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ddx Flashcards

1
Q

Hyphaema ddx

A

-Traumatic
-iatrogenic
-INV
-HSV or HZO iridocyclitis
-clotting disorder / meds
-Fuchs heterochromic IC
intraocular tumour e.g. juvenile xanthogranuloma, retinoblastoma, angioma

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2
Q

hypopyon ddx

A
  • Infection
  • severe AAU - HLAb27 or behcet or foreign body
  • reaction to IOL (sterile hypopyon)
  • retained lens particle (toxic anterior segment syndrome)
  • intraocular tumour necrosis (pseudohypopyon
  • foreign body
  • tight contact lens
  • chronic corneal oedema w ruptured bullae
  • severe inflam from recurrent corneal erosion
  • drugs e.g. rifampicin
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3
Q

blood in schlemm canal on gonioscopy ddx

A
  • iatrogenic (gonioscopy compression)
  • sturge-weber
  • av fistula (cc fistula)
  • svc obstruction
  • hypotony
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4
Q

chemosis ddx

A
  • allergy
  • drugs
  • venous congestion (cc fistula)
  • angioneurotic oedema
  • myxedema
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5
Q

conj dryness

A
  • vit a defic
  • post cicatricial conjunctivitis
  • s-j syndrome
  • ocular cicatricial pemphigoid
  • exposure (lagophthalmos/absent blink reflex/proptosis)
  • radiation
  • chronic dacryoadenitis
  • sjrogen
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6
Q

corneal oedema ddx congenital

A
  • congenital glaucoma
  • congenital heriditary endothelial dystrophy
  • PPMD
  • birth trauma
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7
Q

corneal oedema ddx acquired

A
  • aphakic or pseudophakic bullous keratopathy
  • fuchs endothelial dystrophy
  • contact lens overwear
  • traumatic
  • exposure
  • chemical injury
  • iop rise
  • hydrops
  • HZV/HSV
  • AAU
  • ICE
  • PPMD
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8
Q

Dilated episcleral vessels (w/o pain) ddx

A
  • underlying uveal neoplas,
  • AV fistula e.g CC
  • polycythaemia vera
  • leukaemia
  • ophthalmic vein or cavernous sinus thrombosis
  • extravasclar blockage of vennous outflow
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9
Q

enlarged corneal nerves ddx

A

-multiple endocrine neoplasia type IIb (medularry carcinoma of the thyroid gland, pheochromoctoma, mucosal neuromas, marfinoid)

  • acanthomaeba or chronic keratitis
  • keratoconus
  • neurofibromatosis
  • fuchs endo dys
  • refsm syndrome
  • trauma
  • congenital glaucoma
  • leprosy
  • icthyosis
  • idiopathic / normal
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10
Q

membranous conjunctivitis ddx (membrane removal causes bleeding)

A 
streppcocci
pneumococci
chemical burn
ligneous conj
corynebacterium diptheriae
adeno
hsv
ocular vaccinia
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11
Q

pseudomembranous conjunctivitis ddx

A 
membranous causes +
s-j-s
SLK
gonococci
staph
chlamydia in newborns
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12
Q

cornea opacification in infancy ddx

A 
congenital glaucoma
birth trauma
congenital hereditary endothelial or stromal dystrophy (B/L)
PPMD
AS dysgenesis
metabolic disorder (MPS/mucoliposes) (B/L)
interstitial keratitis
HSV
Ulcer
Coneal dermoid
sclerocornea
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13
Q

Pannus (superficial vascular invasion of cornea)

A 
ocular rosacea
contact lens tight or overworn
phlyctenule
chlamydia (trachoma or inclusion cyst)
SLK
staph hypersens
VKC
HSV or zoster
chemical burn
ocular cicatricial pemphigoid
aniridia
molluscum contagiosum
leprosy
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14
Q

Conj discolouration

A 
racial melanosis (perilimbal)
nevus
PAM
ocular and oculodermal melanocystosis
melanoma
addison
pregnancy
radiation
jaundice
SCH
mascara
drugs - chlorpromazine / topical epinephrine
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15
Q

symblepharon (fusion of palp/bulb conj)

A 
ocular cicatricial pemp
sjs
chem burn
trauma
drugs
chronic inflam
EKC
atopic conj
radiation
congenital
iatrogenic
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16
Q

verticillata

A 
amiodarone
chloroquine
fabry
phenothiazines
indomethacin
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17
Q

acute conj (foll / pap)

A

F:
Pre-auricular lymph = HSV / adeno
Toxic / mollluscum / pediculosis

P:
Severe purulent = GC
Scant purulent = bacterial
watery = allergic / atopic

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18
Q

eyelid swelling

A 
hordeolum
blepharitis
conj
cellulitis
trauma
contact dermatitis
HSV or zoster

Less common - ectropion / urticaria / angio / blepharochalasis / insect / dacryoadenitis / erysipelas / discoid lupus / dermatomyositis

