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Ophthalmology > The Wills Eye Manual: Differential Diagnosis of Ocular Symptoms (Chapter 1) > Flashcards

The Wills Eye Manual: Differential Diagnosis of Ocular Symptoms (Chapter 1) Flashcards

1
Q

Burning? (4 More, 6 Less)

A

More:

  • Blepharitis,
  • Meibomitis,
  • DES
  • Conjunctivitis

Less:

  • Corneal defects
  • Inflamed pterygium or pinguecula
  • Episcleritis
  • SLK
  • Ocular toxicity (med, makeup, contact lens solution)
  • Contact lens-related problems
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2
Q

Define Transient Visual Loss?

A

Vision returns to normal within 24 hours, usually within 1 hour

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3
Q

More common causes of transient visual loss lasting: Few seconds? Few minutes? Ten to 60 minutes?

A

Few seconds: Papilledema (usually bilateral)
Few minutes: Amaurosis fugax
Ten to 60 minutes: Migraine (with or without HA)
Any of these may causes varying lengths of transient visual loss.

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4
Q

Less common causes of transient visual loss? (9)

A
  • Impending CRAO
  • Ischemic optic neuropathy
  • Ocular ischemic syndrome (carotid occlusive disease)
  • Glaucoma
  • Sudden change in BP (i.e. orthostatic hypotension)
  • CNS lesion
  • Optic disc drusen
  • AION (giant cell arteritis)
  • Orbital lesion (vision loss may be associated with EOM)
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5
Q

More common causes of sudden, painless visual loss lasting >24 hours? (7)

A
  • RAO
  • RVO
  • Ischemic optic neuropathy
  • Vitreous hemorrhage
  • Retinal detachment
  • Optic neuritis (pain with EOM in >50% of cases)
  • Sudden discovery of preexisting unilateral visual loss
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6
Q

Less common causes of sudden, painless visual loss lasting >24 hours? (3)

A
  • CNS disease (stroke, tumor, etc)
  • Methanol poisoning
  • Ophthalmic artery occlusion (may also have EOM deficit and ptosis)
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7
Q

More common causes of gradual, painless visual loss over weeks to months/years? (7 )

A
  • Cataract
  • Refractive error
  • Open-angle glaucoma
  • Chronic angle-closure glaucoma
  • Chronic retinal disease (e.g, ARMD, diabetic retinopathy)
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8
Q

Less common causes of gradual, painless visual loss over weeks to months/years? (2)

A
  • Chronic corneal disease (e.g., corneal dystrophy)

- Optic neuropathy/atrophy (e.g., CNS tumor)

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9
Q

Painful loss of vision? (5)

A
  • Acute angle-closure glaucoma
  • Optic neuritis (pain may only be with EOM)
  • Uveitis
  • Endophthalmitis
  • Corneal hydrops (keratoconus)
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10
Q

Posttraumatic visual loss? (12)

A
  • Eyelid swelling
  • Corneal irregularity
  • Hyphema
  • Ruptured globe
  • Traumatic cataract
  • Lens dislocation
  • Commotio retinae
  • Retinal detachment
  • Retinal or vitreous hemorrhage
  • Traumatic optic neuropathy
  • Cranial neuropathies
  • CNS injury
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11
Q

More common causes of distortion of vision? (7)

A
  • Refractive error
  • Acquired myopia
  • Acquired astigmatism
  • Macular disease
  • Corneal irregularities
  • Intoxication (e.g. methanol, ethanol, hallucinogens)
  • Pharmacologic (e.g. scopolamine patch)
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12
Q

Causes of acquired myopia? (5)

A
  • Cataract
  • Diabetes (edema of lens)
  • Ciliary spasm
  • Medications
  • Retinal detachment surgery
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13
Q

Causes of acquired astigmatism? (4)

A
  • Anterior segment surgery
  • Chalazion
  • Orbital fracture
  • Corneal edema
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14
Q

Less common causes of distortion of vision? (7)

A
  • Keratoconus
  • Topical eye drops (e.g. mitotics, cycloplegics)
  • Retinal detachment
  • Migraines
  • Hypotony
  • CNS abnormalities (including papilledema)
  • Nonphysiologic
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15
Q

More common causes of monocular diplopia? (5)

A
  • Refractive error
  • Incorrect spectacle alignment
  • Corneal opacities or irregularities
  • Cataract
  • Iris defects
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16
Q

Less common causes of monocular diplopia? (5)

A
  • Dislocated natural lens or lens implants
  • Macular disease
  • Retinal detachment
  • CNS causes (very rare)
  • Nonphysiologic
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17
Q

Typically intermittent causes of binocular diplopia? (2)

A
  • Myasthenia gravis

- Intermittent decompensation of an existing phoria

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18
Q

Typically constant causes of binocular diplopia? (9)

