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Differentials/Associations Flashcards

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1
Q

Cotton wool spot

A
  • ischemic (HTN, DM, RVO, radiation)
  • immune (SLE, GCA)
  • infectious (HIV, cat scratch, fungemia)
  • embolic (carotid, cardiac, Purtscher)
  • neoplastic (lymphoma, leukemia)
  • myelinated NFL
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2
Q

Retinal hemorrhage

A
  • CRVO/BRVO
  • HTN, DM
  • CNV
  • NVE
  • macroaneurysm
  • Valsalva
  • choroidal rupture
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3
Q

Ptosis

A
  • 3rd nerve palsy (GCA)
  • Horner syndrome
  • myasthenia gravis
  • CPEO
  • intracranial mass
  • intraorbital mass
  • aponeurotic
  • traumatic
  • mechanical
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4
Q

Proptosis

A
  • infectious (orbital cellulitis, mucor)
  • neoplasm
  • inflammatory (Tolosa-Hunt, IOIS)
  • thyroid eye disease
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5
Q

Adult orbital masses

A
  • cavernous hemangioma
  • meningioma (optic nerve sheath)
  • mesenchymal tumor (fibrous histio)
  • optic nerve glioma
  • neurofibroma
  • dermoid cyst
  • mucocele
  • lymphoma or lymphoid hyperplasia
  • metastasis
  • rhabdomyosarcoma
  • lacrimal masses
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6
Q

Leukocoria

A

Retinoblastoma
Toxocariasis
Coats disease
FEVR
Persistent fetal vasculature
Cataract
Retinal astrocytoma (tuberous sclerosis)
ROP
Coloboma

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7
Q

Esodeviations (peds)

A
  • pseudoesotropia
  • congenital (infantile)
  • acquired nonaccommodative
  • accommodative (refractive or non-refractive)
  • sensory deprivation
  • divergence insufficiency
  • CNS/cranial nerve palsy
  • Duane syndrome type 1
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8
Q

Exodeviations (peds)

A
  • pseudoexotropia (large angle K, macula dragging)
  • exophoria
  • intermittent exotropia
  • constant exotropia
  • Duane syndrome type 2
  • 3rd nerve palsy
  • myasthenia
  • INO
  • orbital disease, TED
  • convergence paralysis
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9
Q

Strabismus syndromes

A
  • Duane syndrome (type 1 abd, type 2 add, type 3 both)
  • Brown syndrome (limited elevation in adduction)
  • monocular elevation deficiency (restriction of inferior rectus or paresis of inferior oblique or superior rectus)
  • Mobius syndrome
  • congenital fibrosis syndrome (usually both eyes downward so chin-up)
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10
Q

Corectopia

A
  • ICE (unilateral)
  • Axenfeld Reiger (bilateral)
  • posterior polymorphous dystrophy
  • ectopic lentis et pupillae
  • aniridia
  • trauma
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11
Q

Secondary angle closure

A
  • PAS
  • neovascular membrane
  • ICE
  • lens-induced
  • drug induced (topiramate, sulfonamides) [no PI, use mydriatic and maybe steroids]
  • choroidal swelling
  • posterior tumor
  • aqueous misdirection
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12
Q

Elevated IOP with open angle

A
  • inflammatory glaucoma
  • traumatic (hemolytic)
  • pigmentary glaucoma
  • pseudoexfoliation
  • Posner-Schlossman
  • retrobulbar hemorrhage
  • carotid-cavernous fistula
  • phacolytic/phacoantigenic
  • Schwartz-Matsuo syndrome
  • steroid induced
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13
Q

Glaucoma optic neuropathy

A
  • POAG
  • physiologic cupping
  • low tension glaucoma
  • secondary open angle glaucoma
  • previous glaucomatous damage
  • optic nerve pit
  • optic nerve coloboma
  • optic disc drusen
  • optic atrophy
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14
Q

Glaucoma testing

A
  • RAPD assessment
  • color vision
  • IOP
  • gonioscopy
  • OCT NFL
  • visual fields
  • pachymetry
  • disc photos
  • heavy metal panel/B12/MRI if abnormal
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15
Q

Prostaglandin side effects

A
  • iris darkening
  • periorbital skin darkening
  • HSV
  • CME
  • hypertrichosis
  • contraindicated in pregnancy
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16
Q

