Differential Diagnosis for Transient Right Eye Visual Loss
Single Most Likely Diagnosis
- Amaurosis Fugax: This condition is characterized by transient, sudden loss of vision in one eye, often described as a curtain or shade descending over the eye. The patient's history of uncontrolled hypertension, hyperlipidemia, and smoking increases the risk of atherosclerotic disease, which can lead to emboli causing amaurosis fugax. The presence of a grade 2/6 systolic ejection murmur at the right upper sternal border may also suggest atherosclerotic heart disease.
Other Likely Diagnoses
- Retinal Vein Occlusion: Given the patient's history of hypertension and hyperlipidemia, retinal vein occlusion is a possible cause of transient visual loss. However, it typically presents with more persistent visual disturbances.
- Migraine: Migraines can cause transient visual symptoms, including loss of vision in one eye. The patient's history of smoking and hypertension may also contribute to migraine risk.
- Giant Cell Arteritis: Although less common, giant cell arteritis can cause transient visual loss, especially in older adults. The presence of a systolic ejection murmur may not be directly related, but the condition's association with polymyalgia rheumatica and systemic inflammation could be relevant.
Do Not Miss Diagnoses
- Carotid Artery Dissection: This is a potentially life-threatening condition that can cause transient visual loss due to emboli or decreased blood flow to the eye. The patient's history of hypertension and smoking increases the risk of carotid artery disease.
- Cardiac Source Embolism: The presence of a systolic ejection murmur and the patient's cardiovascular risk factors increase the risk of cardiac source embolism, which can cause transient visual loss.
- Temporal Arteritis with Posterior Ciliary Artery Occlusion: This condition can cause sudden, severe visual loss and is a medical emergency. Although less common, it is crucial not to miss this diagnosis due to its potential for irreversible vision loss.
Rare Diagnoses
- Susac Syndrome: A rare condition characterized by microangiopathic disease affecting the brain, retina, and inner ear, leading to transient visual loss among other symptoms.
- Vasculitis (e.g., Wegener's Granulomatosis): Systemic vasculitis can cause a wide range of symptoms, including transient visual loss, but is much less common than other diagnoses listed here.
- Moyamoya Disease: A rare condition caused by narrowing or blockage of the internal carotid artery and its branches, leading to various neurological symptoms, including transient visual loss.