Differential Diagnosis for Multiple Visions in a 20-year-old Female

Single Most Likely Diagnosis

• Chemical Injury with Residual Symptoms: The patient's initial presentation with symptoms of watering eyes, burning, redness, and light sensitivity after a chemical burn from Cavicide at work, followed by persistent but varying symptoms, suggests that the chemical injury is the most likely underlying cause of her complaints. The evolution of her symptoms, including itchiness, blurry vision, and flashes of light, could be attributed to the healing process of the chemical injury, potential overuse of medicated eye drops, or mechanical irritation from rubbing her eyes.

Other Likely Diagnoses

• Dry Eye Syndrome: Given the patient's complaints of itchiness, blurry vision, and the presence of flashes of light, dry eye syndrome could be a contributing factor, especially if the chemical injury or the use of certain medications has affected her tear production or composition.
• Corneal Abrasion or Ulcer: Although the patient was initially diagnosed with a corneal abrasion and was treated with Vigamox, the persistence of some symptoms could indicate a slow-healing abrasion or the development of a corneal ulcer, particularly if there was overuse of medicated drops or inadequate lubrication.
• Allergic Reaction to Medication: The patient's symptoms could also be exacerbated by an allergic reaction to one of the medications she has been using, such as the antibiotic or steroid eye drops.

Do Not Miss Diagnoses

• Retinal Detachment: Although the patient has been educated on the signs and symptoms of retinal detachment and has been monitored, this condition is a medical emergency that could be precipitated by trauma (including chemical burns) and must not be missed. The presence of flashes of light and floaters (although the patient denies new floaters, the symptom of seeing specks could be related) necessitates careful consideration of this diagnosis.
• Infectious Keratitis: This is a serious infection of the cornea that can result from a chemical injury, especially if the eye is not properly cared for. It requires prompt diagnosis and treatment to prevent vision loss.

Rare Diagnoses

• Traumatic Optic Neuropathy: Although rare, this condition could result from significant trauma, including chemical burns, affecting the optic nerve and leading to vision loss.
• Sympathetic Ophthalmia: This is a rare, inflammatory condition that can occur in one eye after a penetrating injury to the other eye. It is extremely rare but could be considered in the context of a severe chemical burn.

Each of these diagnoses should be considered in the context of the patient's evolving symptoms and medical history, with a focus on the most likely and "do not miss" diagnoses to ensure appropriate management and prevention of long-term vision loss.