Differential Diagnosis for Patient with Ocular Pain and Outward Right Eye Deviation
Single Most Likely Diagnosis
- Cavernous sinus thrombosis: This is a potential complication of paranasal sinusitis, especially if the infection spreads to the cavernous sinus. The patient's symptoms of ocular pain with eye movement and outward deviation of the right eye are consistent with this diagnosis, as the cavernous sinus is located near the eye and its thrombosis can lead to ophthalmoplegia and pain.
Other Likely Diagnoses
- Orbital cellulitis or abscess: These conditions can occur as a direct extension of sinusitis and cause pain with eye movement, proptosis, and limited eye movement. The outward deviation of the eye could be due to swelling or mass effect from the infection.
- Superior ophthalmic vein thrombosis: Similar to cavernous sinus thrombosis, this can be a complication of sinusitis and cause ocular pain and limited eye movement.
Do Not Miss Diagnoses
- Meningitis: Although less likely, meningitis can present with headache, fever, and ocular symptoms if there is increased intracranial pressure or direct involvement of cranial nerves. It is crucial to consider this diagnosis due to its high morbidity and mortality if missed.
- Carotid artery cavernous fistula: This is an abnormal connection between the carotid artery and the cavernous sinus, which can be a complication of trauma or infection. It can cause ocular symptoms, including pain and limited eye movement, and is critical to diagnose due to the risk of severe complications.
Rare Diagnoses
- Tolosa-Hunt syndrome: A rare condition characterized by nonspecific inflammation of the cavernous sinus or superior orbital fissure, leading to painful ophthalmoplegia. It is a diagnosis of exclusion and should be considered if other more common causes are ruled out.
- Gradenigo's syndrome: A rare but serious condition caused by an infection of the petrous apex of the temporal bone, leading to a triad of symptoms including otitis media, deep facial pain, and abducens nerve palsy (which could cause outward deviation of the eye).