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Wills Eye Manual > DDx of Ocular Signs > Flashcards

DDx of Ocular Signs Flashcards

1
Q

DDx of Hyphema

A

traumatic, iatrogenic (eg. intraocular surgery or laser), iris neovascularization, herpes simplex or zoster iridocyclitis, blood dyscrasia or clotting disorder (eg. hemophilia), anticoagulation, Fuchs heterochromic iridocyclitis, intraocular tumor (eg. juvenile xanthogranuloma, retinoblastoma, angioma)

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2
Q

DDx of Hypopyon

A

Infectious K ulcer, endophthalmitis, severe iridocyclitis (eg. HLA-B27 associated, Behcet disease), reaction to an intraocular lens (sterile hypopyon), retained lens particle, device contaminant after cataract surgery (toxic anterior segment syndrome), intraocular tumor necrosis (eg. pseudohypopyon from Rb), retained intraocular foreign body, tight contact lens, chronic K edema with ruptured bullae, severe infalmmatory rxn from a recurrent corneal erosion, Drugs (eg. Rifampin).

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3
Q

DDx of Blood in Canal of Schlemm on Gonioscopy

A

Compression of episcleral vessels by gonioprism (iatrogenic), Sturge-Weber syndrome, AV fistula (carotid-cavernous sinus fistula (c-c fistula)), superior vena cava obstruction, hypotony

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4
Q

DDx for conjunctival swelling (chemosis)

A

Allergy, any ocular or periocular inflammation, post-operative, drugs, venous congestion (eg. c-c fistula), angioneurotic edema, myxedema

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5
Q

DDx for conjunctival dryness (xerosis)

A

Vitamin A deficiency, postcicatricial conjunctivitis, SJS, ocular cicatricial pemphigoid, exposure (eg. lagophthalmos, absent blink reflex, proptosis), radiation, chronic dacryoadenitis, Sjogren syndrome

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6
Q

DDx of Congenital Corneal Edema

A

Congenital glaucoma, congenital hereditary endothelial dystrophy, posterior polymorphous corneal dystrophy (PPMD), birth trauma (foreceps injury)

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7
Q

DDx of Acquired Corneal Edema

A

Postoperative edema, aphakic or pseudophakic bullous keratopathy, Fuchs endothelial dystrophy, CL overwear, traumatic, exposure-related, chemical injury, acute increase in IOP (angle-closure glaucoma), K hydrops (decompensated Keratoconus), Herpes simplex or zoster keratitis, iritis, failed K graft, ICE syndrome, PPMD

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8
Q

DDx of dilated episcleral vessels (without ocular irritation or pain)

A

underlying uveal neoplasm, AV fistula (eg. c-c fistula), polycythemia vera, leukemia, ophthalmic vein or cavernous sinus thrombosis, extravascular blockage of ophthalmic/orbital venous outflow

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9
Q

DDx of enlarged K nerves?

A

Most Imp: MEN IIB (medullary carcinoma of thyroid, pheochromocytoma, mucosal neuromas, may have marfanoid habitus)
- acanthamoeba keratitis, chronic keratitis, keratoconus, neurofibromatosis, Fuchs endothelial dystrophy, Refsum syndrome, trauma, congenital glaucoma, failed K graft, Leprosy, ichthyosis, idiopathic, normal variant

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10
Q

DDx of membranous conjunctivitis? (membrane removal is difficult and causes bleeding)

A

Streptococci, pneumococci, chemical burn, ligneous conjunctivitis, Corynebacterium diphtheriae, HSV, ocular vaccinia

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11
Q

DDx of pseudomembranous conjunctivitis? (membrane removal is easy and without bleeding)

A

DDx includes causes of membranous conjunctivitis as well as:
Adenovirus (rarely causes true membrane formation), ocular cicatricial pemphigoid, SJS, SLK, gonococci, staphylococci, chlamydia in newborns

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12
Q

DDx of Opacification of the Cornea in Infancy

A

Congenital glaucoma, birth trauma (foreceps injury), congenital hereditary endothelial or stromal dystrophy (bilateral), PPMD, developmental abnormality of anterior segment (eg. Peters anomaly), metabolic abnormalities (bilateral; eg. mucopolysaccharidoses, mucolipidoses), interstitial keratitis, HSV, K ulcer, K dermoid, sclerocornea

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13
Q

DDx of Pannus (superficial vascular invasion of the cornea)

