Differential Diagnosis for Scotomas Appearing 4 Days After a Procedure

Given the context of scotomas appearing 4 days after a procedure, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis

  • Posterior Capsule Opacification (PCO) or a complication related to cataract surgery if the procedure was eye-related: This is a common complication following cataract surgery, where scotomas can appear due to opacification of the posterior lens capsule. The timing of 4 days post-procedure fits within the window where such complications can become apparent.

• Other Likely Diagnoses

  • Endophthalmitis: An infection within the eye that can occur post-surgically, leading to vision disturbances including scotomas. The onset can vary but typically occurs within the first week after surgery.
  • Retinal Detachment: A serious condition where the retina separates from the back of the eye, which can be a complication of surgery. Symptoms include sudden appearance of floaters, flashes of light, and scotomas.
  • Cystoid Macular Edema (CME): A condition characterized by the accumulation of fluid in the macula, leading to distorted or blurred vision and scotomas. It is a known complication of various eye surgeries.

• Do Not Miss Diagnoses

  • Central Retinal Artery Occlusion (CRAO): A blockage of the central retinal artery, leading to sudden, painless loss of vision, which could initially present as a scotoma. Prompt diagnosis and treatment are crucial to attempt to restore vision.
  • Central Retinal Vein Occlusion (CRVO): A blockage of the central retinal vein, which can cause sudden vision loss, including scotomas. It requires immediate medical attention to manage potential complications like neovascular glaucoma.
  • Intraocular Infection (e.g., fungal endophthalmitis): Certain infections can have a delayed onset and may present with vision disturbances, including scotomas. These conditions are medical emergencies.

• Rare Diagnoses

  • Toxic or allergic reactions to medications used during or after the procedure: Certain medications can cause rare but serious side effects, including vision disturbances.
  • Sarcoidosis or other systemic diseases affecting the eye: Conditions like sarcoidosis can cause uveitis or other ocular manifestations, including scotomas, though these would be less common in the immediate post-procedural period without prior diagnosis.
  • Migraines or other neurological conditions: Though less likely to be directly related to a procedure, migraines can cause scotomas. However, the context provided suggests a more direct relationship to the procedure.