Topical beta blocker side effects

A
  • asthma
  • COPD
  • heart block
  • bradyarrythmias
  • heart failure
  • depression
  • sexual dysfunction
  • reduced exercise tolerance
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17
Q

Carbonic anhydrase inhibitor side effects

A
  • sulfa allergy
  • metabolic acidosis
  • hypokalemia
  • paresthesias
  • aplastic anemia
  • corneal endothelial dysfunction
  • weight loss
  • sickle crisis in sickle cell
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18
Q

Alpha 2 receptor agonist side effects

A
  • contraindicated in patients taking monoamine oxidase inhibitors
  • children under 5 due to CNS and cardiorespiratory depression
  • local irritation/intolerance
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19
Q

Hyphema

A
  • trauma
  • NV (DM, RVO, OIS)
  • Fuch’s heterochromic iridocyclitis
  • blood dyscrasia or coagulopathy
  • anticoagulant medication
  • HSV
  • UGH syndrome
  • iris or ciliary body melanoma
  • retinoblastoma
  • juvenile xanthogranuloma
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20
Q

Corneal rings

A
  • Kayser-Fleischer ring (Wilson disease, hepatitis, primary biliary cirrhosis) [also sunflower cataract]
  • Fleischer ring (KCN)
  • arcus senilis
  • siderosis or chalcosis
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21
Q

Corneal iron lines

A
  • Hudson-Stahli line
  • Stocker Line (pterygium)
  • Ferry line (bleb)
  • Fleischer ring (KCN)
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22
Q

NF 1 associations

A
  • autosomal dominant; chromosome 17
  • Lisch nodules
  • cafe au lait spots
  • neurofibromas
  • glaucoma (esp w/ plexiform neurofibroma)
  • intertriginal freckling
  • optic nerve glioma
  • sphenoid dysplasia
  • encephalocele
  • prominent corneal nerves
  • intracranial astrocytoma
  • pheochromocytoma
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23
Q

Prominent corneal nerves

A
  • Riley-Day (familial dysautonomia)
  • Refsum syndrome (phytanic acid, RP, hearing loss)
  • NF1
  • leprosy
  • acanthamoeba
  • MEN 2 (medullary thyroid cancer, pheochromocytoma, mucosal neuromas, parathyroid tumors)
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24
Q

