Differential Diagnosis for Left Eye Hurts when Looking Down
- Single most likely diagnosis
- Superior Oblique Myositis or Tendonitis: This condition affects the superior oblique muscle or tendon, which is responsible for rotating the eye downward. Inflammation or strain in this area could cause pain when looking down.
- Other Likely diagnoses
- Trochlear Nerve Palsy: The trochlear nerve controls the superior oblique muscle. A palsy of this nerve could lead to difficulty and pain when attempting to look down due to impaired muscle function.
- Orbital Myositis: Inflammation of the muscles around the eye can cause pain with eye movement, including looking down.
- Dry Eye Syndrome: While not directly related to the direction of gaze, severe dry eye can cause significant discomfort with any eye movement, potentially worsening when looking down due to increased exposure of the ocular surface.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant Cell Arteritis: This condition can cause severe headaches and visual disturbances, including pain with eye movement. It's a medical emergency due to the risk of blindness if not promptly treated.
- Orbital Cellulitis: An infection of the tissues surrounding the eye, which can cause pain with eye movement, among other symptoms. It requires urgent medical attention to prevent serious complications.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause pain with eye movement due to the involvement of the nerves and veins in the cavernous sinus.
- Rare diagnoses
- Brown Syndrome: A condition affecting the superior oblique tendon, leading to limited downward gaze and potential pain when attempting to look down.
- Thyroid Ophthalmopathy: While more commonly associated with proptosis and upward gaze restriction, in rare cases, it can cause pain with downward gaze due to inflammation and swelling of the orbital tissues.
- Tolosa-Hunt Syndrome: A rare condition causing pain with eye movement due to nonspecific inflammation of the cavernous sinus or superior orbital fissure.