Differential Diagnosis for Sharp Pain Behind the Eye
Single Most Likely Diagnosis
- Cluster Headache: This condition is characterized by severe, unilateral orbital or periorbital pain, often described as sharp, and can be accompanied by autonomic symptoms like lacrimation and nasal congestion. The sharp pain behind the eye, especially if it's unilateral and recurrent, makes cluster headache a top consideration.
Other Likely Diagnoses
- Migraine: Migraines can cause sharp pain behind the eye, especially if they involve the ocular or retro-orbital regions. Accompanying symptoms like photophobia, phonophobia, and visual auras can help differentiate migraines from other causes.
- Optic Neuritis: This condition involves inflammation of the optic nerve and can cause sharp pain behind the eye, particularly with eye movement. Vision loss or blurred vision often accompanies the pain.
- Sinusitis: Inflammation or infection of the sinuses, especially the ethmoid or sphenoid sinuses, can cause sharp pain behind the eyes due to the proximity of these sinuses to the orbital region.
Do Not Miss Diagnoses
- Giant Cell Arteritis: Although less common, this condition is critical to diagnose due to the risk of vision loss. It typically presents with headache, jaw claudication, and visual symptoms, including pain behind the eye.
- Acute Angle-Closure Glaucoma: This is an ophthalmologic emergency that can cause severe, sharp pain behind the eye, accompanied by blurred vision, nausea, vomiting, and seeing halos around lights.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause pain behind the eye, along with other symptoms like proptosis, diplopia, and decreased vision.
Rare Diagnoses
- Trigeminal Neuralgia: While more commonly associated with facial pain, trigeminal neuralgia can cause sharp, stabbing pain that might be perceived behind the eye, especially if the ophthalmic branch is involved.
- Tolosa-Hunt Syndrome: A rare condition characterized by painful ophthalmoplegia due to nonspecific inflammation of the cavernous sinus or superior orbital fissure, causing pain behind the eye and diplopia.
- Orbital Pseudotumor (Idiopathic Orbital Inflammatory Disease): This condition can cause sharp pain behind the eye, along with proptosis, diplopia, and decreased vision, due to inflammation of the orbital tissues.