A
  • Isolated sixth, third, or forth nerve palsy
  • Orbital disease (Thyroid eye disease, Idiopathic inflammation, Orbital tumor)
  • Cavernous sinus/superior orbital fissure syndrome
  • Status-post ocular surgery
  • Status-post trauma (Orbital wall fracture, orbital edema)
  • Internuclear ophthalmoplegia
  • Vertebrobasilar artery insufficiency
  • Other CNS lesions
  • Spectacle problem
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19
Q

Eyelash loss? (9)

A
  • Trauma
  • Burn
  • Thyroid disease
  • Vogt-Koyanagi-Harada syndrome
  • Eyelid infection or inflammation
  • Radiation
  • Chronic skin disease (e.g. alopecia areata)
  • Cutaneous neoplasm
  • Trichotillomania
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20
Q

Eyelid crusting? (3 More, 3 Less)

A

More:

  • Blepharitis
  • Meibomitis
  • Conjunctivitis

Less:

  • Canaliculitis
  • Nasolacrimal duct obstruction
  • Dacryocystitis
21
Q

More common causes of eyelid swelling associated with inflammation (usually erythematous)?

A
  • Hordeolum
  • Blepharitis
  • Meibomitis
  • Preseptal or orbital cellulitis
  • Trauma
  • Contact dermatitis
  • Herpes simplex or zoster dermatitis
22
Q

Less common causes of eyelid swelling associated with inflammation (usually erythematous)? (9)

A
  • Ectropion
  • Corneal abnormalities
  • Urticaria or angioedema
  • Blepharochalasis
  • Insect bite
  • Dacryoadenitis
  • Erysipelas
  • Eyelid or lacrimal gland mass
  • Autoimmune disease
23
Q

Eyelid Twitching? (10)

A
  • Orbicularis myokymia (fatigue, caffeine, meds, stress)
  • Corneal or conjunctival irritation
  • Dry eye
  • Blepharospasm (bilateral)
  • Hemifacial spasm
  • Albinism (photosensitivity)
  • Serum electrolyte abnormality
  • Tourettes
  • Tic douloureux
  • Anemia (rarely)
24
Q

Unable to close eyelids? (6)

A
  • Severe proptosis
  • Severe chemosis
  • Eyelid scaring
  • Eyelid retractor muscle scarring
  • Seventh cranial nerve palsy
  • Status-post facial cosmetic or reconstructive surgery
25
Q

Eye “Jumping” (Oscillopsia)? (7)

A
  • Acquired nystagmus
  • Internuclear ophthalmoplegia
  • Myasthenia gravis
  • Vestibular function loss
  • Opsoclonus/ocular flutter
  • Superior oblique myokymia
  • Various CNS disorders
26
Q

More common causes of flashes of light? (5)

A
  • Retinal break or detachment
  • Posterior vitreous detachment
  • Migraine
  • Rapid eye movement
  • Oculodigital stimulation
27
Q

Less common causes of flashes of light? (6)

A
  • CNS disorders (particular occipital lobe)
  • Vestibulobasilar artery insufficiency
  • Optic neuropathies
  • Retinitis
  • Entoptic phenomena
  • Hallucinations
28
Q

Foreign body sensation? (9)

A
  • DES
  • Blepharitis
  • Conjunctivitis
  • Trichiasis
  • Corneal abnormality
  • Contact lens-related problem
  • Episcleritis
  • Pterygium
  • Pinguecula
29
Q

Glare (8)

A
  • Cataract
  • Pseudophakia
  • Posterior capsular opacity
  • Corneal irregularity or opacity
  • Altered pupillary structure or response
  • Status-post refractive surgery
  • Posterior vitreous detachment
  • Pharmacologic (e.g. atropine)
30
Q

Hallucinations (Formed images)? (11)

A
  • Posterior vitreous detachments (white lighting streaks of Moore)
  • Retinal detachment
  • Optic neuropathies
  • Blind eyes
  • Bilateral eye patching
  • Charles Bonnet Syndrome
  • Psychosis
  • Parietotemporal area lesions
  • Other CNS disorders
  • Intoxications
  • Medications
31
Q

Halos Around Lights? (12)

A
  • Cataracts,
  • Pseudophakia
  • Posterior capsular opacity
  • Acute angle-closure glaucoma due to corneal edema
  • Corneal edema of any cause
  • Corneal dystrophies
  • Status-post refractive surgery
  • Corneal haziness
  • Discharge
  • Pigment dispersion syndrome
  • Vitreous opacities
  • Drugs (e.g., digitalis, chloroquine)
32
Q

Itchy Eyes? (

A
  • Conjunctivitis
  • Blepharitis
  • Dry-eye Syndrome
  • Topical drug allergy
  • Contact dermatitis
  • Giant Papillary Conjunctivitis
  • Contact lens-related problem
33
Q

Common causes light sensitivity (Photophobia) with abnormal eye exam? (2 More, Less)

A

More:

  • Corneal abnormality (e.e., abrasion or edema)
  • Anterior uveritis

Less:

  • Conjunctivitis (mild photophobia)
  • Posterior uveitis
  • Scleritis
  • Albinism
  • Total color blindness
  • Aniridia
  • Mydriasis
  • Congenital glaucoma
34
Q

Night Blindness (6 More, 3 Less)?

