Differential Diagnosis
The patient's symptoms of a bulging right eye, swollen and erythematous right upper eyelid, chemosis, limited eye movement due to pain, and decreased visual acuity in the right eye suggest an orbital or periorbital infection or inflammation. Here is the differential diagnosis, categorized for clarity:
Single most likely diagnosis
- E. Orbital cellulitis: This condition is characterized by infection and inflammation of the orbital tissues, which can cause pain, especially with eye movement, bulging of the eye (proptosis), eyelid swelling, and chemosis. The patient's recent history of a severe cold and the presence of these symptoms make orbital cellulitis a highly plausible diagnosis.
Other Likely diagnoses
- A. Acute frontal sinusitis: Given the patient's recent cold symptoms, acute frontal sinusitis could be a contributing factor, especially if the infection has spread to the orbit. However, the absence of headache, nausea, or vomiting makes this less likely as the primary diagnosis.
- C. Cavernous sinus thrombosis: Although less common, this condition can occur as a complication of facial or sinus infections, leading to symptoms such as eye pain, proptosis, and limited eye movement. However, it typically presents with more severe and bilateral symptoms, including cranial nerve deficits.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C. Cavernous sinus thrombosis: Despite being less likely, cavernous sinus thrombosis is a medical emergency that requires prompt diagnosis and treatment to prevent serious complications, including death.
- OD. Endophthalmitis: This is an intraocular infection that can lead to severe vision loss if not promptly treated. While the patient's symptoms do not strongly suggest endophthalmitis, any sign of intraocular infection should be taken seriously.
Rare diagnoses
- F. Sphenobasilar synchondrosis compression: This condition involves the compression of the sphenobasilar synchondrosis, which is a cartilaginous joint in the skull base. It is a rare condition and would not typically present with the symptoms described.
- B. Angle-closure glaucoma: This condition involves a sudden increase in intraocular pressure due to blockage of the drainage canals in the eye. While it can cause eye pain and vision loss, it typically presents with more acute symptoms, including severe headache, nausea, vomiting, and a mid-dilated pupil, which are not described in this case.