Differential Diagnosis for a Deep Aching Red Eye with No Discharge

• Single Most Likely Diagnosis
  • Acute Angle-Closure Glaucoma: This condition is characterized by a sudden increase in intraocular pressure, leading to a deep aching pain, redness, and often accompanied by nausea and vomiting. The absence of discharge and the nature of the pain make this a leading consideration.
• Other Likely Diagnoses
  • Conjunctivitis (Viral or Allergic): Although discharge is often present, some forms of conjunctivitis, especially in the early stages or if the patient has been using drops that reduce discharge, might present with minimal to no discharge. The redness and discomfort could align with these conditions.
  • Scleritis: This is an inflammation of the sclera, which can cause a deep, aching pain and redness of the eye. It's less common than conjunctivitis but should be considered, especially if the pain is severe and localized to the sclera.
  • Keratitis: Inflammation of the cornea can cause pain, redness, and sensitivity to light. While discharge might be minimal, the presence of a deep aching pain and red eye without significant discharge could suggest this diagnosis.
• Do Not Miss Diagnoses
  • Endophthalmitis: This is a severe inflammation of the interior of the eye, usually caused by infection. It's a medical emergency that requires prompt treatment to preserve vision. The absence of discharge does not rule out this condition, and any suspicion warrants immediate investigation.
  • Orbital Cellulitis: An infection of the tissues surrounding the eye, which can cause pain, redness, and swelling. It's critical to identify and treat promptly to avoid serious complications, including vision loss and spread of infection.
  • Retinal Detachment: While not typically associated with redness and discharge, a retinal detachment can cause severe vision problems and pain. It's less directly related to the symptoms described but is a critical condition not to miss.
• Rare Diagnoses
  • Uveitis: Inflammation of the uvea, which can cause eye pain, redness, and sensitivity to light. It's less common and might not always present with the classic symptoms, making it a rare but possible consideration.
  • Ocular Migraine: Some types of migraines can cause visual disturbances and eye pain without headache, which might fit the description given. However, this is less likely and would be considered after ruling out more common causes.