Differential Diagnosis for Eye Injury
The patient presents with a poke in the eye from a branch while gardening, resulting in slight blurred vision and pain. Here's a differential diagnosis organized into categories:
- Single most likely diagnosis
- Corneal abrasion: This is the most likely diagnosis given the mechanism of injury (a poke in the eye with a branch) and the symptoms of blurred vision and pain. A corneal abrasion is a superficial wound to the surface of the cornea and is a common injury in such scenarios.
- Other Likely diagnoses
- Subconjunctival hemorrhage: This could occur if the branch caused a small blood vessel in the conjunctiva to rupture, leading to bleeding underneath the conjunctiva. It might not directly cause blurred vision but could contribute to discomfort and a red appearance of the eye.
- Conjunctivitis (from a foreign body or allergen): If the branch introduced debris or an allergen into the eye, the patient could develop conjunctivitis, which might cause blurred vision, pain, and redness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Open globe injury: Although less likely with a branch poke, an open globe injury (where the integrity of the eyeball is compromised) is a medical emergency. Symptoms can include severe pain, vision loss, and a teardrop-shaped pupil. Missing this diagnosis could result in severe vision loss or the loss of the eye.
- Retinal detachment: Trauma to the eye can cause retinal detachment, where the retina separates from the back of the eye. This is a medical emergency requiring immediate attention to preserve vision. Symptoms can include sudden onset of floaters, flashes of light, and a curtain or shadow descending over the field of vision.
- Rare diagnoses
- Endophthalmitis: This is a rare but serious infection within the eye that can occur after a penetrating eye injury. Symptoms include severe eye pain, redness, decreased vision, and swelling of the eyelids. It's rare but critical to diagnose and treat promptly to prevent vision loss.
- Optic neuritis: This is an inflammation of the optic nerve and can be caused by trauma. It might present with pain on eye movement and decreased vision. While not directly related to the poke, it could be considered in the differential if other symptoms are present.