Differential Diagnosis for Visual Disturbance
The patient reports a sudden onset of a black spot with a grey film in her left eye, which appeared a month after a normal eye exam. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Vitreous Detachment: A common condition where the vitreous gel separates from the retina, causing floaters and flashes of light. The sudden appearance of a black spot with a grey film is consistent with this diagnosis, especially given the patient's recent normal eye exam.
- Other Likely diagnoses
- Retinal Tear or Detachment: A tear or detachment of the retina can cause sudden visual disturbances, including floaters, flashes of light, and a grey curtain or shadow. The patient's symptoms could be indicative of a retinal issue.
- Migraine with Aura: Some people experience visual auras, including grey spots or films, before a migraine headache. The patient's symptoms could be related to a migraine.
- Posterior Vitreous Detachment (PVD) with Hemorrhage: A PVD can cause sudden visual disturbances, and if accompanied by a hemorrhage, could result in a grey film or black spot.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Retinal Artery Occlusion: A blockage of the retinal artery can cause sudden, painless vision loss, which could be preceded by a grey film or black spot. Prompt diagnosis and treatment are crucial to prevent permanent vision loss.
- Retinal Vein Occlusion: A blockage of the retinal vein can cause sudden vision loss, and the patient's symptoms could be indicative of this condition.
- Giant Cell Arteritis: This condition can cause sudden vision loss, especially in older adults, and is a medical emergency.
- Rare diagnoses
- Choroidal Melanoma: A rare type of eye cancer that can cause visual disturbances, including a grey film or black spot.
- Optic Neuritis: Inflammation of the optic nerve can cause sudden vision loss, pain, and other visual disturbances.
- Sympathetic Ophthalmia: A rare, inflammatory condition that can cause vision loss and other symptoms in both eyes, following trauma or surgery to one eye.