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Wills Eye Manual > DDx of Ocular Sxs > Flashcards

DDx of Ocular Sxs Flashcards

1
Q

More Common DDx for Burning?

A

Blepharitis, meibomitis, dry eye syndrome, conjunctivitis (infectious, allergic, mechanical, chemical)

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2
Q

Less Common DDx for Burning?

A

Corneal defects (usually w/ fluorescein staining of K), inflamed pterygium or pinguecula, episcleritis, SLK, ocular toxicity (medication, makeup, CL solutions), Contact lens-related problems

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3
Q

Most Common DDx for Transient Vision Loss (vision returns to normal within 24 hours, usually within 1 hr)

A
  • Papilledema (few seconds and usually bilateral) ;
  • Amaurosis fugax (few minutes and unilateral);
  • Vertebrobasilar artery insufficiency (bilateral and usually few minutes);
  • Migraine (10-60 minutes and with or without subsequent headache)
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4
Q

Less Common DDx for Transient Vision Loss (vision returns to normal within 24 hours, usually within 1 hr)

A

-Impending CRVO, Ischemic optic neuropathy, ocular ischemic syndrome (carotid occlusive disease), glaucoma, sudden change in BP, CNS lesion, optic disc drusen, orbital lesion (vision loss may be a/w eye movement)

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5
Q

DDx for Sudden, Painless Vision loss lasting >24 hrs? (most common)

A

Retinal artery or vein occlusion, ischemic optic neuropathy, GCA, vitreous hemorrhage, retinal detachment, optic neuritis (pain w/ eye movement in >50%), sudden discovery of pre-existing unilateral vision loss

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6
Q

DDx for Sudden, Painless Vision loss lasting >24 hrs? (Less common)

A

Other retinal or CNS disease (eg. Stroke), toxins (eg methanol poisoning), ophthalmic artery occlusion (may be a/w EOM deficits, ptosis)

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7
Q

DDx for gradual (over weeks, months or years), painless visual loss lasting >24 hours? (more common)

A

Cataract, refractive error, open angle glaucoma, chronic angle closure glaucoma, chronic retinal disease (eg. ARMD, Diabetic retinopathy)

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8
Q

DDx for gradual (over weeks, months or years), painless visual loss lasting >24 hours? (Less common)

A

Chronic corneal disease (eg. K dystrophy), optic neuropathy/atrophy (eg. CNS tumor),

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9
Q

DDx for painful vision loss lasting >24 hrs?

A

Acute angle closure glaucoma, optic neuritis (may have pain w/ eye movements), uveitis, endophthalmitis, corneal hydrops (keratoconus)

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10
Q

DDx for post-traumatic vision loss?

A

Eyelid swelling, K irregularity, hyphema, ruptured globe, traumatic cataract, commotio retinae, retinal detachment, retinal/vitreous hemorrhage, lens dislocation, traumatic optic neuropathy, cranial neuropathies, CNS injury, sympathetic ophthalmia (rare)

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11
Q

How do you make a diagnosis of non-physiologic vision loss?

A

Diagnosis of exclusion

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12
Q

DDx for distortion of vision? (most common)

A

Refractive error -including presbyopia, acquired myopia (eg. from cataract, diabetes, pregnancy, ciliary spasm, ciliary body rotation, medications, retinal detachment surgery), acquired astigmatism (eg. from anterior segment surgery, periorbital or eyelid edema/mass (eg. chalazion, orbital trauma), macular disease (eg. CSCR, macular edema, ARMD, CNVM), corneal irregularity, intoxication (eg. methanol, ethanol), pharmacologic (eg. scopolamine patch)

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13
Q

DDx for distortion of vision? (Less common)

A

Keratoconus, topical eye drops (eg. miotics, cycloplegics), retinal detachment, migraine (transient), hypotony, CNS abnormality (including papilledema), non-physiologic

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14
Q

DDx for Monocular Diplopia? (More common)

A

Refractive Error, incorrect spectacle alignment, corneal opacity or irregularity, cataract, iris defect (eg. iridectomy)

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15
Q

DDx for Monocular Diplopia? (Less common)

A

Dislocated natural lens or lens implant, macular disease, retinal detachment, CNS causes (rare), non-physiologic

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16
Q

DDx for typically intermittent Binocular Diplopia?

A

Myasthenia gravis, intermittent decompensation of an existing phoria

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17
Q

DDx for constant Binocular Diplopia?

A
  • Isolated 6th, 3rd, or 4th CN palsy;
  • orbital disease (thyroid eye disease;
  • idiopathic orbital inflammation, tumor);
  • cavernous sinus/superior orbital fissure syndrome,
  • status post ocular surgery (eg. residual anesthesia, displaced muscle, muscle surgery, restriction from scleral buckle, severe aniseikonia after refractive surgery),
  • status-post trauma (eg. orbital wall fx with EOM entrapment, orbital edema),
  • convergence/divergence insufficiency,
  • internuclear ophthalmoplegia,
  • vertebrobasilar artery insufficiency,
  • CNS lesions,
  • spectacle problem
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18
Q

DDx for eyelash loss?

