Differential Diagnosis for Red Eye with Pain and Photophobia but No Vision Change
Single Most Likely Diagnosis
- Acute Anterior Uveitis: This condition is characterized by inflammation of the uvea, leading to symptoms such as eye pain, redness, and photophobia. The absence of vision change does not rule out this diagnosis, as vision can be preserved, especially in the early stages.
Other Likely Diagnoses
- Acute Angle-Closure Glaucoma (without significant vision loss): Although classically associated with severe vision loss, early or mild cases might present with pain, redness, and photophobia without noticeable vision change.
- Corneal Ulcer: An infection of the cornea can cause significant pain, redness, and photophobia. Vision might not be immediately affected, especially if the ulcer is small or peripheral.
- Conjunctivitis (Viral or Bacterial): While typically less painful than uveitis or glaucoma, severe cases of conjunctivitis can cause significant discomfort and photophobia, with vision usually preserved.
Do Not Miss Diagnoses
- Endophthalmitis: A severe, sight-threatening infection within the eye that requires prompt treatment. Early stages might not affect vision significantly but are characterized by severe pain and redness.
- Acute Retinal Detachment: Although often associated with vision changes, a small or peripheral detachment might not immediately affect vision. However, it is a medical emergency.
- Scleritis: Inflammation of the sclera can cause severe pain (often described as deep), redness, and photophobia. It is less common than other conditions but critical to diagnose due to potential complications.
Rare Diagnoses
- Sympathetic Ophthalmia: A rare, bilateral granulomatous uveitis that can occur after penetrating eye injury or surgery. It is crucial to consider in patients with a history of eye trauma or surgery.
- Posterior Scleritis: Similar to scleritis but involves the posterior part of the sclera. It can cause pain, redness, and vision changes, though the latter might be subtle or absent in early stages.
- Intraocular Tumors (e.g., Melanoma): While typically associated with more chronic symptoms, in rare cases, an intraocular tumor can cause acute symptoms like pain and redness, especially if there is associated inflammation or hemorrhage.