NF 2 associations

A
  • autosomal dominant; chromosome 22
  • bilateral acoustic nerve masses
  • juvenile PSC
  • neurofibroma
  • optic nerve sheath meningioma
  • glioma
  • Schwannoma
  • combined hamartoma of the retina and RPE
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25
Sturge-Weber associations
- spontaneous, not heritable - diffuse choroidal hemangioma - glaucoma (treat w/ aqueous suppressants, goniotomy/trab/tube) - iris heterochromia - blood in Schlemm canal - serous retinal detachment (photodynamic therapy, laser, radioactive plaque) - intellectual disability - leptomeningeal angiomatosis - incracerebral calcifications - seizures
26
Tuberous sclerosis associations
- autosomal dominant - retinal astrocytic hamartoma (mulberry) - adenoma sebaceum - seizures - cerebral astrocytomas - intellectual disability - Shagreen patches, ash leaf spots - renal cell carcinoma - cardiac rhabdomyoma
27
Von Hippel-Lindau associations
- autosomal dominant - retinal capillary hemangiomas - bilateral 50% - CNS hemangioblastoma - renal cell carcinoma - pheochromocytoma - laser, cryo, photodynamic therapy, or radiotherapy if therapy is indicated (serous detachment or exudation)
28
Wyburn-Mason associations
- racemose hemangioma - spontaneous, not heritable - orbital racemose hemangioma - midbrain hemangiomas - seizures, neurologic deficits - maxillary/mandibular hemangiomas - no treatment, watch for hemorrhage and NVG
29
Conjunctival telangiectasia
- autosomal recessive - Louis-Barr syndrome (ataxia-telangiectasia) - oculomotor apraxia - supranuclear gaze palsies - nystagmus - strabismus - progressive cerebellar ataxia - immunologic deficiency (frequent infections - increased risk of malignancy - intellectual disability
30
Retinal capillary hemangioma differential
- Coats disease - racemose hemangioma - retinal cavernous hemangioma - FEVR - congenital retinal vascular tortuosity - retinal vasoproliferative tumor - retinal macrovessel
31
Contact fitting by Ks
- 42.5-44.5 use 8.7 BC - 44.5-46.0 use 8.3 BC
32
LARS rule
Related to toric contact fitting. If inferior lines are left or right of 6 o’clock: - left = add 30 degrees to minus cyl axis, right = subtract 30 degrees minus cyl axis
33
Legal blindness in US
- BCVA 20/200 or worse in better seeing eye - field of vision in better eye is 20 degrees or less
34
Monocular diplopia
- refractive error - surface problem - iris defect - irregular astigmatism - lenticular irregularity (cataract, lenticonus, lens dislocation) - retinal problem - diagnose with cover one eye, pinhole testing
35
Nonorganic factors causing poor vision
- uncorrected ametropia (needs refraction) - pupil size (larger than 6, smaller than 2.5 due to diffraction principle) - decreased contrast (bad eye chart or lighting) - eccentric viewing - age (too young or too old)
36
Simple vs compound astigmatism
Write Rx in both plus and minus cylinder notation and if when looking at spherical power: - both positive = compound hyperopic - one positive, one plano = simple hyperopic - one positive, one negative = mixed - one negative, one plano = simple myopic - both negative = compound myopic
37
Prismatic effect of myopic spectacles when reading
- act like base-in prisms which induce esotropia - this makes reading easier - just like adding base-in prism in high plus power readers for low vision
38
Is reading easier with RGPs or SCLs?
With RGPs. The mid-peripheral optic zone in RGP allows for more vault which enhances near vision due to the tear film
39
Types of visual acuity testing
- minimum resolvable letter: 1-5 minutes of arc - minimum visible (spot on wall): 10 seconds of arc - Vernier acuity: 2-10 seconds of arc
40
Snellen chart pearls
- each letter is 5 minutes of arc at 20 feet - to determine arcmin of each letter for larger lines: multiply the inverse of the acuity by 5 (if at 20 feet) - so 20/40 line = inverse 40/20=2, then 2x5=10 arcmin - for observer standing at number of feet for a particular line, the arcmin will always be 5 (so a 20/100 letter will subtend 5 arcmin at 100 feet)
41
ROP stages
- stage 1: flat demarcation line - stage 2: ridged demarcation line - stage 3: ridged line with NV - stage 4a: extrafoveal partial RD - stage 4b: foveal partial RD - stage 5: total RD - don’t forget plus disease
42
ROP treatment thresholds
- zone 1, any stage with plus disease - zone 1, stage 3 without plus disease - zone 2, stage 2 or 3 with plus disease
