Differential Diagnosis
The patient's presentation of a mild peripheral visual field defect, elevated intraocular pressures, and an enlarged cup-to-disc ratio suggests a condition affecting the optic nerve and potentially threatening vision. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Glaucoma: This is the most likely diagnosis given the elevated intraocular pressures and the enlarged cup-to-disc ratio, which are hallmark signs of glaucoma. Glaucoma can cause peripheral visual field defects due to damage to the optic nerve.
Other Likely diagnoses
- Ocular Hypertension: While not a disease per se, ocular hypertension (elevated intraocular pressure without optic nerve damage) can be a precursor to glaucoma and shares similar risk factors such as hypertension and hyperlipidemia.
- Normal Tension Glaucoma: This condition presents with glaucomatous optic neuropathy despite normal intraocular pressures, which could be considered if the patient's pressures are not consistently elevated.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Brain Tumor: Although less likely, a brain tumor (especially in the sellar or suprasellar region) could cause increased intracranial pressure, leading to elevated intraocular pressures and visual field defects. Missing this diagnosis could have severe consequences.
- Carotid Artery Disease: Severe carotid artery stenosis could potentially lead to ocular ischemic syndrome, presenting with elevated intraocular pressures among other symptoms.
Rare diagnoses
- Pseudotumor Cerebri (Idiopathic Intracranial Hypertension): Characterized by elevated intracranial pressure without a mass lesion, which can cause papilledema and visual field defects. It's less common in this demographic without other typical symptoms like headache.
- Optic Neuropathies: Conditions such as anterior ischemic optic neuropathy or optic neuritis could present with sudden visual loss and optic disc abnormalities but typically do not cause elevated intraocular pressures.