Differential Diagnosis for Unilateral Orbital Pain
- Single most likely diagnosis
- Migraine: This is often the most common cause of unilateral orbital pain, characterized by severe, throbbing pain, usually on one side of the head, and can be accompanied by sensitivity to light, sound, or nausea.
- Other Likely diagnoses
- Cluster headache: Known for severe, unilateral orbital pain without an aura, often described as burning or piercing, and can be accompanied by nasal congestion, rhinorrhea, or ptosis on the affected side.
- Trigeminal neuralgia: A condition that causes sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head.
- Optic neuritis: Inflammation of the optic nerve leading to pain (especially with eye movement) and temporary vision loss in one eye, often associated with multiple sclerosis.
- Sinusitis: Infection or inflammation of the sinuses can cause pain and pressure in the face, including around the orbit, especially if the ethmoid or frontal sinuses are involved.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute angle-closure glaucoma: A medical emergency characterized by sudden, severe eye pain, blurred vision, headache, nausea, and vomiting, which requires immediate treatment to prevent permanent vision loss.
- Orbital cellulitis: A bacterial infection of the soft tissues surrounding the eye, which can lead to severe pain, swelling, and vision changes, and can be life-threatening if not promptly treated.
- Cavernous sinus thrombosis: A rare but potentially life-threatening condition where a blood clot forms in the cavernous sinus, leading to symptoms like severe headache, orbital pain, and cranial nerve deficits.
- Rare diagnoses
- Tolosa-Hunt syndrome: A rare disorder characterized by severe and unilateral headaches with extraocular palsies, caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure.
- Raeder syndrome: A rare condition involving a combination of facial pain (often around the eye), miosis, and ptosis, usually due to a lesion affecting the sympathetic nerves to the face.
- Orbital pseudotumor (Idiopathic Orbital Inflammatory Disease): A non-specific inflammation of the orbital tissues without any known cause, which can lead to a wide range of symptoms including pain, swelling, and vision changes.