ddx Flashcards

(68 cards)

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
embolus
cardiac myxoma left / IV drug / purtscher ret (chest trauma or long bone fracture)
26
macular exudate
diabetes cnv htn less - MA, coats (children), peripheral retinal cap hemang, RVO, papiledema, radiation ret
27
normal fundus / decrease VA
``` retrobulbar ON cone degeneration stargardt or ff ON rod monochromatism amblyopia funct ```
28
optociliary shunt vessels
``` orb or intracranial tumour crvo chronic pap e,g, IIH CACG optic nerve glioma ```
29
NVE
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
roth spots
dm leukaemia septic chorioretinitis less - pernicious anaemia, sickle cellm scurvy, SLE and other conn tissue disorder
31
periphlebitis
syphilis sarcoid pars planitis sickle cell less - TB, MS, eales, viral retinitis (HIV), behcets, fungal retinitis, bacteraemia
32
pigmented choroidal lesion
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
non pigmented choroidal lesion
hemangioma - red-orange maybe elevated met - cream or light brown, SRF, multifocal, BL choroidal osteoma (young woman) post scleritis lymphoma sclerochoroidal calcification
34
IOP elevated
``` glaucoma suprachoroidal haem hyphaema cc fist retrobulbar haem orbital disease ```
35
hypotony
``` rupture phthisis bulbi retinal / choroidal detach dehydration iridocyclitis cyclodialysis cleft ocular ischaemia drugs traumatic ciliary body shutdown ```
36
iris heterochromia - lighter
``` cong horner fuchs hic chronic uveitis xanthogranuloma met carc waardenburg syndrome ```
37
iris heterochromia - darker
``` ocular melanocytosis or oculodermal mel... hemosiderosis siderosis retained IOFB ocular melanoma or nevus retinoblastoma leuk/lymph ICE Fuch HIC ```
38
iris lesion
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
INV
``` dm ois crao/brao chronic uveitis chronic ret det tumour other ret vasc disease ```
40
ectopia lentis
``` 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
iridescent lens particle
``` drugs hypo ca myotonic dystrophy hypothyroid familial ```
42
lenticonus
anterior - alport | post - idiopathic
43
APD
severe - ON, ischaemic ON, CRAO, optic chiasm or tract lesion mild - amblyopia, dense vit haem, advance MD, BRVO or AO, ret det
44
anisocoria (constricted)
``` pilocarpine iritis horner argyll robertson chronic adie ```
45
anisocoria (dilated)
mydriatic adie CN3 physiologic
46
limitation ocular motility
w prop - orbital disease w/o prop - CN palsy, MG, chronic prog external ophthalmoplegia, entrapment, ophthalmoplegic migraine, duane syndrome, CNS disorder
47
optic disc atrophy
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
papilledema
``` 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
paradoxical pupil reaction
``` cong stationary night blindness cong achromatopsia on hypoplasia leber cong amaurosis best ON dominant optic atrophy albinism RP amblyopia ```
50
extraocular muscle thickening
thyroid orbitopathy idiopathic orbital inflam syndrome less - tumour lymph met lac gland spread, cc fist, SOV thromb, cavernous hemangioma, rhabdomyosarcoma
51
lac gland lesion
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
optic nerve lesion
glioma (kids) meningioma (adults) less - met, leuk, IOIS, sarcoid, ICP increase w ONH swell
53
orbital lesions
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
leukocoria paeds
``` retinoblastoma, toxocariasis, coats persistent fetal vasc / persistent hyperplastic prim vit cataract retinal astrocytoma ROP ``` other - coloboma, ret det, FEVR, myelimated nerve fibre, toxo
55
nystagmus paeds
``` congenital albinism leber congenital amaurosis cns injury (thalamic) spasmus mutans optic nerve or chiasmal glioma on hypo cataract aniridia cong corneal opacity ```
56
post op shallow AC
IOP high - pupil block, sch, malignant glau iop low - wound leak, choroidal detach, over filtration
57
post op hypotony
``` wound leak choroidal detach ciliary body shutdown cyclodialysis cleft ret det drugs ```
58
prog hyperopia
``` orbital tumour csr post scleritis presbyopia hypoglycaemia cataract refractive surg ```
59
prog myopia
``` myopia diabetes cataract staphyloma corneal ectasia miotic or sulfur drugs ```
60
altitudinal defect
ION BRVO or hemi ON less glauc, ON lesion or chiasm, ON coloboma
61
arcuate scotoma
glaucoma less - ION, drusen, high myope ON
62
binasal defect
glaucoma, bitemp retinal disease e.g. rp rare - bilat occipital disease, tumor or aneurysm comp both on or chiasm, chiasmatic arachnoiditis, nonphysiologic
63
bitemp defect
chiasm lesion (pituitary adenoma, menigioma, craniopharyngioma, aneurysm, glioma) less common - tilted discs rare - nasal RP
64
blind spot enlargement
pap, glauc, drusen, coloboma, myelinated, drugs, myopic disc, MEWDS, acute idiopathic blindspot elargement
65
central scotoma
mac disease. on, ION, optic neuropathy rare - occipital lesion
66
peripheral field constriction
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
homonymous hemi
optic tract or lgn lesion; temp or parietial or occ lesion more = stroke, tumour less = aneurysm trauma
68
vit opacity
``` ateroid hyalosis synchisis scintillans vit haem inflam age relat fb hyaloid remnants amyloidosis or whipple ```