Differential Diagnosis for Red Eye and Ear Pain on the Same Side

Single Most Likely Diagnosis

• Conjunctivitis and Otitis Media: This combination is a common cause of red eye and ear pain, especially in children. The proximity of the eyes and ears, along with shared lymphatic drainage, makes it plausible for infections to affect both areas simultaneously.

Other Likely Diagnoses

• Temporal Arteritis: Although more common in older adults, temporal arteritis can cause pain on one side of the head, including the ear, and can be associated with visual disturbances or redness due to involvement of the ophthalmic artery.
• Trigeminal Neuralgia: This condition can cause severe pain in the face, including the area around the eye and ear, due to irritation of the trigeminal nerve.
• Dental Problems: Tooth infections or abscesses can refer pain to the ear and, in some cases, cause redness or discomfort in the eye due to shared nerve pathways.

Do Not Miss Diagnoses

• Cavernous Sinus Thrombosis: A potentially life-threatening condition that can cause pain and redness around the eye, along with symptoms like ear pain, due to the involvement of the cavernous sinus. It often arises from facial or sinus infections.
• Herpes Zoster (Shingles): When affecting the trigeminal nerve, it can cause severe pain and a rash around the eye (herpes zoster ophthalmicus) and potentially involve the ear, leading to complications like hearing loss if not promptly treated.
• Orbital Cellulitis: An infection of the tissues surrounding the eye, which can cause redness, pain, and swelling of the eye, and may be associated with ear pain due to the spread of infection or shared nerve pathways.

Rare Diagnoses

• Ramsay Hunt Syndrome Type 2: A condition caused by the varicella-zoster virus affecting the geniculate ganglion of the facial nerve, leading to ear pain, facial weakness, and sometimes eye involvement like conjunctivitis or keratitis.
• Tolosa-Hunt Syndrome: A rare disorder characterized by severe and unilateral headaches with extraocular palsies, often accompanied by pain in the distribution of the trigeminal nerve, which could include the ear and eye areas.
• Eagle Syndrome: Caused by an elongated styloid process or calcified stylohyoid ligament, leading to referred pain in the ear and face, including the eye area, due to irritation of the surrounding nerves.