Differential Diagnosis for Scleral Hematoma without Trauma
- Single most likely diagnosis
- Hypertension: Scleral hemorrhage can occur due to uncontrolled high blood pressure, which causes blood vessels to rupture, leading to hematoma formation.
- Other Likely diagnoses
- Diabetes mellitus: Diabetic patients are prone to vascular complications, including retinal and scleral hemorrhages, due to microvascular damage.
- Aging: As people age, the sclera becomes thinner and more susceptible to spontaneous hemorrhage.
- Bleeding disorders (e.g., hemophilia, von Willebrand disease): Coagulopathy can increase the risk of spontaneous bleeding, including scleral hematoma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant hypertension: This is a severe form of hypertension that can cause rapid deterioration of vision and even death if left untreated.
- Scleritis: Inflammation of the sclera can cause pain, redness, and swelling, and if left untreated, can lead to vision loss and other complications.
- Orbital cellulitis or abscess: Infection of the orbit can spread to the sclera, causing hematoma and potentially life-threatening complications.
- Rare diagnoses
- Amyloidosis: This condition involves the deposition of abnormal proteins in various tissues, including the sclera, which can lead to spontaneous hemorrhage.
- Scleral choristoma: A rare congenital condition where abnormal tissue grows in the sclera, potentially causing hemorrhage.
- Sarcoidosis: An autoimmune disease that can affect various parts of the body, including the eyes, and cause scleral inflammation and hemorrhage.