Differential Diagnosis for Right Sided Headache behind R Eye with Ptosis and Vision Loss

• Single Most Likely Diagnosis

  • Cluster Headache: This condition is characterized by severe, unilateral headaches often described as occurring around or behind one eye. The presence of ptosis (drooping eyelid) and the specific location of the pain are consistent with cluster headaches, which can also cause tearing, redness, and vision disturbances due to the involvement of the autonomic nervous system.

• Other Likely Diagnoses

  • Migraine with Aura: Migraines can cause severe, unilateral headaches and are often accompanied by visual auras, which could explain the vision loss. Ptosis can occur due to the involvement of the nerves supplying the eye muscles.
  • Temporal Arteritis (Giant Cell Arteritis): This condition involves inflammation of the blood vessels and can cause headaches, vision loss (due to ischemia of the optic nerve), and even ptosis if the nerves controlling eye movement are affected.
  • Trigeminal Neuralgia: While primarily known for causing facial pain, trigeminal neuralgia can sometimes present with pain around the eye and could potentially cause vision disturbances or ptosis if the nerves controlling these functions are irritated.

• Do Not Miss Diagnoses

  • Aneurysm or Arteriovenous Malformation (AVM): These vascular abnormalities can cause sudden, severe headaches (often described as "the worst headache of my life") and can lead to vision loss and ptosis if they compress or bleed into surrounding structures, including nerves.
  • Pituitary Apoplexy: A condition where the pituitary gland suddenly hemorrhages or becomes infarcted, leading to severe headache, vision loss (due to compression of the optic chiasm), and potentially ptosis if cranial nerves are affected.
  • Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause headache, vision loss, and cranial nerve palsies (including those leading to ptosis) due to thrombosis of the cavernous sinus.

• Rare Diagnoses

  • Tolosa-Hunt Syndrome: A rare disorder characterized by headache, vision loss, and cranial nerve palsies (which could include ptosis) due to inflammation of the cavernous sinus or superior orbital fissure.
  • Raeder’s Syndrome: A rare condition that presents with a triad of miosis (pupil constriction), ptosis, and facial pain, often due to a lesion in the middle cranial fossa affecting the sympathetic nerves to the eye.