A

Trauma, Burn, cutaneous neoplasm (eg. sebaceous gland carcinoma), eyelid infection or inflammation, radiation, chronic skin disease (eg. alopecia areata), VKH, thyroid disease, trichotillomania

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19
Q

DDx for Eyelid Crusting? (Most common)

A

Blepharitis, meibomitis, conjunctivitis

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20
Q

DDx for Eyelid Crusting? (Less common)

A

Canaliculitis, NLD obstruction, dacryocystitis

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21
Q

DDx for Eyelid swelling that is a/w inflammation/erythema? (most common)

A

Hordeolum, blepharitis, conjunctivitis, preseptal or orbital cellulitis, trauma, contact dermatitis, herpes simplex or zoster dermatitis

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22
Q

DDx for Eyelid swelling that is a/w inflammation/erythema? (Less common)

A

Ectropion, corneal abnormality, urticaria or angioedema, blepharochalasis, insect bite, dacryoadenitis, erysipelas, eyelid or lacrimal gland mass, autoimmunities (eg. discoid lupus, dermatomyositis)

23
Q

DDx for Eyelid swelling that is NOT a/w inflammation/erythema?

A

Chalazion, dermatochalasis, prolapse of orbital fat (retropulsion of the globe increases the prolapse), eyelid or lacrimal gland mass, eyelid laxity, Foreign body, cardiac/renal/thyroid disease, superior vena cava syndrome

24
Q

DDx for Eyelid twitch?

A

Orbicularis myokymia (a/w fatigue, excess caffeine, medication, or stress), corneal or conjunctival irritation (esp from an eyelash, cyst, or foreign body/suture), dry eye, blepharospasm (bilateral), hemifacial spasm, serum electrolyte abnormality, touretes, tic douloureux, albinism/congenital glaucoma (photosensitivity), anemia (rare)

25
Q

DDx of Eyelids unable to close (Lagophthalmos)?

A

Severe proptosis, ectropion or eyelid laxity, severe chemosis, eyelid scarring, eyelid retractor muscle scarring, CN7 palsy, status post facial cosmetic /reconstructive surgery

26
Q

DDx of Eyes “jumping” (oscillopsia)?

A

Acquired nystagmus, Internuclear ophthalmoplegia, myasthenia gravis, vestibular function loss, opsoclonus/ocular flutter, superior oblique myokymia, various CNS disorders

27
Q

DDx of Flashes of Light (more common)?

A

Retinal break/detachment, PVD, migraine, rapid eye movements (particularly in darkness), oculodigital stimulation, dysphotopsias caused by IOL

28
Q

DDx of Flashes of Light (less common)?

A

CNS (particularly occipital lobe) disorders, vestibulobasilar artery insufficiency, optic neuropathies, retinitis/uveitis, entoptic phenomena, drug-related, hallucinations, iatrogenic (eg. post laser photocoagulation)

29
Q

DDx of Foreign Body Sensation?

A

Dry Eye Syndrome, Blepharitis, Conjunctivitis, Trichiasis, corneal or conjunctival abnormality (eg. cyst, K abrasion, or FB, recurrent erosion, superficial punctate keratopathy), contact lens-related problem, episcleritis, pterygium, pinguecula

30
Q

DDx of Glare?

A

Cataract, pseudophakia, PCO, K irregularity or opacity, altered pupillary/iris structure or response, status-post refractive surgery, PVD, pharmacologic (eg. atropine)

31
Q

DDx of hallucinations (formed images)?

A

PVD, retinal detachment, optic neuropathies, blind eyes, bilateral eye patching, Charles Bonnet syndrome, psychosis, parietotemporal lesions, other CNS causes, medications

32
Q

DDx of Halos around lights?

A

Cataract, pseudophakia, PCO, acute angle closure glaucoma, K edema (eg. bullous keratopathy, CL overwear), K dystrophies, s/p refractive surgery, corneal haziness, discharge, PDS, vitreous opacities, drugs (eg. digitalis, chloroquine)

33
Q

DDx of Itchy Eyes?

A

Conjunctivitis (es. allergic, vernal, and viral), blepharitis, dry eye syndrome, topical drug allergy or contact dermatitis, giant papillary conjunctivitis, CL-related problems

34
Q

DDx of Light Sensitivity (photophobia) with an Abnormal eye exam? (more common)

A

Corneal abnormality (eg. abrasion, or edema), anterior uveitis

35
Q

DDx of Light Sensitivity (photophobia) with an Abnormal eye exam? (less common)

A

Conjunctivitis (mild photophobia), posterior uveitis, scleritis, albinism, total color blindness, aniridia, mydriasis of any etiology (eg. pharmacologic, traumatic), congenital glaucoma

36
Q

DDx of Light Sensitivity (photophobia) with a normal eye exam?