43
ROP timing of first exam
31 weeks post menstrual age or 4 weeks postnatal age, whichever is later.
44
Pediatric cataract
- idiopathic - congenital - familial - galactosemia (galactokinase deficiency, oil-droplet cataract may be reversible with dietary change) - persistent fetal vascular - rubella - Lowe syndrome (oculocerebrorenal syndrome) [X-linked recessive] - aniridia - Alport syndrome - Peter’s anomaly - trauma
45
Congenital cataract systemic testing
- galactokinase levels (tested at birth) - hematuria/proteinuria, hearing testing, renal biopsy (Alport syndrome) - amino acid content (Lowe syndrome) - antibody titers for rubella - TORCH titers
46
TORCH
- toxoplasma - others (HIV, syphilis, parvovirus, varicella) - rubella - CMV - HSV
47
Axenfeld-Reiger associations
- autosomal dominant - posterior embryotoxon (prominent anterior Schwalbe line) - bilateral polycoria/corectopia - PITX2 and FOXC1 - microdontia - skeletal abnormalities - cardiac defects - growth hormone deficiency - intellectual disability
48
Alport syndrome associations
- X-linked - kidney disease and hearing loss - type IV collagen problem - anterior or posterior lenticonus - corneal epithelium or endothelium changes/vesicles - retinopathy (predisposed to injury) - test for hematuria, hearing, renal biopsy - ACEi for hematuria/proteinuria - cataract surgery - renal transplant
49
Aniridia associations
- autosomal dominant or sporadic - bilateral iris absence - glaucoma - foveal hypoplasia, nystagmus - PAX6 deletion = WAGR = Wilms tumor, aniridia, genital abnormalities, retardation) - 30% chance of Wilms tumor in aniridia requires screening - Gillespie syndrome (cerebellar ataxia, optic atrophy)
50
Albinism associations
- oculocutaneous (autosomal recessive) - ocular only (X-linked recessive) - refractive error - strabismus - nystagmus - foveal hypoplasia - Hermansky-Pudlak (platelet dysfunction, Puerto Rican descent) - Chediak-Higashi (white blood cell dysfunction, predisposed to lymphoma) - benefit from FL-41 tint in glasses - refraction and amblyopia treatment - needs sun protection - discuss low vision aids
51
Purtscher retinopathy associations
- compression injury to head, chest, lower extremity - pseudo-Purtscher - acute pancreatitis - malignant hypertension - collagen vascular disease - thrombotic thrombocytopenic purpura - chronic renal failure - retrobulbar injection - amniotic fluid embolism - long bone fracture - supportive therapy (risk of permanent vision loss)
52
Acanthamoeba keratitis testing
- routine cultures - Gram, Giemsa, clacofluor white may show cysts - nonutrient agar with E. coli overlay - corneal biopsy - confocal microscopy
53
Fungal keratitis associations
- injury with vegetable matter - satellite lesions - filamentous fungi, Fusarium or Aspergillus (previously healthy, vegetable matter, contacts) - non-filamentous, Candida (previously diseased or hospitalized) - routine cultures - Gram, Giemsa, calcofluor white, KOH - corneal biopsy - topical natamycin, voriconazole, or amphoteracin - may add oral voriconazole - NO steroids
54
Corneal ulcer differential
- bacterial - fungal - HSV/VZV - acanthamoeba - atypical mycobacteria - Staph hypersensitivity - ocular rosacea - PUK/Mooren - topical anesthetic abuse
55
Corneal cultures
- blood (most bacteria) - Sabouraud dextrose (fungi) - thioglycolate broth (aerobic and anaerobic) - chocolate (Haemophilus, Neisseria) - Lowenstein-Jensen (mycobacteria, Nocardia) [esp in LASIK pts] - nonnutrient agar with E. coli overlay (acanthamoeba) - acid-fast stain (mycobacteria, Nocardia)
56
Crystalline keratopathy differential
- infectious crystalline keratopathy (Strep viridans, Corynebacterium, pseudomonas) - lattice corneal dystrophy - amyloidosis - lymphoproliferative (multiple myeloma) - Schnyder corneal dystrophy - Bietti corneoretinal dystrophy
57
Interstitial keratitis differential
- congenital syphilis (bilateral whereas other causes are often unilateral) - acquired syphilis - HSV/VZV - TB - Cogan syndrome (associated hearing loss - Lyme disease - EBV - leprosy
58
Congenital syphilis stigmata
- saddle nose deformity - Hutchinson teeth - saber shins - frontal bossing - salt and pepper chorioretinitis or optic atrophy
59
Relevant connective tissue diseases
- rheumatoid arthritis - SLE - HLA-B27 - granulomatosis with polyangiitis - relapsing polychondritis - polyarteritis nodosa
