Differential Diagnosis for 49-year-old Female with Right Eye Swelling and Tenderness
- Single most likely diagnosis:
- Blepharitis or Hordeolum (Stye): The presence of a stye, along with symptoms of eye swelling and tenderness, points towards an infectious or inflammatory condition of the eyelid. The patient's symptoms and the absence of trauma or visual changes make this a likely diagnosis.
- Other Likely diagnoses:
- Preseptal or Orbital Cellulitis: Although less likely given the absence of fever or significant visual changes, these conditions can present with eyelid swelling and tenderness. The patient's history of RA might increase her susceptibility to infections.
- Angioedema: This condition could cause eyelid swelling but typically would be bilateral and associated with other systemic symptoms or a history of allergies.
- Dacryocystitis: Inflammation of the lacrimal sac could cause swelling and tenderness, especially if there's an obstruction or infection, but it's less common and might be associated with discharge or tearing.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Orbital Abscess: A serious condition that requires immediate attention, characterized by severe pain, proptosis, and vision changes, which the patient does not exhibit but could rapidly develop.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that could present with eye swelling, pain, and possibly visual changes, especially in the context of an infection.
- Giant Cell Arteritis: Given the patient's age and history of RA, this condition, which can cause eye pain and swelling among other symptoms, should be considered, especially if there are systemic symptoms like headache or jaw claudication.
- Rare diagnoses:
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A systemic vasculitis that can affect the eyes, causing a variety of symptoms including swelling and pain, but is much less common.
- Sarcoidosis: This condition can cause uveitis, conjunctivitis, or eyelid swelling among its myriad manifestations, but would be less likely without other systemic symptoms or a known history of the disease.
- Relapsing Polychondritis: An autoimmune disorder that can cause inflammation of the cartilaginous structures, including those around the eye, leading to swelling and pain, but is quite rare.