Differential Diagnosis
- Single most likely diagnosis
- Herpes Zoster (Shingles): The patient's symptoms of unilateral eye redness, watery eye, and inability to blink properly, followed by facial numbness and tingling on the same side, are consistent with herpes zoster ophthalmicus. The onset of symptoms around 3 pm today suggests an acute presentation.
- Other Likely diagnoses
- Bell's Palsy: The patient's inability to blink properly and facial numbness could be indicative of Bell's palsy, which is an idiopathic facial nerve paralysis. However, the presence of eye redness and watery eye makes this diagnosis less likely.
- Trigeminal Neuralgia: The patient's facial numbness and tingling could be related to trigeminal neuralgia, but the absence of sharp, stabbing pain and the presence of eye symptoms make this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cavernous Sinus Thrombosis: Although rare, cavernous sinus thrombosis is a life-threatening condition that can present with unilateral eye symptoms, facial numbness, and tingling. It is essential to consider this diagnosis due to its high mortality rate if left untreated.
- Stroke or Transient Ischemic Attack (TIA): The patient's symptoms of facial numbness and tingling could be indicative of a stroke or TIA, especially if there is involvement of the trigeminal nerve. Although the patient denies numbness or tingling in the extremities, it is crucial to rule out a stroke or TIA due to their potential for severe consequences.
- Rare diagnoses
- Multiple Sclerosis: The patient's symptoms of facial numbness and tingling could be related to multiple sclerosis, but the absence of other neurological symptoms and the acute onset of symptoms make this diagnosis less likely.
- Sjögren's Syndrome: The patient's symptoms of eye redness and watery eye could be indicative of Sjögren's syndrome, but the presence of facial numbness and tingling and the acute onset of symptoms make this diagnosis less likely.
- Lyme Disease: The patient's symptoms of facial numbness and tingling could be related to Lyme disease, but the absence of other symptoms such as a rash or fever and the acute onset of symptoms make this diagnosis less likely.