60
Marginal ulcer differential
- PUK - Mooren ulcer - sclerokeratitis - infectious keratitis - Terrien marginal degeneration - Staph marginal keratitis - exposure keratitis - phlyctenuosis (Staph, TB) - pellucid marginal degeneration - furrow degeneration
61
Dry eye testing
- Schirmer testing - MMP9 (elevated in DES) - tear osmolarity (elevated in DES) - lactoferrin (low in DES) - Sjogren antibodies - history of radiation?
62
Epithelial and Bowman corneal dystrophies
- epithelial basement membrane dystrophy (shadowing/monocular diplopia) - Meesman - Reis-Buckler/Thiel-Behnke (recurs in graft after PKP) - painful erosions in all
63
Corneal stromal dystrophies
- lattice (erosions common) - granular (intervening spaces, spares periphery, erosions uncommon) - macular (no intervening spaces, involves periphery, erosions common, autosomal recessive) - Schnyder (work up systemic cholesterol, rarely requires PK or PTK)
64
Corneal endothelial dystrophies
- Fuch’s - posterior polymorphous corneal dystrophy - CHED (autosomal recessive) - KP differential
65
Posterior polymorphous corneal dystrophy associations
- autosomal dominant - bilateral - glaucoma - corectopia, iridocorneal adhesions - keratoconus - Alport syndrome - treat glaucoma, edema with Muro - consider DMEK or PKP
66
CHED associations
- autosomal recessive - can be associated with deafness (Harboyan syndrome) - nystagmus - beaten copper endothelium - treat with Muro - PKP, DSAEK, DMEK
67
LASIK complications
- infection - free flap (flat corneas) - buttonhole flap (steep corneas) - epithelial defect - epithelial downgrowth - flap striae - diffuse lamellar keratitis - corneal haze/scarring - HOAs - dry eye - pressure-induced stromal keratitis
68
Acute conjunctivitis differential
- viral/EKC (watch for membranes) - HSV - allergic - vernal/atopic (giant papillae) - bacterial - gonococcal - pediculosis - molluscum - medicamentosa
69
Vernal conjunctivitis associations
- seasonal - giant papillae - Horner-Trantas dots (limbal eosinophils) - shield ulcer (add steroid, topical abx, scrape it)
70
Special consideration for bacterial conjunctivitis in kids
- look out for Haemophilus influenzae otitis media - treat with Augmentin
71
Gonococcal conjunctivitis
- Gram stain will show Gram-negative intracellular diplococci - watch for corneal involvement - treat with IM ceftriaxone and PO azithromycin - IV ceftriaxone if corneal involvement; watch for perforation, use topical fluoroquinolone ointment
72
Chronic conjunctivitis differential
- chlamydial inclusion conjunctivitis - Parinaud’s oculoglandular - contact lens related - conjunctival tumor - molluscum contagiosum
73
Chlamydial inclusion conjunctivitis
- serotypes D-K - young people with urethritis, vaginitis,or cervicitis - tarsal or bulbar follicles - corneal pannus - palpable preauricular node - peripheral SEIs - test for immunofluorescence or PCR - Giemsa will show basophilic intracytoplasmic inclusion bodies - PO azithromycin - topical erythromycin ointment - longer course of doxy if does not resolve
74
Trachoma associations
- serotypes A-C - follicular conjunctivitis - tender preauricular node - superior corneal SEIs, pannus, limbal follicles - extensive conjunctival scarring - Arlt line - trichiasis - corneal scarring - azithromycin, erythromycin, or doxycycline PO and ointment
75
Parinaud’s oculoglandular conjunctivitis
- Bartonella henselae (azithromycin or Bactrim and topical gentamicin) - tularemia (treat with gentamicin, sometimes critically ill) - tuberculosis - syphilis
76
Superior limbic keratoconjunctivitis associations
- thyroid disease - sectoral thickening, inflammation, and radial injection of the superior conj - superior corneal micropannus and filaments - same differential as episcleritis and phlyctenule - treat with DES/blepharitis measures - topical tacrilolimus and acetylcystein - low potency steroid - low concentration silver nitrate - doxycycline - conjunctival resection/recession
77
Ocular cicatricial pemphigoid differential
- Stevens-Johnson or toxic epidermal necrolysis - history of membranous conjunctivitis - severe chemical burn - chronic topical medication - previous radiation or surgery
78
OCP treatment
- aggressive lubrication - serum tears - punctual plugs - moisture goggles - treat blepharitis - cautious topical steroids (corneal melting) - systemic steroids - immunosuppressants - dapsone (watch out for G6PD deficiency due to hemolysis) - cautious surgery for ectropion, entropion, trichiasis - mucous membrane grafts
