Differential Diagnosis for the Patient's Vision Changes
The patient's symptoms of blurry vision, glare, and worsening condition in one eye suggest several possible diagnoses. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Cataract: The patient's age, symptoms of blurry vision, and glare, especially at night, are classic for cataracts. The significant smoking history also increases the risk of cataract development. The fact that the symptoms are worse in one eye is consistent with cataracts, which can develop asymmetrically.
Other Likely Diagnoses
- Age-related Macular Degeneration (AMD): Given the patient's age and smoking history, AMD is a possible cause of her vision changes. However, the presence of glare and the asymmetric nature of her symptoms make cataracts more likely.
- Diabetic Retinopathy: Although the patient's medical history does not mention diabetes, it's possible she has undiagnosed diabetes. Diabetic retinopathy can cause blurry vision and should be considered, especially if there are other signs of diabetes.
- Hypertensive Retinopathy: The patient's history of essential hypertension could contribute to hypertensive retinopathy, which might cause vision changes. However, this condition typically causes more systemic symptoms and findings.
Do Not Miss Diagnoses
- Retinal Detachment: This is a medical emergency that can cause sudden vision changes, including increased floaters and flashes of light. Although the patient's symptoms have developed over time, retinal detachment can sometimes present more subtly and should always be considered in cases of vision loss.
- Giant Cell Arteritis: This condition can cause vision loss, especially in older adults, and is a medical emergency. Although the patient is relatively young for giant cell arteritis, it should be considered, especially if there are systemic symptoms like headache or jaw claudication.
- Brain Tumor: A brain tumor affecting the visual pathway could cause vision changes. This would be less likely given the patient's symptoms but should be considered to avoid missing a potentially life-threatening condition.
Rare Diagnoses
- Optic Neuritis: This condition can cause vision loss and is often associated with multiple sclerosis. It's less likely given the patient's age and the nature of her symptoms but could be considered if other diagnoses are ruled out.
- Chalazion or Other Ocular Tumors: Although rare, ocular tumors could cause vision changes. These would be less likely and might be associated with other symptoms like a visible mass or more significant discomfort.