What is the cause of a 2-week progressive decrease in near vision in the right eye, without diplopia, vision loss, paresthesia, or scotomas, in a patient with a history of migraines (migraine headaches)?

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Differential Diagnosis

  • Single most likely diagnosis
    • Migraine avec aura sans céphalée : The patient has a history of migraines and typically experiences similar symptoms before an episode, but has not had a headache in the past 2 weeks. The symptoms of blurred vision, sensation of having something behind the eye, and progression over 2 weeks are consistent with a migraine aura without headache.
  • Other Likely diagnoses
    • Réfractive error or accommodative spasm : The patient is scheduled to see an optometrist, which suggests that a refractive error or accommodative spasm could be contributing to the symptoms of blurred vision at near.
    • Dry eye or other ocular surface disorder : The sensation of having something behind the eye could be related to dry eye or another ocular surface disorder.
    • Presbyopia : The patient's age is not specified, but presbyopia (age-related decline in near vision) could be a contributing factor to the symptoms of blurred vision at near.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Glaucome à angle fermé : Although the patient does not have typical symptoms of glaucoma, such as severe eye pain or vision loss, it is essential to rule out this condition due to its potential for irreversible vision loss.
    • Détachement de la rétine : The patient's symptoms of blurred vision and sensation of having something behind the eye could be related to a retinal detachment, which requires prompt treatment to prevent vision loss.
    • Tumeur oculaire : Although rare, an ocular tumor could cause symptoms similar to those experienced by the patient, and it is crucial to rule out this possibility.
  • Rare diagnoses
    • Sclérite : Inflammation of the sclera could cause symptoms such as blurred vision and sensation of having something behind the eye, although this is a rare condition.
    • Uvéite : Inflammation of the uvea could also cause similar symptoms, although this is also a rare condition.
    • Neuropathie optique : Optic neuropathy could cause symptoms such as blurred vision, although this is a rare condition and would typically be associated with other symptoms such as pain or loss of vision.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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