79
Lacrimal mass differential
- sarcoidosis - IOIS - IgG4-related - infectious - pleomorphic adenoma - adenoid cystic carcinoma - malignant mixed epithelial tumor - lymphoproliferative - TB - other orbital mass
80
ABCD for drug induced cataract
- Amiodarone - Busulfan - Chlorpromazine - Dexamethasone
81
STUMPED pediatric corneal clouding
- Sclerocornea - Tears in Descemet (trauma) - Ulcer - Mucopolysaccharidosis - Peter’s anomaly - Edema (CHED) - Dermoid
82
Nonorganic vision loss differential
- ambylopia - cortical blindness - retrobulbar optic neuritis - cone-rod dystrophy - chiasmal tumor - cancer associated retinopathy
83
Tests for nonorganic vision loss
- pupillary exam (lack of RAPD suggests anterior pathways normal but doesn’t rule out cortical blindness) - mirror test - optokintetic test (20/200 or better) - base out prism test (look for inward movement of eye) - vertical prism dissociation test - Worth four dot test - start with smallest lines and work way up chart - fog the normal seeing eye - retest visual acuity at near or closer than 20 feet - look for tunneling of visual field
84
Choroidal melanoma testing
- low internal reflectivity on A-scan - double circulation on IVFA - check for mets to liver or lung - continued surveillance for mets or recurrence
85
COMS treatment guide
- small (2.5 mm): observation - medium (10 mm): plaque brachytherapy - large (>10 mm): enucleation without radiation
86
Clinically significant macular edema
- retinal thickening within 500 um of the foveal center - hard exudates within 500 um of the foveal center - retinal thickening > 1 DD, part of which is within 1 DD of the foveal center
87
High risk PDR
- NVD greater than 1/4 size of disc - NVD with VH - NVE > 1/2 DD with VH - any NVI or NVA
88
Maternal diabetes follow-up schedule
- gestational: none - no NPDR: 1st and 3rd trimester - mild/moderate NPDR: every trimester - severe NPDR: monthly - PDR: monthly (treat with PRP if needed)
89
Gillespie syndrome
- aniridia - cerebellar ataxia - intellectual disability - optic nerve hypoplasia
90
Morning glory disc associations
- basal encephalocele - callosal agenesis - Moyamoya or other cerebrovascular anomalies - PHACE syndrome
91
PHACES syndrome
- posterior fossa abnormalities - HEMANGIOMA of the face - arterial anomalies - cardiac anomalies - ocular anomalies (morning glory) - sternal or abdominal clefting
92
CHARGE syndrome
- Colobomas of the eye (typically not lid) - Heart defects - Atresia of the nasal choanae - Retardation of growth/development - Genitiurinary malformations - Ear malformations
93
CT/CTA finding in carotid-cavernous fistula
- enlarged superior ophthalmic vein
94
Double Maddox rod testing in CN4 palsy
- unilateral: less than 10 degrees of excyclotorsion - bilateral: greater than 10-15 degrees
95
Vertical fusional amplitudes in CN4 palsy
- congenital: 8-12 prism diopters - acquired: 2-3 prism diopters
96
Rheumatologic work up
- ESR/CRP/CBC - HLA-B27 - ACE/lysozyme - RPR/FTA-ABS - chest xray - ANCA - ANA - RF - Lyme - EBV
97
Light-near dissociation
- bilateral optic neuropathy or retinopathy - Adie tonic pupil - dorsal midbrain (Parinaud) syndrome - syphilis (Argyl-Robinson) - third nerve palsy (aberrant regeneration) - diabetes, alcohol
98
X-linked retinoschisis treatment
- PO carbonic anhydrase inhibitors if foveal schisis - PPV if nonclearing VH - surgical repair of RD - amblyopia treatment
99
Tay-Sachs associations
- autosomal recessive, Jewish heritage - cherry red spot - hexosaminadase A deficiency - gangliosides accumulate - progressive neurodegeneration - seizures - no cure, treat associated symptoms
100
Niemann-Pick associations
- autosomal recessive - cherry red spot - sphingomyelin accumulates - progressive neurodegeneration - no cure, treat symptoms such as seizures
101
CRVO etiologies
- HTN - optic disc edema - glaucoma - hypercoagulable state (protein C and S deficiency, factor V Leiden, polycythemia, multiple myeloma) - abnormal platelet function - medications (OCPs, diuretics) - vasculitis - migraine
102
Eleschnig spots
- previous choroidal infarcts from malignant HTN
103
Unilateral hypertensive retinopathy changes
- suspect carotid occlusive disease sparing the uninvolved eye
104
Severe diabetic retinopathy requirements
