Differential Diagnosis for Pressure Behind the Eye, Temple, and Forehead
Single Most Likely Diagnosis
- Chronic Sinusitis: This condition is characterized by inflammation of the sinuses that persists over time, often causing pressure and pain in the face, including behind the eyes, temples, and forehead. The lack of response to antibiotics such as amoxicillin and amoxicillin-clavulanic acid suggests a possible chronic condition that may require further evaluation and treatment, including consideration of fungal sinusitis or sinusitis due to resistant bacteria.
Other Likely Diagnoses
- Acute Sinusitis with Complications or Resistance: Although the patient has been treated with antibiotics, the possibility of resistant bacterial infection or complications such as orbital cellulitis or abscess cannot be ruled out without further imaging and evaluation.
- Tension-Type Headache or Migraine: These conditions can cause unilateral pain and pressure, including in the areas described, and may be accompanied by other symptoms such as photophobia or phonophobia. The presence of mucus might be coincidental or related to a concurrent condition.
- Dental Issues: Dental problems, such as an abscess or impacted tooth, can refer pain to the face, including the areas behind the eye, temple, and forehead.
Do Not Miss Diagnoses
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause facial pain, including behind the eyes, and is often associated with sinusitis or facial infections. It requires immediate medical attention.
- Orbital Cellulitis or Abscess: Infections in the tissue surrounding the eye can cause severe pain, swelling, and vision changes. These conditions are medical emergencies.
- Temporal Arteritis (Giant Cell Arteritis): Although more common in older adults, this condition can cause unilateral headache and facial pain, and if left untreated, can lead to blindness.
Rare Diagnoses
- Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, which can cause intense pain in parts of the face, including the areas described.
- Sphenoid Sinusitis: Infection of the sphenoid sinus, which is located near the base of the skull, can cause deep facial or retro-orbital pain and is often resistant to standard antibiotic treatments.
- Fungal Ball or Invasive Fungal Sinusitis: More common in immunocompromised patients, these conditions can cause chronic sinusitis symptoms that do not respond to conventional antibiotic therapy.