeola
  • Hydrocystoma
  • Molluscum contagiosum
  • Seborrhoeic keratosis
  • Xanthelasma.

Continued information gathering 

In order to differentiate between blepharitis and dermatitis, it is necessary to get a fuller history of Louise’s symptoms and inspect both the anterior and posterior lid margins. 

She has complained of intermittent itching and watery eyes, and initial visual inspection reveals inflamed eye lid margins. These symptoms are consistent with blepharitis. Examination usually also reveals eye lash loss or misdirection accompanied with debris within the lashes. Varying degrees of conjunctival redness may also be present. 

You inspect Louise’s eyes and note some lash loss in both eyes, no conjunctival redness of note and normal findings for visual acuity and pupil responses. There also appears to be no obvious redness of the eyelids or surrounding skin. These findings are consistent with a differential diagnosis of blepharitis.

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