Differential Diagnoses Symptoms - Texas Tech University ...

Differential Diagnoses

and other Useful Lists and Tables For Ophthalmologists

Symptoms Signs Case Presentations

Kenn Freedman MD PhD

Department of Ophthalmology and Visual Sciences Texas Tech University Health Sciences Center Lubbock, Texas USA

Acknowledgments and Disclaimer

The differential diagnoses and lists contained herein are not meant to be

exhaustive, but are to give in most cases the most common causes of many

ocular / visual symptoms, signs and situations. Included also in these lists are

also some less common, but serious conditions that must be "ruled-out". These

lists have been based on years of experience, and I am grateful for God's help in

developing them. I also owe gratitude to several sources* including Roy's

classic text on Ocular Differential Diagnosis.

* Please see

references at end of document

This presentation, of course, will continue to be a work in progress and any concerns or suggestions as to errors or omissions or picture copyrights will be considered. Please feel free to contact me at kenn.freedman@ttuhsc.edu

Kenn Freedman

Lubbock, Texas - October 2018

Disclaimer: The diagnostic algorithm for the diagnosis and management of Ocular or Neurological Conditions contained in this presentation is not intended to replace the independent medical or professional judgment of the physician or other health care providers in the context of individual clinical circumstances to determine a patient's care.

Use of this Presentation

The lists are divided into three main areas

1. Symptoms 2. Signs from the Eight Point Eye Exam 3. Common Situations and Case Presentations

The index for all of the lists is given on the following 3 pages. The lists follow in the presentation in the order shown in the index. Each entry in the index (blue) is also a link and when clicked will take to you that specific list in the document.

If you want to go to another list within the document you will find a

link on each page (shown below) which will take you back to the

original index of links

Click to Return To Links

At the end is also a list of abbreviations used in the presentation

Symptoms

Loss of Vision Transient Visual Phenomena Floaters Flashes, Photopsias Diplopia Monocular Diplopia Binocular Diplopia ? Ocular Misalignment Transient Diplopia Oscillopsia Night Blindness Transient Visual Loss Photophobia Headache Eye and Face Pain Epiphora Foreign Body Sensation and Itching Problems Opening Eyes Chronic Red Eye

Loss of Visual Acuity and Refractive Issues

Decreased Distance Visual Acuity Refractive Shift ? Myopic Refractive Shift ? Hyperopic Refractive Shift ? Astigmatic Asymmetric and Irregular Astigmatism Dull or Abnormal Retinoscope Reflex Poor Near Visual Acuity Problems with Glasses

Loss of Visual Field (VF)

Visual Field Defects and Localizing Lesions VF Defects Respecting the Horizontal Midline VF Defects Respecting the Vertical Midline Bitemporal Hemianopsia Homonymous Hemianopsia Central, Centrocecal and Cecal VF Defects Severe Constriction of VF, Tunnel VF

Eyelids and Orbit

Blepharospasm Loss of Sensation, Numbness of Face around Eye Ptosis Eyelashes and Eyelid Margin Eyelid Malpositions ? Entropion and Trichiasis Eyelid Malpositions ? Ectropion Eyelid Retraction Lagophthalmos and Lid Lag Seventh Nerve Palsy Eyelid Mass / Lesion Signs Suggesting Orbital Disease Eyelid Edema Conjunctival Hemorrhage and Peri-Orbital Ecchymosis Proptosis Orbital Tumors Enophthalmos Orbital Inflammation Visible and Palpable Orbital Masses Orbital and Facial Distortions Distortions of the Globe

Index of all Lists with Links

Motility and Alignment Problems

Types and Causes of Motility Problems Abduction Deficit Adduction Deficit Acquired Esotropia Acquired Exotropia Apparent Horizontal Strabismus Hypertropia / Hypotropia Elevation and Upgaze Deficits Depression and Downgaze Deficits Convergence and Divergence Ophthalmoplegia ? One Eye Ophthalmoplegia ? Both Eyes Head Turns and Tilts / Torticollis Causes of Nystagmus Acquired Nystagmus Downbeat Nystagmus

Pupils

Leukocoria Corectopia Poor Pupil Mobility Anisocoria Anisocoria ? Which Pupil is Abnormal? Dilated Pupil(s) Transient Pupil Dilation Constricted Pupil(s) Light Near Dissociation Relative Afferent Pupillary Defect Bilateral Miotic or Mydriatic Pupils

Anterior Segment

Conjunctival Bumps - Papillae and Follicles Chemosis Injected, Congested or Prominent Conjunctival Vessels Symblepharon Conjunctival or Epibulbar Mass Spot on the White of Eye, Scleral Lesion Scleral Thinning, Episcleritis, and Scleritis Corneal Fluorescein Staining or Pooling Corneal Epithelial Defects ? Chronic or Non-Healing Corneal Haze or Opacification Acute Corneal Edema Chronic Corneal Edema Punctate Corneal Staining Corneal Infiltrates Corneal Ulcer Corneal Vessels and Pannus Decreased Corneal Sensation Keratic Precipitates (KP) Anterior Uveitis Cells in the Anterior Chamber Hypopion Hyphema Neovascularization of the Iris Lesions of the Iris Defects of the Iris Lens Opacification Lens Abnormalities

Index of all Lists with Links

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