Differential Diagnosis for Bilateral Eye Pain
Single Most Likely Diagnosis
- Dry Eye Syndrome: A common condition, especially in older adults, characterized by inadequate tear production or poor tear quality, leading to eye discomfort and pain. The absence of erythema (redness) and the bilateral nature of the pain support this diagnosis.
Other Likely Diagnoses
- Acute Angle-Closure Glaucoma (without erythema): Although typically associated with redness, it's possible for this condition to present without erythema, especially in the early stages. The severe eye pain, particularly if worse in one eye, could suggest this diagnosis.
- Conjunctivitis: Viral or allergic conjunctivitis could cause bilateral eye pain, though typically, there would be some degree of redness or discharge. The absence of erythema does not entirely rule out this diagnosis, especially if the condition is mild or in its early stages.
- Sinusitis: Referral pain from sinusitis, especially if the sinuses are inflamed, can cause eye pain. Given the proximity of the sinuses to the eyes, this is a plausible diagnosis, especially if the patient has other symptoms like facial pain or nasal congestion.
Do Not Miss Diagnoses
- Giant Cell Arteritis: This condition can cause severe, sudden-onset headache and eye pain, often unilateral but can be bilateral. It's a medical emergency due to the risk of vision loss if not promptly treated. The absence of erythema does not rule out this diagnosis.
- Endophthalmitis: An infection within the eye, usually following surgery or trauma, which can cause severe eye pain. Although less likely without a clear history of trauma or surgery, it's a critical diagnosis not to miss due to its potential for severe vision loss.
- Temporal Arteritis: Similar to giant cell arteritis, temporal arteritis can cause eye pain and is a medical emergency due to the risk of blindness if not treated promptly.
Rare Diagnoses
- Scleritis: Inflammation of the sclera, which can cause deep, boring eye pain. It's less common than other conditions like conjunctivitis or dry eye but should be considered, especially if the pain is severe and deep.
- Uveitis: Inflammation of the uvea, which can cause eye pain, sensitivity to light, and vision problems. It's less common and might not always present with redness, especially in its early stages.
- Trigeminal Neuralgia: A chronic pain condition that affects the trigeminal nerve, which can cause sudden, severe, shock-like or stabbing pain in parts of the face, including the eyes. It's rare and typically has a distinct, episodic pattern of pain.