- diffuse DBH in all quadrants - two quadrants of venous beading - one quadrant of prominent IRMA
105
Bilateral multilayered retinal hemorrhages in an adult
- Terson syndrome - subarachnoid hemorrhage, intracranial hemorrhage, or TBI - IVFA shows leakage around the disc - watch for ghost cell glaucoma, RD, and ERM after - PPV if nonclearing VH
106
Peripheral retinal ischemia and NV in young male with unknown etiology
- Eales disease - peripheral retinal periphlebitis - anterior uveitis - late optic atrophy, neovascular glaucoma, or retinal detachment - treat acute disease with steroids - possibly some benefit from anti-tuberculosis therapy - PRP of avascular retina - PPV if nonclearing VH
107
VH differential
- PVD - retinal tear/detachment - DM - RVO - ARMD - sickle cell - RAM - Valsalva - tumor - Eales - Terson
108
Band keratopathy differential
- JIA - silicone oil - chronic retinal detachment - metabolic disease (hyperoarathyroidism, hypercalcemia) - renal failure - gout, saroicdosis - trauma - end stage glaucoma
109
Band keratopathy testing
- ESR/CRP - RF - ANA - CMP - phosphorus/calcium - ACE - uric acid
110
Anterior uveitis differential
- idiopathic - HLA-B27 - infection (TB, Lyme, syphilis, HSV) - trauma - autoimmune (sarcoid, RA, Wegener) - drug induced (rifabutin, cidofovir, sulfonamides) - tumor - Fuch’s heterochromic - posterior uveitis with anterior spillover
111
Corneal crystals differential
- Schyder dystrophy - cystinosis (kidney disease) - Bietti corneoretinal dystrophy (night blindness) - lymphoproliferative disorder (B symptoms) - fluoroquinolone use - infectious crystalline keratopathy
112
Stargardt associations
- autosomal recessive - ABCA4 gene - progressive vision loss, photophobia, loss of color vision - bull’s eye maculopathy - pisciform flecks - central scotoma on HVF - “dark choroid” on IVFA - mix hypoAF and hyperAF flecks on FAF - decreased photopic and scotopic response on ERG in advanced cases - no real therapy, VA typically stabilizes at better than 20/400 - tinted glasses and low vision aids
113
RP syndromes and differential
- past trauma or inflammation - Refsum (avoid phytanic acid milk/fats) - Usher (hearing loss) - Bassen-Kornzweig (supplement vit AEK) - Kearns-Sayre (EKG, cardiology, CPEO) - syphilis - thioridazine toxicity - gyrate atrophy, choroideremia - Leber congenital amaurosis
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RP testing
- ERG: prolonged dark adaptation and increased absolute rod threshold - HVF: ring scotoma - OCT: retinal thinning, ERM, CME, VMT - IVFA: CME
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RP treatment
- vitamin A supplementation - smoking cessation - oral or topical CAI for CME - UV blocking glasses - CE/IOL if PSC - low vision counseling - potential gene therapy in the future - retinal implant for end stage RP
116
Leber congenital amaurosis associations
- autosomal recessive - often shows pigmentary retinopathy - moderate to severe vision loss - nystagmus - photophobia - oculodigital sign - sluggish or non-responsive pupils - markedly reduced or flat ERG - associated with keratoconus - gene therapy shows promise
117
ROP differential
- FEVR - Coats disease - persistent fetal vasculature - toxocara - Norrie disease (micropthalmia, developmental delays, deafness) - incontenentia pigments (X-linked dominant, skin findings, developmental delay and seizures)
118
Gyrate atrophy associations
- nyctalopia and loss of peripheral vision in first decade of life - scalloped progressive RPE atrophy - PSC cataracts - high myopia - CME on OCT and IVFA - flat ERG - FAF shows areas of hypoAF corresponding to RPE atrophy - high ornithine levels - intravitreal steroid for CME - low protein diet, supplement B6
119
Choroideremia associations
- X-linked recessive: men primarily affected - diffuse, progressive degeneration of the RPE - nyctalopia and peripheral vision loss - no optic atrophy - PSC and CME - decreased photopic and scotopic ERG early, eventually extinguished - IVFA shows scalloped areas of missing choriocapillaris - FAF shows areas of hypoAF corresponding to areas of RPE atrophy
120
Bullseye maculopathy differential
- chloroquine/hydroxy toxicity - cone-rod dystrophy - Stargardt disease - solar retinopathy - ARMD - macular hole
121
Multifocal ERG in hydroxychloroquine toxicity
- depression of signals in the perifoveal region
122
