Differential Diagnosis for Bilateral Black Eyes without Known Trauma
- Single most likely diagnosis
- Periorbital ecchymosis due to nasal or sinus infection: This is a common cause of bilateral black eyes, especially if the patient has a recent history of upper respiratory infection or sinusitis. The infection can cause blood to leak into the soft tissues around the eyes, resulting in discoloration.
- Other Likely diagnoses
- Allergic reactions: Allergic reactions, such as those caused by insect bites or certain medications, can lead to swelling and discoloration around the eyes.
- Contact dermatitis: Irritation from contact with certain substances, such as makeup or soap, can cause inflammation and discoloration around the eyes.
- Basal skull fracture: Although the patient denies known trauma, it's possible that they may have experienced a minor injury that they don't recall or didn't think was significant.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cavernous sinus thrombosis: This is a rare but potentially life-threatening condition that can cause periorbital edema and ecchymosis. It's often associated with infection or trauma.
- Orbital cellulitis: This is a serious infection of the tissues surrounding the eye that can cause periorbital swelling, redness, and discoloration.
- Leukemia or other hematologic disorders: Certain blood disorders can cause easy bruising or bleeding, which may manifest as bilateral black eyes.
- Rare diagnoses
- Amyloidosis: This is a group of rare diseases that can cause abnormal protein deposits in various tissues, including the skin around the eyes, leading to discoloration.
- Scurvy: This is a rare condition caused by vitamin C deficiency, which can cause bleeding and discoloration around the eyes.
- Neurofibromatosis: This is a genetic disorder that can cause tumors to grow on nerve tissue, including around the eyes, leading to discoloration and other symptoms.