A

More:

  • Refractive error (especially undercorrected myopia)
  • Advanced glaucoma or optic atrophy
  • Small pupil
  • Retinitis pigmentosa
  • Congenital stationary night blindness
  • Status-post panretinal photocoagulation

Less:

  • Vitamin A deficiency
  • Gyrate atrophy
  • Choroideremia
35
Q

Mild to moderate ocular pain? (13)

A
  • Dry-eye syndrome
  • Blepharitis
  • Infectious conjunctivitis
  • Episcleritis
  • Inflamed pinguecula or pterygium
  • Foreign body (corneal or conjunctival)
  • Corneal disorder (e.g., superficial punctate keratopathy)
  • Superior limbic keratoconjunctivitis
  • Ocular medication toxicity
  • Contact lens-related problems
  • Postoperative
  • Ocular ischemic syndrome
  • Eye strain from uncorrected refractive error
36
Q

Moderate to severe pain? (6)

A
  • Corneal disorder
  • Trauma
  • Anterior uveitis
  • Scleritis
  • Endophthalmitis
  • Acute angle-closure glaucoma
37
Q

Periorbital pain? (7)

A
  • Trauma
  • Hordeolum
  • Preseptal cellulitis
  • Dacryocystitis
  • Dermatitis (e.g. contact, herpes zoster, herpes simplex)
  • Referred pain (e.g., dental, sinus)
  • Tic douloureux
38
Q

Orbital pain? (9)

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
39
Q

Asthenopia? (5)

A
  • Uncorrected refractive error
  • Phoria or tropia
  • Convergece insufficiency
  • Accommodative spasm
  • Pharmacologic (miotics)
40
Q

Adnexal causes of red eye? (10)

A
  • Trichiasis
  • Distichiasis
  • Floppy eyelid syndrome
  • Entropion or ectropion
  • Lagophthalmos
  • Blepharitis
  • Meibomitis
  • Acne rosacea
  • Dacryocystitis
  • Canaliculitis
41
Q

Conjunctival causes of red eye? (11)

A
  • Ophthalmia neonatorum (infants)
  • Conjunctivitis
  • Subconjunctival hemorrhage
  • Inflamed pinguecula
  • Superior limbic keratoconjunctivitis
  • Conjunctival foreign body
  • Symblepharon
  • Ocular cicatricial pemphigoid
  • Stevens-Johnson Syndrome
  • Toxic epidermal necrolysis
  • Conjunctival neoplasm
42
Q

Corneal causes? (8)

A
  • Infectious or inflammatory keratitis
  • Contact lens-related problems
  • Corneal foreign body
  • Recurrent corneal erosion
  • Pterygium
  • Neurotrophic keratopathy
  • Medicamentosa
  • Ultraviolet or chemical burns
43
Q

Other causes of red eye?

A
  • Trauma
  • Postoperative
  • Dry-eye syndrome
  • Endophthalmitis
  • Anterior uveitis
  • Episcleritis
  • Scleritis
  • Pharmacologic
  • Angle-closure glaucoma
  • Carotid-cavernous fistula (corkscrew conjunctival vessels)
  • Cluster headaches
44
Q

Transient “Spots” in front of the eyes? (1)

A

-Migraines

45
Q

Permanent or longstanding “Spots” in front of the eyes? (4 More, 4 Less)

A

More:

  • Posterior vitreous detachment
  • Intermediate or posterior uveitis
  • Vitreous hemorrhage
  • Vitreous condensations/debris

Less:

  • Microhyphema
  • Hyphema
  • Retinal break or detachment
  • Corneal opacity or foreign body
46
Q

Tearing in adults with pain present?

A
  • Corneal abnormality (e.g., abrasion, foreign body or rust ring, recurrent erosion, edema)
  • Anterior uveitis
  • Eyelash or eyelid disorder
  • Conjunctival foreign body
  • Dacryocystitis
  • Dacryoadenitis
  • Canaliculitis
  • Trauma
47
Q

Tearing with minimal or no pain?

A
  • Dry-eye syndrome
  • Blepharitis
  • Nasolacrimal duct obstruction
  • Punctal occlusion
  • Lacrimal sac mass
  • Ectropion
  • Conjunctivitis
  • Emotional states
  • Crocodile tears (congenital or seventh nerve palsy)
48
Q

Tearing in children?

A
  • Nasolacrimal duct obstruction
  • Congenital glaucoma
  • Corneal or conjunctival foreign body

Ophthalmology (9 decks)

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