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Oral boards > Wills DDx of ocular Sx > Flashcards

Wills DDx of ocular Sx Flashcards

1
Q

Burning More common

A

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

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2
Q

Burning Less common

A 
Cornea problem 
inflammed pterygium/pinguecula
episcleritis
superior limbic keratoconjunctivitis
ocular toxicity (medication, CL solution, makeup)
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3
Q

Decreased Vision - transient visual loss

+More common

A

*transient visual loss (VA returns to normal w/in 24 hrs usually w/in 1 hour)

Few seconds (usually bilateral): papilledema
Few min: amaurosis fugax (TIA u/L), vetebrobasilar artery insufficiency (bilateral)
10-60 min: migraine (w/or w/o subsequent headache)

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4
Q

Decreased Vision - transient visual loss

+Less common

A 
*transient visual loss (VA returns to normal w/in 24 hrs usually w/in 1 hour)
impending CRVO
ischemic optic neuropathy
ocular ischemic syndrome (carotid occlusive dz)
glaucoma
sudden change in BP
CNS lesion
ON drusen
GCA
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5
Q

Decreased Vision > 24 hrs-sudden, painless (MC)

A

Retina artery or vein occlusion
ischemic optic neuropathy
VH
RD
optic neuritis (usually pain with eye movements)
sudden discovery of pre-existing u/L visual loss

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6
Q

Decreased Vision > 24 hrs-sudden, painless (LC)

A

other retina or CNS dz (e.g. stroke)

methanol poisoning

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7
Q

Decreased vision - gradual, painless loss (over weeks, months, years) = MC

A 
Cataract
Refractive error
POAG
chronic retina dz (ARMD)
Diabetic retinopathy
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8
Q

Decreased vision - gradual, painless loss (over weeks, months, years) = LC

A

chronic cornea disease (e.g. cornea dystrophy)

optic neuropathy/atrophy (e.g. CNS tumor)

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9
Q

Decreased VA (painful loss)

A 
acute angle closure glaucoma
optic neuritis (pain with eye movement)
uveitis
endophthalmitis
cornea hydrops (keratoconus)
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10
Q

Decreased VA (post-traumatic visual loss)

A 
eyelid swelling
cornea irregularity
hyphema
ruptured globe
traumatic cataract
lens dislocation
commotio retinae
RD
retina/vitreous hemorrhage
traumatic optic neuropathy
CNS injury
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11
Q

Always remember in VA loss

A

nonphysiologic visual loss

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12
Q

Distortion of vision (MC)

A
  • Refractive error: including presbyopia, acquired myopia (from cataract, DM, ciliary spasm, medications, RD surgery)
  • Acquired astigmatism (e.g. from anterior segment surgery, chalazion, orbital fracture, & edema)
  • macular disease [e.g. CSR, macular edema, ARMD, CNVM)
  • cornea irregularity
  • intoxication (EtOh, methanol)
  • pharmacologic (scopolamine patch)
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13
Q

Distortion of vision (LC)

A 
Keratoconus
topical eye drops (miotics, cycloplegics)
RD
migraine (transient)
hypotony
CNS abnormality (including papilledema)
nonphysiologic
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14
Q

Monocular Diplopia (MC)

A 
refractive error
incorrect spectacle alignment
corneal opacity or irregularity (including corneal or refractive surgery)
cataract
iris defects (e.g. iridectomy)
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15
Q

Monocular Diplopia (LC)

A 
Dislocated natural lens or lens implant
macular disease
RD
CNS causes (rare)
nonphysiologic
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16
Q

Binocular diplopia (typically intermittent)

A

myasthenia gravis

intermittent decompensation of existing phoria

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17
Q

Binocular diplopia (constant)

A

isolated CN3/4/6 palsy
orbital disease (e.g. TED, orbital pseudotumor, tumor)
cavernous sinus/superior orbital fissure syndrome
status-post ocular surgery (e.g. residual anesthesia, displaced muscle, undercorrection or overcorrection after muscle surgery, restriction from scleral buckle, severe aniseikonia s/p refractive surgery)
s/p trauma (e.g. orbital wall fracture with extraocular muscle entrapment, orbital edema)
INO
vertebrobasilar artery insufficiency
Other CNS lesion
spectacle problem

