Differential Diagnosis for the Patient's Condition

The patient presents with an increase in bruising around both eyes after a fall, without loss of consciousness, vomiting, or neurodeficits. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Periorbital hematoma: This is the most likely diagnosis given the history of a fall and the presence of bruising around the eyes. The mechanism of injury and the location of the bruising are consistent with a periorbital hematoma, which is a collection of blood in the tissues around the eye.

• Other Likely Diagnoses

  • Basilar skull fracture: Although the patient denies loss of consciousness and has no neurodeficits, a basilar skull fracture could still be possible, especially if the fracture is non-displaced and not causing significant symptoms.
  • Subgaleal hematoma: This is a collection of blood between the skull and the scalp, which could potentially track down to the face and cause periorbital bruising.

• Do Not Miss Diagnoses

  • Epidural hematoma: Although the patient denies loss of consciousness, an epidural hematoma could still be present, especially if it is small and not causing significant mass effect. This diagnosis is critical to rule out due to the potential for rapid deterioration.
  • Subarachnoid hemorrhage: This is another diagnosis that could be present despite the lack of loss of consciousness, and it is critical to rule out due to the high morbidity and mortality associated with it.

• Rare Diagnoses

  • Cavernous sinus thrombosis: This is a rare but potentially life-threatening condition that could cause periorbital bruising and swelling. It is often associated with facial trauma, infection, or other conditions that cause thrombosis of the cavernous sinus.
  • Orbital fracture with hemorrhage: This is another rare diagnosis that could cause periorbital bruising, especially if there is an associated fracture of the orbital bones.