Reason for closer f/u with hydroxychloroquine
- dose > 5 mg/kg - renal or liver disease - taking medication > 10 years
123
Hypercoagulable work up
- ANA - RPR - PT/INR - homocysteine - lupus anticoagulant - SPEP/UPEP - protein C/S - factor V Leiden - antithrombin III
124
ERG findings in CRAO
- normal A-wave - diminished B-wave
125
Toxo differential
- syphilis - CMV retinitis - fungal chorioretinitis - histoplasmosis - TB - toxocariasis
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Crouzon syndrome differential
- Apert syndrome - Goldenhar syndrome
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Stargardt differential
- fundus albipunctatus (CHNB variant, no macular degeneration or pigment changes, prolonged dark adaptation time but normal ERG) - retinitis punctata albescens (more marked VA, fields, and night blindness deterioration) - cone-rod dystrophy (more color vision deficit) - chloroquine/hydroxychloroquine toxicity - drusen
128
Treatment for choroidal effusion due to hypotony
- check for wound leak - gonio to look for cyclodialysis cleft - topical steroids, cycloplegics - if severe with iridocorneal or lens touch: reform AC with viscoelastic - surgical drainage if persists or if kissing choroidals
129
RP inheritance
- autosomal dominant best prognosis - X-linked has worst prognosis
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Serous retinal detachment differential
- VKH - sympathetic ophthalmia - malignant hypertension - CSCR - choroidal tumor - optic pit - uveal effusion syndrome - posterior scleritis - APMPPE
131
Birdshot associations
- bilateral - middle aged female - HLA-A29 - VITRITIS - postequatorial creamy white, yellow lesions, from disc, somewhat spares macula - CME, chronic, progressive - standard autoimmune therapy
132
APMPPE associations
- bilateral - young, M=F - viral prodrome - early hypofluorescence, later hyperfluorescence on IVFA - CEREBRAL VASCULITIS - spontaneous resolution
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MEWDS associations
- unilateral - young female - mild vitritis and anterior uveitis - foveal granularity with surrounding hyperfluorescence in wreath pattern on IVFA - spontaneous resolution
134
Serpiginous associations
- bilateral - middle age M=F - IVFA similar to APMPPE: hypo early, hyper late - chronic, progressive, central scarring - CNV - standard autoimmune treatment
135
PIC associations
- bilateral - young, myopic female - no vitritis - small, yellow, round lesions in the macula - self-limited - late CNV
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Multifocal choroiditis associations
- bilateral - young, myopic female - vitritis, anterior uveitis - white-yellow lesions evolve into punched-out scars - vision loss due to scarring and CNV - IVFA may show disc leakage, subretinal pooling, CME, or CNV - standard autoimmune therapy
137
Neuro testing
- pupils, color plates - Hertel - HVF - OCT nerve and macula - B-scan
138
7th nerve palsy differential
- Bell palsy - central lesion - CPA mass (acoustic neuroma) - trauma - infection (otitis media, Guillain-Barre, HZV, Lyme, syphilis) - infiltration - neoplasm (parotid)
139
Bell palsy treatment
- corneal exposure - oral steroids - consider oral antivirals
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Proptosis in children
- orbital cellulitis - rhabdomyosarcoma - metastatic nueroblastoma - lymphangioma - capillary hemangioma - leukemia - optic nerve glioma - ONSM - dermoid cyst - carotid cavernous fistula - mucocele
141
Horner syndrome in a child
- metastatic neuroblastoma
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3rd nerve palsy in immunocomprimised
Cavernous sinus syndrome - AV fistula - cavernous sinus thrombosis - mucor - Tolosa-Hunt
143
Methods for assessing visual potential in white cataract
- check for RAPD - potential acuity meter - lighter perception and direction of orientation - projecting color - ERG - Haidinger’s brush
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Goldenhar exam
- facial asymmetry - microphthalmia - epibulbar dermoids, lipodermoids - coloboma, commonly upper eyelid - aural tags - Duane syndrome
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Goldenhar therapy
- eyelid reconstruction if exposure from coloboma - resection of limbal dermoid if astigmatism or amblyopia - facial reconstruction - ear reconstruction

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