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18
Q

Eyelash loss

A 
trauma
burn
thyroid disease
VKH
eyelid infection or inflammation
radiation
chronic skin disease 
cutaneous neoplasm
trichotillomania
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19
Q

Eyelid crusting MC

A

blepharitis, meibomitis, conjunctivitis

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20
Q

Eyelid crusting LC

A

canaliculitis, nasolacrimal duct obstruction, dacryocystitis

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21
Q

Eyelid swelling associated with inflammation (MC)

A 
hordeolum
blepharitis
conjunctivitis
preseptal/orbital cellulitis
trauma
contact dermatitis
HSV/zoster dermatitis
22
Q

Eyelid swelling associated with inflammation (LC)

A 
ectropion
cornea abnormalitiy
urticaria/angioedema
blepharochalasis
insect bite
dacyroadenitit
erysipelas
eyelid/lacrimal gland mass
autoimmunities (discoid lupus, dermatomyositis)
23
Q

Eyelid swelling noninflammatory

A 
chalazion
dermatochalasis
prolapse of orbital fat (retropulsion of the globe increases the prolapse)
laxity of the eyelid skin
cardiac
renal
thyroid eye disease
superior venal cava syndrome
eyelid/lacrimal gland mass
foreign body
24
Q

Eyelid twitch

A 
orbicularis myokymia (related to fatigue, excess caffeine, medication or stress)
cornea/conjunctival irritation (especially from an eyelash, cyst, or conjunctival foreign body)
dry eye
blepharospasm (bilateral)
hemifacial spasm
albinism (photosensitivity)
serum electrolyte abnormality
tourettes
tic douloureux
anemia (rare)
25
Q

Eyelids unable to close (lagophthalmos)

A 
severe proptosis
severe chemosis
eyelid scarring
eyelid retractor muscle scarring
CN7 palsy
s/p facial cosmetic/reconstructive surgery
26
Q

eyes “jumping” (oscillopsia)

A 
acquired nystagmus
INO
myasthenia gravis
vestibular function loss
opsoclonus/ocular flutter
SO myokymia
various CNS disorders
27
Q

Flashing lights (more common)

A 
retinal break/detachment
PVD
migraine
rapid eye movements (particular in darkness)
oculodigital stimulation
28
Q

Flashing lights (less common)

A 
CNS (particularly occipital lobe disorders)
vestibulobasilar artery insufficiency
optic neuropathies
retinitis
entoptic phenomena
hallucinations
29
Q

FB sensation

A 
dry eye
blephriatis
conjunctivitis
trichiasis
K abnormalitiy (Abrasion/FB)
recurrent erosion
SPK
contact lens related problem
episcleritis
pterygium
pinguecula
30
Q

Glare

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)
31
Q

Hallucinations (formed images)

A 
PVD (white lightning streaks of Moore)
RD
optic neuropathies
blind eyes
bilateral eye patching
Charles Bonnet syndrome
psychosis
parietotemporal area lesions
other CNS causes
medications
32
Q

Halos around lights

A 
cataract
pseudophakia
posterior capsular opacity
acute angle-closure glaucoma or cornea edema from another cause (e.g. aphakic/pbk, CL overwear)
cornea dystrophies
s/p refractive surgery
corneal haziness
discharge
pigment dispersion syndrome 
vitreous opacities
drugs (e.g. digitalis, chloroquine)
33
Q

Itchy Eyes

A

Conjunctivitis (especially allergic, vernal, and viral)
blepharitis, dry eye syndrome
topical drug allergy or contact dermatitis
GPC (giant papillary conjunctivitis)
or another CL-related problem

34
Q

photophobia with abnormal eye exam (MC)

A 
cornea abnormality (e.g. abrasion or edema)
anterior uveitis
35
Q

photophobia with abnormal eye exam (LC)

