Differential Diagnosis
- Single most likely diagnosis
- Diabetic retinopathy: The patient's history of type 1 diabetes mellitus, gradual painless loss of vision, and findings on endoscopy examination (multiple microaneurysms, flame-shaped hemorrhages, and vascular proliferation) are all consistent with diabetic retinopathy, which is a common complication of long-standing diabetes.
- Other Likely diagnoses
- Hypertensive retinopathy: The patient's elevated blood pressure (133/88) could contribute to hypertensive retinopathy, which may present with similar findings on endoscopy examination, including microaneurysms and hemorrhages.
- Retinal vein occlusion: This condition can cause sudden or gradual vision loss and may be associated with diabetes, hypertension, and other vascular risk factors.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Retinal detachment: Although less likely, retinal detachment is a medical emergency that requires prompt treatment to prevent permanent vision loss. The patient's symptoms and endoscopy findings could be consistent with a retinal detachment, especially if there is a retinal tear or hole.
- Central retinal artery occlusion: This condition is a medical emergency that requires immediate treatment to restore blood flow to the retina and prevent permanent vision loss. Although the patient's vision loss is gradual, central retinal artery occlusion should be considered in the differential diagnosis.
- Rare diagnoses
- Sarcoidosis: This systemic inflammatory disease can cause uveitis, retinal vasculitis, and other ocular manifestations that may lead to vision loss.
- Eale disease: A rare condition characterized by retinal vasculitis, ischemia, and neovascularization, which can cause vision loss and may be associated with diabetes or other systemic diseases.
- Ocular ischemic syndrome: A rare condition caused by severe carotid artery stenosis or occlusion, leading to chronic ocular hypoperfusion and vision loss.