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19
Q

ptosis

A

mechanical - mass / contact lens / upper eyelid inflam

myogenic - congenital

aponeurotic

neurogenic - MS / horner / cn3 / MG /marcus gunn jaw winking syndrome /ophthalmoplegic migraine

pseudoptosis - ipsilat enophthal / contralat proptosis or eyelid retraction / microphthalmia / phthisis bulbi / dermatochalasis / brow ptosis / tumour inflam mass / duane syndrome / blepharospasm / edema

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20
Q

benign eyelid lesion

A

benign - seb k / chalazion / stye / cysts - epidermal inclusion - sebacceous - eccrine & apocrine hydrocystomas / molluscum / nevus / xanthelasma / squamous papilloma / actinic keratosis / blepharitis / allergic conj / verrucae / neurofibroma / hemangioma etc

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21
Q

malignant eyelid lesion

A 
bcc
seb gland carcinoma
scc
keratoacanthoma
melanoma / lymphoma / met / merkel cell / kaposi sarcoma
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22
Q

bulls eye mac

A 
AMD
stargardt or fundus flavimaculatus
albinism
cone dystrophy
chloroquine/hydroxy retinopathy
spielmeyer-vogt syndrome
central areolar choroidal dystrophy
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23
Q

choroidal folds

A 
orb or choroidal tumour
idiopathic orbital inflam syndrome
thyroid eye disease
post scleritis
hypotony
ret det
marked hyperopia
scleral lac
papilledema
post op
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24
Q

CNV

A 
AMD
ocular histoplasmosis syndrome
high myopia
PCV
angioid streaks
choroidal rupture (trauma)

less - ONH drusen / tumour / ret scar after laser

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25
Q

embolus

A

cardiac myxoma left / IV drug / purtscher ret (chest trauma or long bone fracture)

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26
Q

macular exudate

A

diabetes
cnv
htn

less - MA, coats (children), peripheral retinal cap hemang, RVO, papiledema, radiation ret

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27
Q

normal fundus / decrease VA

A 
retrobulbar ON
cone degeneration
stargardt or ff
ON
rod monochromatism
amblyopia
funct
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28
Q

optociliary shunt vessels

A 
orb or intracranial tumour
crvo
chronic pap e,g, IIH
CACG
optic nerve glioma
29
Q

NVE

A

post pole - DM, CRVO

peri - sickle cell ret, BRVO, sarcoid,, syphilis, OIS, pars planitis, coats, ROP, chronic uveitis, leukaemia, eales disease, familial exudative vitreoretinopathy

30
Q

roth spots

A

dm
leukaemia
septic chorioretinitis

less - pernicious anaemia, sickle cellm scurvy, SLE and other conn tissue disorder

31
Q

periphlebitis

A

syphilis
sarcoid
pars planitis
sickle cell

less - TB, MS, eales, viral retinitis (HIV), behcets, fungal retinitis, bacteraemia

32
Q

pigmented choroidal lesion

A

nevus

melanoma (T>2 F (SRF) S (F/F) O (pig) M <3mm ONH)

CHRPE (flat black crisp margin peripheral surroundinng depig and pig halo)

reactive hyperplasia or RPE - flat black irreg margins - prev trauma or inflam - multifocal

Sub ret blood

melanocytoma of ON

choroidal detach

33
Q

non pigmented choroidal lesion

A

hemangioma - red-orange maybe elevated

met - cream or light brown, SRF, multifocal, BL

choroidal osteoma (young woman)

post scleritis

lymphoma

sclerochoroidal calcification

34
Q

IOP elevated

A 
glaucoma
suprachoroidal haem
hyphaema
cc fist
retrobulbar haem
orbital disease
35
Q

hypotony

A 
rupture
phthisis bulbi
retinal / choroidal detach
dehydration
iridocyclitis
cyclodialysis cleft
ocular ischaemia
drugs
traumatic ciliary body shutdown
36
Q

iris heterochromia - lighter

A 
cong horner
fuchs hic
chronic uveitis
xanthogranuloma
met carc
waardenburg syndrome
37
Q

iris heterochromia - darker

A 
ocular melanocytosis or oculodermal mel...
hemosiderosis
siderosis
retained IOFB
ocular melanoma or nevus
retinoblastoma
leuk/lymph
ICE
Fuch HIC
38
Q

iris lesion

A

PIG
nevus / mel / adeno of iris pigment epi

NON PIG
amelanotic mel / inflam nod (sarcoid-tb-leprosy) / neurofibroma / syphilis / juvenile xanthogranuloma / IOFB / leiomyoma / post seg tumour seed

39
Q

INV

A 
dm
ois
crao/brao
chronic uveitis
chronic ret det
tumour
other ret vasc disease
40
Q

ectopia lentis

A 
pxf
trauma (if >25% zon)
marfan (sup temp - BL)
homocystonuria (inf nas - BL)
wells-marchesani syndrome (small lens to AC)

other - syph, cong, aniridia, ehler danlos, crouzon, high myope , hyper mature cat, hyperlysinema, sulfite oxidase deficiency

41
Q

iridescent lens particle

A 
drugs
hypo ca
myotonic dystrophy
hypothyroid
familial
42
Q

lenticonus

A

anterior - alport

post - idiopathic

43
Q

APD

A

severe - ON, ischaemic ON, CRAO, optic chiasm or tract lesion

mild - amblyopia, dense vit haem, advance MD, BRVO or AO, ret det

44
Q

anisocoria (constricted)