A 
conjunctivitis (mild photophobia)
posterior uveitis
scleritis
albinism
total color blindness aniridia
mydriasis of any etiology (pharmacologic, traumatic)
congenital glaucoma
36
Q

photophobia with normal eye exam

A 
migraine
meningitis
retrobublar optic neuritis
subarachnoid hemorrhage
trigeminal neuralgia
lightly pigmented eye
37
Q

Night blindness (MC)

A

refractive error (esp undercorrected myopia)
advanced glaucoma or optic atrophy
small pupil (esp from miotic gtts)
retinitis pigmentosa
CSNB
s/p PRP
drugs (phenothiazines, chloroquine, quinine)

38
Q

Night blindness (LC)

A

vitamin A deficiency, gyrate atrophy, choroideremia

39
Q

Ocular pain (typically mild to moderate)

A 
dry eye
blepharitis
infectious conjunctivitis
episcleritis
inflammed pinguecula or pterygium
FB (cornea or conjunctival)
corneal disorder (SPK)
superior limbic keratoconjunctivitis
ocular medication toxicity
CL-related problems
post-operative
ocular ischemic syndrome
eye strain from uncorrected refractive error
40
Q

Typically moderate to severe ocular pain

A 
corneal disorder (e.g. abrasion, erosion, infiltrate/ulcer/keratitis, chemical injury, UV burn)
trauma
anterior uveitis,
scleritis
endophthalmitis
acute angle-closure glaucoma
41
Q

Periorbital pain

A 
trauma
hordeolum
preseptal cellulitis
dacyrocystitis
dermatitis (e.g. contact, chemical, varicella zoster, or herpes simplex)
referred pain (e.g. dental, sinus)
tic douloureaux
42
Q

Orbital

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
43
Q

asthenopia (nonspecific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache and occasional double vision)

A 
uncorrected refractive error
phoria or tropia
convergence insufficiency
accommodative spasm
pharmacologic (miotic)
44
Q

red eye: adnexal causes

A 
trichiasis
distichiasis
floppy eyelid syndrome
entropion/ectropion
lagophthalmos
blepharitis
meibomitis
acne rosacea
dacyocystitis
canaliculitis
45
Q

red eye: conjunctival causes

A 
ophthalmia neonatorum in infants
conjunctivitis (bacterial, viral, chemical, allergic, atopic, vernal, medication toxicity)
subconjunctival hemorrhage
inflamed pingeucula
superior limbal keratoconjunctivitis
giant papillary conjunctivitis
conjunctival foreign body
symblepharon and associated etiologies (e.g. OCP, S-J syndrome, toxic epidermal necrolysis)
conjunctival neoplasia
46
Q

red eye: cornea causes

A 
infections/inflammatory keratitis
CL related problems
cornea foreign body
recurrent corneal erosion
pterygium
neurotrophic keratopathy
medicamentosa
UV or chemical burn
47
Q

red eye: other

A 
trauma
post-operative
dry eye syndrome
endophthalmitis
anterior uveitis
episcleritis
scleritis
pharmacologic (e.g. prostaglandin analogs)
angle-closure glaucoma
carotid-cavernous fistula
cork-screw conjunctival vessels
cluster headache.
48
Q

spots in vision (MC)

A

PVD
intermediate/posterior uveitis
VH
vitreous condensations/debris

49
Q

spots in vision (LC)

A

microhyphema/hyphema
RD or retinal break
cornea opacity or FB

Note: some pts are referring to a blind spot in their visual field 2/2 retinal, ON, CNS disorder

50
Q

Tearing: Adults (pain present)

A 
K abnormality (e.g. abrasion, FB, rust ring, recurrent erosion, edema), 
anterior uveitis
eyelash or eyelid disorder (trichiasis, entropion)
conjunctival foreign body
dacryocystitis
dacryoadenitis
canaliculitis
trauma
51
Q

Tearing: minimal/no pain

A 
dry eye syndrome
blepharitis
nasolacrimal duct obstruction
punctal occlusion
lacrimal sac mass
ectropion
conjunctivitis (especially allergic and toxic)
emotional states
crocodile tears (congenital or CN7 palsy)
52
Q

children

A

nasolacrimal duct obstruction
congenital glaucoma
cornea or conjunctival foreign body
or other irritative disorder

Oral boards (13 decks)

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