Differential Diagnosis for the Patient's Condition

The patient presents with a history of trauma to the right side of the face from a spiked volleyball, followed by complaints of pain in the right eye one week later. Key findings include normal visual acuity, normal ocular movements, a smaller right pupil, circumcorneal hyperemia, photophobia, and a limited fundoscopic exam. Based on these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Traumatic Iritis or Uveitis: This condition is likely given the history of trauma, photophobia, and circumcorneal hyperemia. The smaller pupil on the affected side also supports this diagnosis, as it can be a sign of irritation of the uveal tract.

• Other Likely Diagnoses

  • Hyphema: Although the patient does not have a reported decrease in visual acuity that would typically accompany a significant hyphema, a small amount of blood in the anterior chamber could cause pain and photophobia without severely affecting vision.
  • Corneal Abrasion or Ulcer: The history of trauma and symptoms of pain and photophobia could also suggest a corneal injury. However, the presence of circumcorneal hyperemia and a smaller pupil might lean more towards uveal involvement.
  • Traumatic Glaucoma: This could be a consideration, especially if the trauma caused an increase in intraocular pressure. However, the absence of specific symptoms like severe eye pain, nausea, vomiting, or decreased vision makes this less likely.

• Do Not Miss Diagnoses

  • Retinal Detachment: Although rare, retinal detachment is a vision-threatening condition that can occur after trauma. It is crucial to rule out this condition with a thorough fundoscopic examination, despite the current limitations.
  • Globe Rupture: This is a severe and sight-threatening condition that requires immediate surgical intervention. The presence of severe pain, decreased vision, and a soft eye could suggest this diagnosis, but the patient's relatively preserved vision and absence of other specific signs make it less likely.
  • Endophthalmitis: This is an intraocular infection that can occur after trauma, especially if the globe was penetrated. It is a medical emergency and must be considered, even if the patient does not have the typical symptoms of decreased vision, severe pain, and significant redness.

• Rare Diagnoses

  • Sympathetic Ophthalmia: This is a rare, bilateral granulomatous uveitis that can occur after penetrating eye injury. It is a concern in cases of significant trauma but is relatively rare and would be considered if the patient develops uveitis in the uninjured eye.
  • Traumatic Cataract: This could be a late complication of the injury but would not explain the patient's current symptoms of pain and photophobia without other signs like decreased vision.