Differential Diagnosis for Seeing Black Spots, Pressure, and Pain in Both Eyes
Single Most Likely Diagnosis
- Migraine with Visual Auras: This condition is characterized by the presence of visual symptoms such as seeing black spots (scotomas), which can be accompanied by pressure and pain, typically on one side of the head but can sometimes be bilateral. The visual disturbances are often followed by a headache.
Other Likely Diagnoses
- Dry Eye Syndrome: Prolonged dryness can lead to irritation, discomfort, and sometimes the sensation of pressure or pain in the eyes. While less likely to cause black spots, severe cases might lead to blurred vision or the perception of spots.
- Eye Strain: Prolonged use of computers, reading, or other activities that require focused attention can lead to eye strain, which may cause headaches, blurred vision, and the sensation of pressure or pain in the eyes.
- Glaucoma: Especially acute angle-closure glaucoma, which can present with severe eye pain, blurred vision, and seeing halos around lights due to increased intraocular pressure. However, black spots are less commonly reported.
Do Not Miss Diagnoses
- Giant Cell Arteritis: This condition can lead to sudden, severe vision loss, and while it's less common, it's critical to diagnose early to prevent permanent vision loss. Symptoms can include headaches, jaw claudication, and visual disturbances.
- Temporal Arteritis: Similar to giant cell arteritis, it can cause visual symptoms including blindness, and it's essential to diagnose promptly.
- Optic Neuritis: Inflammation of the optic nerve can cause pain with eye movement and vision loss, including blind spots or black spots in the visual field.
- Papilledema: Increased intracranial pressure can cause swelling of the optic disc, leading to symptoms like headache, vision changes (including seeing black spots), and double vision.
Rare Diagnoses
- Ocular Migraine: A condition that can cause temporary blindness or blindness in one eye, often with a headache. It's less common than migraines with visual auras but can be more alarming due to the transient blindness.
- Charles Bonnet Syndrome: Typically occurs in individuals with significant vision loss, where they see complex visual hallucinations, including patterns, shapes, or even people. While not directly related to pain or pressure, it's a rare condition that affects vision perception.
- Vitreous Detachment: Posterior vitreous detachment can cause floaters (which might be perceived as black spots) and flashes of light. It's usually painless but can be alarming. In rare cases, it can lead to more serious conditions like retinal detachment.