Differential Diagnosis for Black Eye and Swelling after a Fall

Single Most Likely Diagnosis

• Periorbital Hematoma: This is the most common diagnosis for a black eye, which occurs due to bleeding into the tissues around the eye following trauma, such as a fall. The symptoms of periorbital hematoma include bruising, swelling, and sometimes pain around the eye.

Other Likely Diagnoses

• Orbital Fracture: A fracture of the bones surrounding the eye can occur from a fall, leading to symptoms like swelling, bruising, and sometimes double vision or limited eye movement.
• Conjunctival Hemorrhage: Bleeding underneath the conjunctiva, the membrane covering the white part of the eye, can cause a red, swollen appearance and is often associated with trauma.
• Corneal Abrasion: A scratch on the cornea, which can happen during a fall, may cause pain, redness, and sensitivity to light.

Do Not Miss Diagnoses

• Orbital Compartment Syndrome: A serious condition where pressure within the orbit increases, potentially threatening vision. Symptoms include severe pain, proptosis (bulging of the eye), and limited eye movement.
• Retinal Detachment: Trauma can cause the retina to detach from the back of the eye, leading to symptoms like flashes of light, floaters, and a curtain or shadow descending over the field of vision.
• Globe Rupture: A severe injury where the outer membranes of the eyeball are breached, which can lead to severe vision loss and requires immediate medical attention.

Rare Diagnoses

• Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition where a blood clot forms in the cavernous sinus, which can be a complication of facial trauma. Symptoms include proptosis, chemosis (swelling of the conjunctiva), and cranial nerve palsies.
• Optic Neuropathy: Trauma can cause damage to the optic nerve, leading to vision loss. This can be immediate or delayed and may be associated with other signs of trauma to the eye or head.