A

Migraine, meningitis, retrobulbar optic neuritis, subarachnoid hemorrhage, trigeminal neuralgia, lightly pigmented irides

37
Q

DDx of Night Blindness (more common)?

A
  • Refractive error (esp. undercorrected myopia),
  • advanced glaucoma or optic atrophy,
  • small pupil (esp from miotic drops),
  • retinitis pigmentosa,
  • congenital stationary night blindness,
  • s/p panretinal photocoagulation,
  • drugs (eg. phenothiazines, chloroquine, quinine)
38
Q

DDx of Night Blindness (Less common)?

A

Vitamin A deficiency, gyrate atrophy, choroideremia

39
Q

DDx of mild-moderate ocular pain?

A

Dry eye syndrome, blepharitis, infectious conjunctivitis, episcleritis, inflamed pinguecula/pterygium, foreign body (corneal or conj), corneal disorder (eg. SPK), SLK, ocular medication toxicity, CL-related problems, post-operative, ocular ischemic syndrome, eye strain from uncorrected refractive error (asthenopia)

40
Q

DDx of moderate-severe ocular pain?

A

Corneal disorder (eg. abrasion, erosion, infiltrate/ulcer/keratitis, chemical injury, UV burn), trauma, anterior uveitis, scleritis, endophthalmitis, acute angle closure glaucoma

41
Q

DDx of Periorbital pain?

A

Trauma, hordeolum, preseptal cellulitis, dacryocystitis, dermatitis (eg. contact, chemical, varicella zoster, herpes simplex), referred pain (eg. dental, sinus), GCA, tic douloureux

42
Q

DDx of orbital pain?

A

sinusitis, trauma, orbital cellulitis, idiopathic orbital inflammatory syndrome, orbital tumor or mass, optic neuritis, acute dacryoadenitis, migraine or cluster headache, diabetic cranial nerve palsy, post-infectious neuralgia (herpetic)

43
Q

DDx of Asthenopia? (eye strain - eyes are sore, tired, achy)

A

Uncorrected refractive error, phoria or tropia, convergence insufficiency, accommodative spasm, pharmacologic (miotics)

44
Q

DDx of Red Eye: what are the 4 categories?

A

Adnexal causes,
Conjunctival causes,
Corneal causes,
Other

45
Q

DDx of Red Eye: what are the adnexal causes?

A

Trichiasis, distichiasis, floppy eyelid syndrome, entropion or ectropion, lagophthalmos, blepharitis, meibomitis, acne rosacea, dacryocystitis, canaliculitis

46
Q

DDx of Red Eye: what are the conjunctival causes?

A

Ophthalmia neonatorum (in infants), conjunctivitis (bacterial, viral, chemical, allergic, atopic, vernal, medication toxicity), subconjunctival hemorrhage, inflamed pinguecula, superior limbic keratoconjunctivitis, giant papillary conjunctivitis, conjunctival foreign body, symblepharon and associated etiologies (eg. ocular cicatricial pemphigoid, SJS, TEN), conjunctival neoplasia

47
Q

DDx of Red Eye: what are the corneal causes?

A

Infectious or inflammatory keratitis, CL-related problems, K foreign body, recurrent corneal erosion, pterygium, neurotrophic keratopathy, medicamentosa, UV or chemical burn

48
Q

DDx of Red Eye: what are the Other causes? (ie. not K, conj, or adnexal causes)

A

Trauma, postoperative, dry eye syndrome, endophthalmitis, anterior uveitis, episcleritis, scleritis, pharmacologic (eg. prostaglandin analogs), angle-closure glaucoma, carotid-cavernous fistula (corkscrew conjunctival vessels), cluster headache

49
Q

DDx for TRANSIENT “spots” in front of the eyes

A

Migraine

50
Q

DDx for Permanent/Long-standing “spots” in front of the eyes

A

More Common: PVD, Intermediate or Posterior Uveitis, Vitreous hemorrhage, vitreous condensation/debris

Less Common: Hyphema/microhyphema, retinal break or detachment, corneal opacity/dystrophy or foreign body

51
Q

DDx for Tearing in adults a/w pain present?

A

Corneal abnormality (eg. abrasion, FB, rust ring, recurrent erosion, edema), anterior uveitis, eyelash or eyelid disorder (eg. trichiasis, entropion), conjunctival foreign body, dacryocystitis, dacryoadenitis, canaliculitis, trauma

52
Q

DDx for Tearing in adults a/w Minimal / No pain present?

A

Dry eye syndrome, blepharitis, NLD obstruction, punctal occlusion, lacrimal sac mass, ectropion, conjunctivitis (esp. allergic and toxic), crocodile tears (congenital or 7th nerve palsy), emotional state

53
Q

DDx for tearing in children?

A

NLD obstruction, congenital glaucoma, corneal or conjunctival foreign body, other irritative disorder

Wills Eye Manual (5 decks)

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