Differential Diagnosis for Headaches and Near Blackout Episodes

Given the symptoms of bad headaches, near blackout episodes when sitting up or standing, and bad pain in the right eye, especially with a history of retinal detachment surgery, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition is characterized by a rapid increase in heart rate and other symptoms that occur upon standing, which could explain the near blackout episodes. The recent surgery could potentially contribute to or exacerbate symptoms due to changes in body position, fluid shifts, or medication effects.
• Other Likely Diagnoses
  • Post-concussive syndrome or migraine: Given the history of recent surgery and potential for head or eye strain, these conditions could contribute to headaches and sensitivity to light or position.
  • Dry eye or other ocular surface disorders: Following retinal detachment surgery, the eye may experience dryness or irritation, leading to pain, especially if the patient is not adequately using prescribed eye drops or if there's an issue with the ocular surface.
  • Hypotension: Especially orthostatic hypotension, which could be exacerbated by dehydration, medication, or the body's response to recent surgery, leading to dizziness upon standing.
• Do Not Miss Diagnoses
  • Retinal detachment complication: Although the patient had surgery, complications such as a new or recurrent detachment, or other issues like cataract, glaucoma, or endophthalmitis (infection inside the eye), could cause severe eye pain and vision changes.
  • Intracranial hypotension: This condition, which can occur spontaneously or post-surgically, involves low pressure in the brain, leading to headaches that worsen with standing and improve with lying down.
  • Cerebral venous sinus thrombosis: A blood clot in the brain's venous sinuses, which could be a complication of surgery, dehydration, or other factors, and presents with headache, vision changes, and potentially seizures or other neurological deficits.
• Rare Diagnoses
  • Arterial dissection: A tear in the lining of an artery in the neck or brain, which could lead to stroke or transient ischemic attacks, and might present with severe headache and neurological symptoms.
  • Third cranial nerve (oculomotor nerve) palsy: This could result from an aneurysm or other compressive lesion, leading to eye pain, double vision, and potentially other neurological symptoms.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially further diagnostic testing to determine the underlying cause of the symptoms.