Eye Pain: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

Eyes (H00-H59)

  • Accommodation spasm – prolonged contraction of the ciliary muscle.
  • Ametropia (defective vision) – hyperopia (farsightedness, hyperopia); myopia (nearsightedness); astigmatism (astigmatism).
  • Blepharitis (inflammation of the eyelids).
  • Dacryocystitis (lacrimal sac inflammation)
  • Ectropium senile with trichiasis – outward turn of the eyelid with inward turn of the eyelashes.
  • Endophthalmitis – inflammation of the inner segments of the eye.
  • Entropium senile – inward turn of the eyelid.
  • Erosio corneae (abrasion of the corneal epithelium) – localization: mostly in the lower third of the cornea (because of drying of the corneal surface in insufficiency of eyelid closure).
  • Episcleritis – inflammation of the episclera (top layer of the sclera / sclera); clinical picture: inflammation of the connective tissue between the sclera and conjunctiva; moderately painful.
  • Glaucoma, acute / glaucoma attack; symptomatology: eye pain, nausea (nausea)/vomiting, usually unilateral eye redness, extremely hard eyeball, sudden loss of vision (see fog; see veils), see color rings (halos); clinical findings: red eye with moderately wide, fixed pupils; eyes often appear dull and cloudy; differential diagnoses: subarachnoid hemorrhage (SAB), apoplexy (stroke), migraine; because of acute vomiting also to gastrointestinal tract. Acute vomiting also think of gastroenteritis.
  • Hordeolum (sty) – usually painful.
  • Corneal erosion, corneal ulcer (corneal ulcer).
  • Infectious keratitis – infection of the cornea of the eye by.
    • Bacteria such as staphylo- or streptococci.
    • Viruses such as the herpes simplex virus (HSV)
    • Fungi, v. a. Aspergillus or Candida
    • Protozoa such as acanthamoebae
  • Iritis, acute (inflammation of the iris),
  • Irritated pinguecula (eyelid fissure stain).
  • Irritated pterygium (wing fur)
  • Keratitis (inflammation of the cornea)
  • Conjunctivitis, acute (conjunctivitis) (infectious conjunctivitis; viral conjunctivitis/keratoconjunctivitis epidemica).
  • Conjunctivitis sicca (dry eye).
  • Non-infectious keratitis due to:
    • Injuries
    • Blinding (keratoconjunctivitis photoelectrica, keratitis photoelectrica, photokeratitis, or welder’s glare): acute death of the epithelium of the exposed ocular surface due to UV-C radiation.
    • Burn, chemical burn
    • Foreign body
    • Contact lens intolerance
  • Optic neuritis (inflammation of the optic nerve).
  • Orbitaphlegmone – acute inflammation of the orbit (bony eye socket); often continued sinusitis (sinusitis).
  • Pseudotumor orbitae – lymphocytic inflammation of the entire orbit.
  • Scleritis (inflammation of the sclera of the eye) – clinical picture: diffuse, washed-out red eye with dilated vessels; bulbar pain (pain of the eyeball) with often reduced vision.
  • Sympathetic ophthalmia (eng. : Sympathic ophthalmia) – probably an autoimmune disease affecting the eyes, which can occur after traumatic injury to the vascular membrane of one eye or after surgery or injury to the eye with involvement of the uvea (middle eye skin).
  • Tenonitis – inflammation of the Tenon’s capsule.
  • Trichiasis – inward turning of the eyelashes.
  • Ulcus corneae (corneal ulcer)
  • Uveitis – inflammation of the middle skin of the eye, which consists of the choroid (choroid), the ray body (corpus ciliare) and the iris.

Cardiovascular system (I00-I99).

  • Aneurysm of the A.carotis interna in the area de N.oculomotorius
  • Carotid-cavernosal fistula (carotid-cavernosal fistula) – acquired vascular anomaly in the form of arteriovenous fistulas between internal or external carotid arteries and the cavernous sinus; symptomatology: Onset usually painless with a unilateral reddened eye (with massive dilatation (blood vessel dilation) of the conjunctival and episcleral vessels), in the further course develops a secondary glaucoma with sometimes considerable pain (extremely rare emergency).

Infectious and parasitic diseases (A00-B99).

  • Infectious keratitis (infection of the cornea of the eye) caused by:
    • Bacteria such as staphylo- or streptococci, Mycobacterium tuberculosis.
    • Viruses such as the herpes simplex virus (HSV keratitis), herpes zoster
    • Fungi, v. a. Aspergillus or Candida
    • Protozoa such as acanthamoebae, Toxoplasma gondii
    • Nematodes (Nematoda; nematodes) such as Onchocerca volvulus (onchocerciasis (river blindness)).

Musculoskeletal system and connective tissue (M00-M99).

  • Arteritis temporalis (synonyms: Arteriitis cranialis; Horton’s disease; giant cell arteritis; Horton-Magath-Brown syndrome) – systemic vasculitis (vascular inflammation) affecting the arteriae temporales (temporal arteries), especially in the elderly.
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.

Neoplasms – tumor diseases (C00-D48).

  • Nasopharyngeal tumor – neoplasm originating from the nasopharynx.
  • Neoplasms of the eye, unspecified.

Psyche – nervous system (F00-F99; G00-G99)

Injuries, poisoning and other consequences of external causes (S00-T98).

  • Eye injuries, unspecified
  • Burning, blinding, etc. of the eye

Medication

  • Immunotherapeutics (fingolimod)

Further

  • Foreign body
  • Condition after abrasio corneae (scraping of the cornea).