Differential Diagnosis for Eye Pain with Decreased Visual Acuity
Single Most Likely Diagnosis
- Acute Angle-Closure Glaucoma: This condition is characterized by sudden onset of eye pain, decreased visual acuity, and often accompanied by nausea, vomiting, and seeing halos around lights. It is a medical emergency requiring immediate treatment to prevent permanent vision loss.
Other Likely Diagnoses
- Conjunctivitis: Inflammation of the conjunctiva can cause eye pain and decreased visual acuity, especially if there is a significant amount of discharge or if the condition progresses to involve the cornea.
- Keratitis: Inflammation of the cornea can cause pain, blurred vision, and sensitivity to light. It can be due to infection, injury, or underlying conditions like dry eye.
- Uveitis: Inflammation of the uvea, which includes the iris, ciliary body, and choroid, can cause eye pain, sensitivity to light, and decreased visual acuity.
- Retinal Detachment: Although often painless, some patients may experience eye pain along with flashes of light and floaters, leading to decreased visual acuity.
Do Not Miss Diagnoses
- Endophthalmitis: A severe infection within the eye that can follow surgery, trauma, or blood-borne infection. It presents with severe eye pain, decreased vision, and significant inflammation.
- Orbital Cellulitis: An infection of the tissues surrounding the eye, which can cause pain, swelling, and decreased visual acuity. It can lead to serious complications if not promptly treated.
- Temporal Arteritis (Giant Cell Arteritis): An inflammation of the blood vessels that can cause eye pain, headache, and sudden loss of vision in one or both eyes. It is a medical emergency requiring immediate steroid treatment.
Rare Diagnoses
- Scleritis: A severe inflammation of the sclera that can cause deep, boring eye pain and tenderness, often accompanied by redness and decreased visual acuity.
- Optic Neuritis: Inflammation of the optic nerve that can cause pain with eye movement, decreased visual acuity, and loss of color vision. It is often associated with multiple sclerosis.
- Sympathetic Ophthalmia: A rare, inflammatory condition that can occur after penetrating eye injury or surgery, leading to inflammation in the uninjured eye and potentially causing vision loss.