A

Ocular rosacea, tight contact lens or CL overwear, phlyctenule, chlamydia (trachoma and inclusion conjunctivitis), SLK (micropannus only), staphylococcal hypersensitivity, vernal keratoconjunctivitis, HSV or zoster, chemical burn, ocular cicatricial pemphigoid, aniridia, molluscum contagiosum, leprosy

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14
Q

DDx of pigmentation/discoloration of the conjunctiva

A

Racial melanosis (perilimbal), nevus, primary acquired melanosis, melanoma, ocular and oculodermal melanocytosis (congenital, blue-gray), Addison disease, pregnancy, radiation, jaundice, resolving subconj hemorrhage, conjunctival or subconj FB, pharmacologic (eg. chlorpromazine, topical epinephrine), cosmetic (eg. mascara/makeup deposits, tattoo)

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15
Q

DDx of symblepharon (fusion of palpebral and bulbar conjunctiva)

A

ocular cicatricial pemphigoid, SJS, chemical burn, trauma, drugs, long-standing conjunctival or episcleral inflammation, EKC, atopic conjunctivitis, radiation, congenital, iatrogenic (post-surgical)

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16
Q

DDx of Whorl-like opacity in the corneal epithelium (Verticillata)

A

Amiodarone, chloroquine, Fabry disease and carrier state, phenothiazines, indomethacin

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17
Q

DDx of Bull’s-Eye Macular Lesion

A

ARMD, Stargardt disease or fundus flavimaculatus, albinism, cone dystrophy, rod-cone dystrophy, chloroquine or hydroxychloroquine retinopathy, adult-onset foveomacular vitelliform dystrophy, Spielmeyer-Vogt syndrome, central areolar choroidal dystrophy

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18
Q

DDx of choroidal folds

A

Orbital or choroidal tumor, idiopathic orbital inflammatory syndrome, thyroid eye disease, posterior scleritis, hypotony, retinal detachment, marked hyperopia, scleral laceration, papilledema, postoperative

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19
Q

DDx of choroidal neovascularization (gray-green membrane or blood seen deep to the retina) - More Common

A

ARMD, ocular histoplasmosis syndrome, high myopia, idiopathic polypoidal choroidal vasculopathy, angioid streaks, choroidal rupture (trauma)

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20
Q

DDx of choroidal neovascularization (gray-green membrane or blood seen deep to the retina) - Less Common

A

Drusen of the optic nerve head, tumors, retinal scarring after laser photocoagulation, posterior uveitis (eg. VKH, MFC, serpiginous choroiditis), idiopathic

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21
Q

DDx for retinal arterial embolus

A
  • Platelet-fibrin (dull gray and elongated): carotid disease, less commonly cardiac
  • Cholesterol (sparkling yellow, usually at an arterial bifurcation): Carotid disease
  • Calcium (dull white, typically around or on the disc): cardiac disease
  • Cardiac myxoma (common in young patients, particularly in the left eye; often occludes the ophthalmic or CRA and is not seen)
  • Talc and cornstarch (small yellow-white glistening particles in macular arterioles; may produce peripheral retinal neovascularization): IV drug abuse
  • Lipid or Air (CWS, not emboli are often seen): results from chest trauma (Purtscher retinopathy) and fx of long bones
  • Others: tumors, parasites, other FB
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22
Q

DDx for Macular exudates

A

More Common: Diabetes, choroidal (subretinal) neovascular membrane, HTN

Less Common: Macroaneurysm, Coats disease (children), peripheral retinal capillary hemangioma, retinal vein occlusion, papilledema, radiation retinopathy

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23
Q

DDx for normal fundus in the presence of decreased vision

A

Retrobulbar optic neuritis, cone degeneration, Stargardt dz or fundus flavimaculatus, other optic neuropathy (eg. Leber hereditary optic neuropathy, tumor, alcohol, or tobacco), rod monochromatism, amblyopia, CAR, MAR, nonphysiologic visual loss

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24
Q

DDx for optociliary shunt vessels on the disc (AKA retinochoroidal shunt vessels)

A

Orbital or intracranial tumor (esp. meningioma), prior CRVO, chronic papilledema (eg. pseudotumor cerebri), chronic open angle glaucoma, optic nerve glioma

