Differential Diagnosis for Sudden Vision Loss with Dilated Pupil After Trauma to the Eye
- Single Most Likely Diagnosis
- Traumatic optic neuropathy or retinal detachment: This is the most likely diagnosis given the history of trauma to the eye, which can cause direct damage to the optic nerve or retina, leading to vision loss and a dilated pupil due to disruption of the afferent pupillary pathway.
- Other Likely Diagnoses
- Hyphema with increased intraocular pressure (IOP): Trauma can cause bleeding in the anterior chamber (hyphema), which may lead to increased IOP, causing pain, vision loss, and a mid-dilated pupil.
- Lens dislocation or rupture: The force of the ball hitting the eye could dislocate or rupture the lens, potentially causing acute vision loss and changes in pupil reaction due to irritation of the iris or ciliary body.
- Vitreous hemorrhage: Trauma can cause bleeding into the vitreous humor, leading to sudden vision loss, and while the pupil might not always be dilated, it's a plausible consequence of significant intraocular blood.
- Do Not Miss Diagnoses
- Globe rupture: Although less common, a rupture of the eyeball is a medical emergency that requires immediate surgical intervention to preserve vision and the integrity of the eye. Symptoms can include severe vision loss, a teardrop-shaped pupil, and significant pain.
- Retinal artery occlusion: While less directly related to trauma, if the trauma caused an embolus or significant spasm, it could lead to retinal artery occlusion, resulting in sudden, painless vision loss, which is an emergency.
- Rare Diagnoses
- Choroidal rupture: A break in the choroid, a layer between the sclera and retina, can occur from trauma, potentially leading to vision loss and other complications, though it might not directly cause a dilated pupil.
- Traumatic cataract: The force of the injury could cause lens damage leading to cataract formation, which might result in vision loss but is less likely to cause an immediately dilated pupil.
- Optic disc edema or traumatic optic neuritis: Inflammation or swelling of the optic disc due to trauma could lead to vision loss, though a dilated pupil would be less characteristic of these conditions initially.