Differential diagnoses: Eye problems

Dr Nigel Stollery compares the presenting features of four eye conditions.

Conjunctival cyst


  • Also known as a retention cyst
  • Thin-walled, fluid-filled sac within the conjunctiva
  • Often asymptomatic, but may cause discomfort and increase tearing
  • May be idiopathic or occur because of inflammation, allergic reactions or trauma


  • Treatment is not always required
  • Cyst will often resolve if left untreated
  • If symptomatic, topical lubricants can be helpful
  • Where required, surgical excision can be undertaken

Arcus senilis


  • White, beige or blue ring at the corneal margin
  • Commonly seen with advancing age
  • May be associated with hypercholesterolaemia and lipid deposition in the affected area
  • Usually bilateral
  • If unilateral, may be associated with carotid artery disease


  • Treatment not required
  • Elevated cholesterol should be managed in the usual way
  • Reduction in cholesterol will not change appearance of the arcus



  • Benign growth of the conjunctiva
  • Associated with UV light exposure, low humidity and dust
  • Most commonly occurs on the nasal side of the sclera
  • Symptoms include soreness, tearing, itching
  • In advanced cases, vision may be affected


  • Symptoms can be helped by artificial tears
  • Treatment not usually required until it reaches the pupil and affects vision
  • Treatments include irradiation, conjunctival autografting and amniotic membrane transplantation

Subconjunctival haemorrhage


  • Common cause of a red eye
  • Occurs after a small bleed behind the conjunctiva
  • Looks alarming, but is usually asymptomatic and harmless
  • Most have no cause, but may develop after straining or coughing
  • May be worse in patients with hypertension on anticoagulants
  • May recur


  • Treatment not required
  • If bruising elsewhere, clotting studies should be performed
  • If hypertension suspected, BP should be checked

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

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