Differential Diagnosis
- Single most likely diagnosis
- G) Right optic nerve: The patient's symptoms of sudden onset of vision loss in one eye, accompanied by pain on movement of the eye, and a poorly reactive pupil to direct light, are highly suggestive of optic neuritis, which typically affects the optic nerve. The normal optic fundi and absence of other eye abnormalities further support this diagnosis.
- Other Likely diagnoses
- F) Retina: Conditions such as retinal detachment or central retinal artery occlusion could cause sudden vision loss. However, these conditions would likely have other findings on examination, such as abnormalities in the optic fundi.
- H) Right optic radiation: While less likely, a lesion in the optic radiation could cause visual field defects, but it would not typically cause pain on eye movement or a poorly reactive pupil.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- G) Right optic nerve (if considering giant cell arteritis): In older adults, giant cell arteritis can cause optic neuritis and is a medical emergency due to the risk of bilateral vision loss. Although the patient is 37, it's essential to consider this diagnosis due to its potential severity.
- F) Retina (if considering central retinal artery occlusion): This condition requires immediate treatment to restore vision and is a medical emergency.
- Rare diagnoses
- E) Optic chiasm: Lesions here, such as those caused by pituitary tumors, could affect vision but would typically cause bitemporal hemianopia and might have other systemic symptoms.
- I) Right optic tract: Lesions here could cause homonymous hemianopia but would be less likely to cause pain on eye movement or a poorly reactive pupil.
- J) Right visual cortex: Lesions in the visual cortex could cause visual field defects but would not typically cause pain on eye movement or affect pupil reactivity.