A 
pilocarpine
iritis
horner
argyll robertson
chronic adie
45
Q

anisocoria (dilated)

A

mydriatic
adie
CN3
physiologic

46
Q

limitation ocular motility

A

w prop - orbital disease

w/o prop - CN palsy, MG, chronic prog external ophthalmoplegia, entrapment, ophthalmoplegic migraine, duane syndrome, CNS disorder

47
Q

optic disc atrophy

A

glaucoma, crv or ao, prev ischaemic ON, chronic ON, chronic pap, compressive ON/tract/rad, prev traumatic ON

less - syphilis, ret degen, toxicm metabolic, leber, lysosomal storage, radiation

48
Q

papilledema

A 
pseudo (OND / congentical anomaly)
papillitis
HTN
CRVO
ischaemic ON
infiltrate (sarcoid tb leuk met)
leber
ONH tumour
diabetic papillopathy
thyroid related
uveitis - syph sarc
amiodarone
49
Q

paradoxical pupil reaction

A 
cong stationary night blindness
cong achromatopsia
on hypoplasia
leber cong amaurosis
best
ON
dominant optic atrophy
albinism
RP
amblyopia
50
Q

extraocular muscle thickening

A

thyroid orbitopathy
idiopathic orbital inflam syndrome

less - tumour lymph met lac gland spread, cc fist, SOV thromb, cavernous hemangioma, rhabdomyosarcoma

51
Q

lac gland lesion

A

sarcoid
IOIS
infection
benign mixed epitheliual tumour (pleiomorphic adeno)
dermoid cyst
lymphoproliferative tumour
adenoid cystic carcinoma
malignant mixed epithelial tumour (pleiomorphoc adenocarcinoma)
lacrimal gland cyst (dacryops)
TB / syph / leuk / met / muscoepidermoid carc / plasmcytoma)

52
Q

optic nerve lesion

A

glioma (kids)
meningioma (adults)

less - met, leuk, IOIS, sarcoid, ICP increase w ONH swell

53
Q

orbital lesions

A

pseudoprop - enlarge globe, eno fellow eye, eyelid position

inflam - TED, IOIS, sarc, weg etc

infect - cell, subperiosteal abscess

neo - dermoid, cap hemang, rhabdomyosarc, met, lymphangioma, ON glioma, neurofibroma, leuk, lyphoma, neurilemmoma, mucocele

trauma - #, retrobulb h, fb, cc fist

malformation - congm vascular etc

54
Q

leukocoria paeds

A 
retinoblastoma, 
toxocariasis, 
coats
persistent fetal vasc / persistent hyperplastic prim vit
cataract
retinal astrocytoma
ROP

other - coloboma, ret det, FEVR, myelimated nerve fibre, toxo

55
Q

nystagmus paeds

A 
congenital
albinism
leber congenital amaurosis
cns injury (thalamic)
spasmus mutans
optic nerve or chiasmal glioma
on hypo
cataract
aniridia
cong corneal opacity
56
Q

post op shallow AC

A

IOP high - pupil block, sch, malignant glau

iop low - wound leak, choroidal detach, over filtration

57
Q

post op hypotony

A 
wound leak
choroidal detach
ciliary body shutdown
cyclodialysis cleft
ret det
drugs
58
Q

prog hyperopia

A 
orbital tumour
csr
post scleritis
presbyopia
hypoglycaemia
cataract
refractive surg
59
Q

prog myopia

A 
myopia
diabetes
cataract
staphyloma
corneal ectasia
miotic or sulfur drugs
60
Q

altitudinal defect

A

ION
BRVO or hemi
ON

less glauc, ON lesion or chiasm, ON coloboma

61
Q

arcuate scotoma

A

glaucoma

less - ION, drusen, high myope ON

62
Q

binasal defect

A

glaucoma, bitemp retinal disease e.g. rp

rare - bilat occipital disease, tumor or aneurysm comp both on or chiasm, chiasmatic arachnoiditis, nonphysiologic

63
Q

bitemp defect

A

chiasm lesion (pituitary adenoma, menigioma, craniopharyngioma, aneurysm, glioma)

less common - tilted discs

rare - nasal RP

64
Q

blind spot enlargement

A

pap, glauc, drusen, coloboma, myelinated, drugs, myopic disc, MEWDS, acute idiopathic blindspot elargement

65
Q

central scotoma

A

mac disease. on, ION, optic neuropathy

rare - occipital lesion

66
Q

peripheral field constriction

A

glaucoma, RP, gyrate, chronic pap, PRP, crao w cilioretinal sparing, bilateral occ CVA mac spare, carcinoma, melanoma, AI assoc retinopathy, drugs, vit a defic

67
Q

homonymous hemi

A

optic tract or lgn lesion; temp or parietial or occ lesion
more = stroke, tumour
less = aneurysm trauma

68
Q

vit opacity

A 
ateroid hyalosis
synchisis scintillans
vit haem
inflam
age relat
fb
hyaloid remnants
amyloidosis or whipple

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