Differential Diagnosis for a 44-year-old Female with Red Eye, Pain, and Forehead Pain
Single Most Likely Diagnosis
- Acute Conjunctivitis: This is a common condition that can cause redness and pain in the eye, often accompanied by discharge. The presence of forehead pain could be related to referred pain or associated conditions like sinusitis. The intact visual acuity and lack of proptosis make this a plausible initial diagnosis.
Other Likely Diagnoses
- Dry Eye Syndrome: This condition can cause eye pain and redness, especially if the patient has a history of dry eye or uses contact lenses. Forehead pain could be related to tension headaches often associated with dry eye.
- Blepharitis: Inflammation of the eyelids can cause redness, pain, and discomfort in the eyes, along with forehead pain due to the involvement of the eyelids and surrounding tissues.
- Sinusitis: Given the forehead pain, sinusitis could be a contributing factor, especially if the patient has symptoms like nasal congestion or facial pain. Sinusitis can cause referred pain to the eyes.
Do Not Miss Diagnoses
- Acute Angle-Closure Glaucoma: Although the patient's visual acuity is intact, and there's no proptosis, acute angle-closure glaucoma is an emergency that can present with severe eye pain, redness, and sometimes forehead pain due to the severe headache it can cause. Missing this diagnosis could lead to permanent vision loss.
- Orbital Cellulitis: While the lack of proptosis makes this less likely, orbital cellulitis is a serious infection that requires prompt treatment. It can cause pain, redness, and decreased vision, though the latter is not present in this case.
- Giant Cell Arteritis: This condition can cause headache, jaw claudication, and visual disturbances, including pain and redness in the eyes. It's a medical emergency due to the risk of permanent vision loss if not treated promptly.
Rare Diagnoses
- Scleritis: A severe inflammatory disease that affects the sclera, causing intense pain, redness, and tenderness to the touch. It's less common than other conditions like conjunctivitis or blepharitis but should be considered in the differential due to its severity.
- Keratitis: Inflammation of the cornea can cause pain, redness, and sensitivity to light. While it's a possible diagnosis, it's less likely given the lack of specific symptoms like photophobia or a history of contact lens use.
- Temporal Arteritis: Similar to giant cell arteritis but typically affecting smaller branches of the external carotid artery, it can cause forehead pain and, less commonly, eye symptoms.