Differential Diagnosis for Periorbital Edema, Echymosis, and Ocular Injuries

Single Most Likely Diagnosis

• Blunt Trauma to the Eye: Given the symptoms of periorbital edema, ecchymosis, inability to open one eye, and specific ocular findings like asymmetry, deviation of the pupil, and a laceration of the sclera, blunt trauma is the most straightforward explanation. The mechanism of injury likely involved a significant force to the face, causing these multiple ocular and periocular injuries.

Other Likely Diagnoses

• Orbital Fracture: The presence of periorbital edema and ecchymosis, along with an inability to open one eye, could indicate an orbital fracture, especially if there was a significant blow to the face. This could also explain the deviation of the pupil and the scleral laceration if the fracture compromised the integrity of the orbit.
• Ruptured Globe: Although the question specifies a laceration of the sclera, a ruptured globe should be considered, especially with the other signs of trauma. The rupture could lead to the asymmetry and pupil deviation noted.

Do Not Miss Diagnoses

• Intraocular Foreign Body: This is a critical diagnosis not to miss, as it can lead to severe complications, including infection and vision loss. The presence of a scleral laceration increases the risk of an intraocular foreign body.
• Retinal Detachment: Trauma can cause retinal detachment, which is an emergency requiring prompt treatment to preserve vision. Symptoms might not be immediately apparent, making it crucial to consider in the differential.
• Optic Nerve Injury: Given the trauma, an optic nerve injury is possible, which could result in severe and potentially permanent vision loss. Early recognition and management are vital.

Rare Diagnoses

• Sympathetic Ophthalmia: Although rare, this is an inflammatory condition that can occur after penetrating eye injuries, including scleral lacerations. It affects both the injured and the uninjured eye and can lead to severe vision loss if not recognized and treated.
• Endophthalmitis: This is a rare but serious infection within the eye that can occur after trauma, especially with a penetrating injury like a scleral laceration. It requires immediate antibiotic treatment to preserve vision.