25
DDx of Posterior pole retinal neovascularization
Diabetes, prior CRVO
26
DDx of peripheral retinal neovascularization
Sickle cell retinopathy, prior BRVO, diabetes, sarcoidosis, syphilis, OIS (carotid occlusive dz), pars planitis, Coats disease, ROP, embolization from IV drug abuse (talc retinopathy), chronic uveitis, others (leukemia, anemia, Eales disease, familial exudative vitreoretinopathy)
27
DDx of Roth Spots (Retinal Hemorrhages with white centers)
MC: Diabetes, Leukemia, septic chorioretinitis (2/2 bacterial endocarditis Less Common: Pernicious anemia, SSA, scurvy, SLE, connective tissue dz
28
DDx of Sheathing of retinal veins (periphlebitis)
MC: Syphilis, sarcoidosis, pars planitis, Sickle cell disease LC: TB, MS, Eales disease, viral retinitis (HIV, herpes), Behcet disease, fungal retinitis, bacteremia
29
DDx of decreased IOP (hypotony)
Ruptured globe, phthisis bulbi, retinal/choroidal detachment, iridocyclitis, severe dehydration, cyclodialysis cleft, ocular ischemia, drugs (glaucoma meds), post-operative, traumatic ciliary body shutdown
30
DDx of Iris Heterochromia - Involved iris is lighter than normal
Congenital Horner syndrome, most cases of Fuchs heterochromic iridocycltitis, chronic uveitis, juvenile xanthogranuloma, metastatic carcinoma, Waardenburg syndrome
31
DDx of Iris Heterochromia - Involved iris is darker than normal
Ocular melanocytosis or oculodermal melanocytosis, hemosiderosis, siderosis, retained IOFB, ocular malignant melanoma, diffuse iris nevus, retinoblastoma, leukemia, lymphoma, ICE syndrome, some cases of Fuchs heterochromic iridocyclitis
32
DDx of Melanotic (brown) iris lesion
Nevus, Melanoma, adenoma, adenocarcinoma of the iris pigment epithelium Cysts, FBs, neurofibromas and other lesions may appear pigmented in heavily pigmented irides.
33
DDx of Amelanotic (white, yellow or orange) iris lesion
amelanotic melanoma, inflammatory nodule or granuloma (eg. sarcoid, TB, leprosy, other granulomatous dz), neurofibroma, patchy hyperemia of syphilis, JXG, medulloepithelioma, FB, cyst, leiomyoma, seeding from posterior segment tumor
34
DDx of Neovascularization of the Iris
Diabetic retinopathy, OIS, after CRVO/BRVO or CRAO/BRAO, chronic uveitis, chronic RD, intraocular tumor (eg. RB, melanoma), other retinal vascular dz
35
DDx of Iridescent Lens particles
Drugs, Hypocalcemia, myotonic dystrophy, hypothyroidism, familial, idiopathic
36
DDx of Anterior Lenticonus (marked convexity of anterior lens)
``` Alport syndrome (hereditary nephritis) AL - ALport ```
37
DDx of Posterior Lenticonus (marked concavity of posterior lens surface)
Usually idiopathic, may be a/w persistent fetal vasculature
38
DDx of severe APD (2-3+)
Optic nerve disease (ischemic optic neuropathy, optic neuritis, tumor, glaucoma), CRAO, CRVO, less commonly a lesion of the optic chiasm or tract
39
DDx of mild APD (1+)
any causes of more severe APD, amblyopia, dense vit heme, advanced AMD, BRVO, BRAO, RD, other retinal disease
40
DDx of ocular motility limitation without exophthalmos and resistance to retropulsion
Isolated CN 3, 4, or 6 palsy, multiple ocular motor nerve palsies (eg. cavernous sinus and assoc. syndromes), myasthenia gravis, CPEO and assoc. syndromes, orbital blow-out fx with muscle entrapment, ophthalmoplegic migraine, Duane syndrome, other CNS disorders
41
DDx of Optic disc atrophy
MC: Glaucoma, prior CRVO or CRAO, prior Ischemic optic neuropathy, chronic optic neuritis, chronic papilledema, compression of optic nerve/chiasm/tract, prior traumatic optic neuropathy LC: syphilis, retinal degeneration (eg. RP), toxic or metabolic optic neuropathy, LHON, Leber congenital amaurosis, radiation neuropathy, lysosomal storage disease (Tay-sachs), other congenital/hereditary optic atrophy
42
DDx of Paradoxical pupillary reaction (pupil dilates in light and constricts in darkness)
Congenital stationary night blindness, congenital achromatopsia, optic nerve hypoplasia, Leber congenital amaurosis, Best disease, optic neuritis, dominant optic atrophy, albinism, RP, rarely amblyopia
43
DDx of EOM thickening on imaging
