Differential Diagnosis for Inability to Open Left Eye after Duraplasty

• Single most likely diagnosis
  • Frontal nerve (cranial nerve VII) palsy or damage: This is a common complication following neurosurgical procedures like duraplasty, especially if the surgery involved areas near the frontal nerve. The frontal nerve controls the muscles of the forehead and eye, including those responsible for opening the eye.
• Other Likely diagnoses
  • Local anesthesia effect: If local anesthesia was used during the procedure, its effects might not have worn off, leading to temporary inability to open the eye.
  • Edema or swelling: Post-operative swelling around the eye could mechanically limit the ability to open it.
  • Retrobulbar hemorrhage: Although less common, bleeding behind the eye can cause increased pressure and limit eye movement, including opening.
• Do Not Miss diagnoses
  • Cavernous sinus thrombosis: A rare but potentially life-threatening condition that could occur post-operatively, leading to symptoms including inability to move the eye.
  • Orbital compartment syndrome: Increased pressure within the orbit can compromise the blood supply to the eye and surrounding tissues, leading to severe vision loss if not promptly addressed.
  • Stroke or cerebral vasospasm: Complications from the surgery could lead to a stroke or vasospasm affecting the areas of the brain controlling eye movement.
• Rare diagnoses
  • Myasthenia gravis: An autoimmune disease that could be unmasked or exacerbated by surgery, leading to muscle weakness, including the muscles controlling eye opening.
  • Guillain-Barré Syndrome: A rare autoimmune disorder that can occur after surgery, leading to ascending paralysis which might include the muscles of the face and eyes.
  • Tolosa-Hunt syndrome: A rare disorder characterized by inflammation of the cavernous sinus or superior orbital fissure, leading to painful ophthalmoplegia (paralysis of the eye muscles).