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Differential Diagnosis for Sudden Unilateral Vision Loss

Single Most Likely Diagnosis

  • Dry Eye Syndrome: Given the history of PRK surgery three years prior, dry eye syndrome is a common complication that can cause blurry and foggy vision, especially in bright light conditions. The symptoms of dry eye can be intermittent and may not be detected on a standard eye exam or OCT scan.

Other Likely Diagnoses

  • Migraine-Related Vision Disturbances: Migraines can cause transient visual disturbances, including blurry and foggy vision, which may be unilateral and triggered by light. The fact that the symptoms are intermittent and not constant makes this a plausible diagnosis.
  • Ocular Surface Disease: Conditions like blepharitis or meibomian gland dysfunction can cause intermittent vision disturbances, especially in bright light, and may not be detected on routine eye exams.
  • Residual Refractive Error: Although the patient had a PRK procedure, there could be residual refractive errors or irregularities in the cornea that cause blurry vision, particularly in certain lighting conditions.

Do Not Miss Diagnoses

  • Giant Cell Arteritis: Although less likely in a 30-year-old, giant cell arteritis can cause sudden, unilateral vision loss and is a medical emergency. It's essential to rule out this condition due to its potential for severe and permanent vision loss.
  • Optic Neuritis: This condition can cause sudden vision loss, pain, and sensitivity to light. It's crucial to consider optic neuritis, especially if the patient experiences any pain or other neurological symptoms.
  • Retinal Detachment: A retinal detachment can cause sudden, unilateral vision loss, and it's essential to rule out this condition promptly to prevent permanent vision loss.

Rare Diagnoses

  • Uveitis: Inflammation of the uvea can cause blurry and foggy vision, but it's less likely given the lack of other symptoms like pain, redness, or sensitivity to light.
  • Corneal Ectasia: A rare complication of PRK surgery, corneal ectasia can cause progressive vision loss and distortion, but it's less likely given the stable nature of the symptoms.
  • Neurological Conditions: Conditions like multiple sclerosis or a brain tumor can cause vision disturbances, but these would typically be accompanied by other neurological symptoms.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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