Wills DDx of ocular Sx Flashcards
Burning More common
Blepharitis
meibomitis
dry eye syndrome
conjunctivitis (infectious, allergic, mechanical, chemical)
Burning Less common
Cornea problem inflammed pterygium/pinguecula episcleritis superior limbic keratoconjunctivitis ocular toxicity (medication, CL solution, makeup)
Decreased Vision - transient visual loss
+More common
*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)
Decreased Vision - transient visual loss
+Less common
*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
Decreased Vision > 24 hrs-sudden, painless (MC)
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
Decreased Vision > 24 hrs-sudden, painless (LC)
other retina or CNS dz (e.g. stroke)
methanol poisoning
Decreased vision - gradual, painless loss (over weeks, months, years) = MC
Cataract Refractive error POAG chronic retina dz (ARMD) Diabetic retinopathy
Decreased vision - gradual, painless loss (over weeks, months, years) = LC
chronic cornea disease (e.g. cornea dystrophy)
optic neuropathy/atrophy (e.g. CNS tumor)
Decreased VA (painful loss)
acute angle closure glaucoma optic neuritis (pain with eye movement) uveitis endophthalmitis cornea hydrops (keratoconus)
Decreased VA (post-traumatic visual loss)
eyelid swelling cornea irregularity hyphema ruptured globe traumatic cataract lens dislocation commotio retinae RD retina/vitreous hemorrhage traumatic optic neuropathy CNS injury
Always remember in VA loss
nonphysiologic visual loss
Distortion of vision (MC)
- 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)
Distortion of vision (LC)
Keratoconus topical eye drops (miotics, cycloplegics) RD migraine (transient) hypotony CNS abnormality (including papilledema) nonphysiologic
Monocular Diplopia (MC)
refractive error incorrect spectacle alignment corneal opacity or irregularity (including corneal or refractive surgery) cataract iris defects (e.g. iridectomy)
Monocular Diplopia (LC)
Dislocated natural lens or lens implant macular disease RD CNS causes (rare) nonphysiologic
Binocular diplopia (typically intermittent)
myasthenia gravis
intermittent decompensation of existing phoria
Binocular diplopia (constant)
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
Eyelash loss
trauma burn thyroid disease VKH eyelid infection or inflammation radiation chronic skin disease cutaneous neoplasm trichotillomania
Eyelid crusting MC
blepharitis, meibomitis, conjunctivitis
Eyelid crusting LC
canaliculitis, nasolacrimal duct obstruction, dacryocystitis
Eyelid swelling associated with inflammation (MC)
hordeolum blepharitis conjunctivitis preseptal/orbital cellulitis trauma contact dermatitis HSV/zoster dermatitis
Eyelid swelling associated with inflammation (LC)
ectropion cornea abnormalitiy urticaria/angioedema blepharochalasis insect bite dacyroadenitit erysipelas eyelid/lacrimal gland mass autoimmunities (discoid lupus, dermatomyositis)
Eyelid swelling noninflammatory
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
Eyelid twitch
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)
Eyelids unable to close (lagophthalmos)
severe proptosis severe chemosis eyelid scarring eyelid retractor muscle scarring CN7 palsy s/p facial cosmetic/reconstructive surgery
eyes “jumping” (oscillopsia)
acquired nystagmus INO myasthenia gravis vestibular function loss opsoclonus/ocular flutter SO myokymia various CNS disorders
Flashing lights (more common)
retinal break/detachment PVD migraine rapid eye movements (particular in darkness) oculodigital stimulation
Flashing lights (less common)
CNS (particularly occipital lobe disorders) vestibulobasilar artery insufficiency optic neuropathies retinitis entoptic phenomena hallucinations
FB sensation
dry eye blephriatis conjunctivitis trichiasis K abnormalitiy (Abrasion/FB) recurrent erosion SPK contact lens related problem episcleritis pterygium pinguecula
Glare
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)
Hallucinations (formed images)
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
Halos around lights
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)
Itchy Eyes
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
photophobia with abnormal eye exam (MC)
cornea abnormality (e.g. abrasion or edema) anterior uveitis
photophobia with abnormal eye exam (LC)
conjunctivitis (mild photophobia) posterior uveitis scleritis albinism total color blindness aniridia mydriasis of any etiology (pharmacologic, traumatic) congenital glaucoma
photophobia with normal eye exam
migraine meningitis retrobublar optic neuritis subarachnoid hemorrhage trigeminal neuralgia lightly pigmented eye
Night blindness (MC)
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)
Night blindness (LC)
vitamin A deficiency, gyrate atrophy, choroideremia
Ocular pain (typically mild to moderate)
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
Typically moderate to severe ocular pain
corneal disorder (e.g. abrasion, erosion, infiltrate/ulcer/keratitis, chemical injury, UV burn) trauma anterior uveitis, scleritis endophthalmitis acute angle-closure glaucoma
Periorbital pain
trauma hordeolum preseptal cellulitis dacyrocystitis dermatitis (e.g. contact, chemical, varicella zoster, or herpes simplex) referred pain (e.g. dental, sinus) tic douloureaux
Orbital
sinusitis trauma orbital cellulitis idiopathic orbital inflammatory syndrome orbital tumor or mass optic neuritis acute dacryoadenitis migraine or cluster headache diabetic cranial nerve palsy
asthenopia (nonspecific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache and occasional double vision)
uncorrected refractive error phoria or tropia convergence insufficiency accommodative spasm pharmacologic (miotic)
red eye: adnexal causes
trichiasis distichiasis floppy eyelid syndrome entropion/ectropion lagophthalmos blepharitis meibomitis acne rosacea dacyocystitis canaliculitis
red eye: conjunctival causes
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
red eye: cornea causes
infections/inflammatory keratitis CL related problems cornea foreign body recurrent corneal erosion pterygium neurotrophic keratopathy medicamentosa UV or chemical burn
red eye: other
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.
spots in vision (MC)
PVD
intermediate/posterior uveitis
VH
vitreous condensations/debris
spots in vision (LC)
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
Tearing: Adults (pain present)
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
Tearing: minimal/no pain
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)
children
nasolacrimal duct obstruction
congenital glaucoma
cornea or conjunctival foreign body
or other irritative disorder
