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Beta en inglés 2 > 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
Eye "Jumping" (Oscillopsia)? (7)
- Acquired nystagmus - Internuclear ophthalmoplegia - Myasthenia gravis - Vestibular function loss - Opsoclonus/ocular flutter - Superior oblique myokymia - Various CNS disorders
26
More common causes of flashes of light? (5)
- Retinal break or detachment - Posterior vitreous detachment - Migraine - Rapid eye movement - Oculodigital stimulation
27
Less common causes of flashes of light? (6)
- CNS disorders (particular occipital lobe) - Vestibulobasilar artery insufficiency - Optic neuropathies - Retinitis - Entoptic phenomena - Hallucinations
28
Foreign body sensation? (9)
- DES - Blepharitis - Conjunctivitis - Trichiasis - Corneal abnormality - Contact lens-related problem - Episcleritis - Pterygium - Pinguecula
29
Glare (8)
- 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
Hallucinations (Formed images)? (11)
- 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
Halos Around Lights? (12)
- 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
Itchy Eyes? (
- Conjunctivitis - Blepharitis - Dry-eye Syndrome - Topical drug allergy - Contact dermatitis - Giant Papillary Conjunctivitis - Contact lens-related problem
33
Common causes light sensitivity (Photophobia) with abnormal eye exam? (2 More, Less)
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
Night Blindness (6 More, 3 Less)?
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
Mild to moderate ocular pain? (13)
- 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
Moderate to severe pain? (6)
- Corneal disorder - Trauma - Anterior uveitis - Scleritis - Endophthalmitis - Acute angle-closure glaucoma
37
Periorbital pain? (7)
- Trauma - Hordeolum - Preseptal cellulitis - Dacryocystitis - Dermatitis (e.g. contact, herpes zoster, herpes simplex) - Referred pain (e.g., dental, sinus) - Tic douloureux
38
Orbital pain? (9)
- 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
Asthenopia? (5)
- Uncorrected refractive error - Phoria or tropia - Convergece insufficiency - Accommodative spasm - Pharmacologic (miotics)
40
Adnexal causes of red eye? (10)
- Trichiasis - Distichiasis - Floppy eyelid syndrome - Entropion or ectropion - Lagophthalmos - Blepharitis - Meibomitis - Acne rosacea - Dacryocystitis - Canaliculitis
41
Conjunctival causes of red eye? (11)
- 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
Corneal causes? (8)
- Infectious or inflammatory keratitis - Contact lens-related problems - Corneal foreign body - Recurrent corneal erosion - Pterygium - Neurotrophic keratopathy - Medicamentosa - Ultraviolet or chemical burns
43
Other causes of red eye?
- Trauma - Postoperative - Dry-eye syndrome - Endophthalmitis - Anterior uveitis - Episcleritis - Scleritis - Pharmacologic - Angle-closure glaucoma - Carotid-cavernous fistula (corkscrew conjunctival vessels) - Cluster headaches
44
Transient "Spots" in front of the eyes? (1)
-Migraines
45
Permanent or longstanding "Spots" in front of the eyes? (4 More, 4 Less)
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
Tearing in adults with pain present?
- 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
Tearing with minimal or no pain?
- Dry-eye syndrome - Blepharitis - Nasolacrimal duct obstruction - Punctal occlusion - Lacrimal sac mass - Ectropion - Conjunctivitis - Emotional states - Crocodile tears (congenital or seventh nerve palsy)
48
Tearing in children?
- Nasolacrimal duct obstruction - Congenital glaucoma - Corneal or conjunctival foreign body

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