Differential Diagnosis for Inability to Open Eyes while Driving

• Single most likely diagnosis:
  • Sleep Deprivation or Fatigue: This is the most likely cause, as driving can be a monotonous task that may induce sleep, especially if the individual is already tired or sleep-deprived.
• Other Likely diagnoses:
  • Drowsy Driving due to Medication: Certain medications can cause drowsiness, and if taken before driving, could lead to an inability to keep eyes open.
  • Hypoglycemia: Low blood sugar can cause dizziness, confusion, and fatigue, potentially leading to an inability to keep eyes open while driving.
  • Migraine or Headache: Severe headaches can cause sensitivity to light and lead to a desire to close one's eyes, potentially impairing driving ability.
• Do Not Miss diagnoses:
  • Stroke or Transient Ischemic Attack (TIA): Although less likely, a stroke or TIA could cause sudden weakness or numbness, including affecting the muscles used to open the eyes, and is critical to diagnose promptly.
  • Diabetic Ketoacidosis: A serious complication of diabetes that can cause severe illness, including altered mental status that might manifest as an inability to keep eyes open.
  • Encephalitis or Meningitis: Infections of the brain or meninges can cause severe symptoms, including altered mental status, and are medical emergencies.
• Rare diagnoses:
  • Myasthenia Gravis: A chronic autoimmune disorder that leads to rapid fatigue and muscle weakness, which could potentially affect the eye muscles.
  • Botulism: A rare but serious illness caused by a toxin that can lead to muscle weakness, including the muscles controlling eye movement.
  • Ocular Myasthenia: A form of myasthenia gravis that specifically affects the muscles around the eyes, potentially causing drooping eyelids or an inability to open the eyes.