MC: thyroid orbitopathy (often spares tendon), idiopathic orbital inflammatory syndrome LC: Tumor (eg. lymphoma, mets, or spread of lacrimal gland tumor), c-c fistula, superior ophthalmic vein thrombosis, cavernous hemangioma, rhabdomyosarcoma (peds)
44
DDx of Optic nerve lesion (Isolated)
MC: Optic nerve glioma (esp in kids), optic nerve meningioma (esp in adults) LC: Mets, Leukemia, idiopathic orbital inflammatory syndrome, sarcoidosis, increased intracranial pressure w/ secondary ON swelling
45
DDx of Nystagmus in infancy
Congenital nystagmus, albinism, Leber congenital amaurosis, CNS (thalamic injury), spasmus nutans, optic nerve or chiasmial glioma, optic nerve hypoplasia, congenital cataracts, aniridia, congenital corneal opacities
46
Postop complications: | DDx of Shallow AC w/ increased IOP
Pupillary block glaucoma, capsular block syndrome, suprachoroidal hemorrhage, malignant glaucoma
47
Postop complications: | DDx of Shallow AC w/ decreased IOP
Wound leak, choroidal detachment, overfiltration after glaucoma filtering procedure
48
DDx of Hypotony
Wound leak, choroidal detachment, cyclodialysis cleft, retinal detachment, ciliary body shutdown, pharm aqueous suppression, overfiltration after glaucoma filtering procedure
49
DDx of progressive hyperopia
orbital tumor pressing on posterior surface of the eye, serous elevation of the retina (eg. CSCR), posterior scleritis, presbyopia, hypoglycemia, cataracts, after radial keratotomy or other refractive surgery
50
DDx of progressive myopia
High (pathologic) myopia, diabetes, staphyloma and elongation of the globe, corneal ectasia (keratoconus or s/p K refractive surgery), medications (eg. miotic drops, sulfa drugs, tetracycline), childhoold (physiologic)
51
DDx of Altitudinal field defect
MC: Ischemic Optic Neuropathy, HRAO/BRAO, HRVO/BRVO, optic neuritis LC: Glaucoma, optic nerve or chiasmal lesion, optic nerve coloboma
52
DDx of Arcuate scotoma
MC: glaucoma LC: Ischemic optic neuropathy (esp. nonarteritic), optic disc drusen, high myopia, optic neuritis
53
DDx of Binasal field defect
MC: glaucoma, bitemporal retinal disease (eg. Retinitis pigmentosa) LC: bilateral occipital disease, tumor or aneurysm compressing both optic nerves or chiasm, chiasmatic arachnoiditis, nonphysiologic
54
DDx of bitemporal hemianopsia
MC: chiasmal lesion (eg. Pituitary adenoma, meningioma, craniopharyngioma, aneurysm, glioma) LC: tilted optic discs Rare: nasal retinitis pigmentosa
55
DDx of Blind spot enlargement
Papilledema, glaucoma, optic nerve drusen, optic nerve coloboma, myelinated (medullated) nerve fibers off the disc, drugs, myopic disc with a crescent, MEWDS, Acute idiopathic blind spot enlargement syndrome (AIBSE - may be on spectrum with MEWDS)
56
DDx of Central scotoma
Macular disease, optic neuritis, ischemic optic neuropathy (more commonly produces an altitudinal defect), optic atrophy (eg. from tumor compressing the nerve, toxic or metabolic disease) Rarely: occipital cortex lesion
57
DDx of constriction of peripheral visual fields (tunnel vision)
glaucoma, retinitis pigmentosa or other peripheral retinal disorders (eg. gyrate atrophy), chronic papilledema, s/p PRP or cryotherapy, CRAO w/ cilioretinal artery sparing, bilateral occipital lobe infarction w/ macular sparing, nonphysiologic vision loss, medications (eg. phenothiazines), vit. A deficiency, CAR, MAR, or autoimmune-associated retinopathy
58
DDx of homonymous hemianopsia
Temporal, parietal, or occipital lobe lesion of the brain (eg. stroke and tumor more common, aneurysm and trauma less common), optic tract or lateral geniculate body lesion. Migraine may cause transient homonymous hemianopsia.
59
DDx of vitreous opacities
asteroid hyalosis, vit heme, inflammatory cells from vitritis or posterior uveitis, snowball opacities of pars planitis or sarcoidosis, normal vitreous strands from age-related vitreous degeneration, tumor cells, FB, hyaloid remnants, synchysis scintillans, rarely: amyloidosis or Whipple dz.

Wills Eye Manual (5 decks)

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