Differntial Diagnosis Of Ophthalmology Diseases

Causes of Common Ocular Symptoms and Signs

Sudden painless loss of vision

• Central retinal artery occlusion
• Central retinal vein occlusion
• Vitreous haemorrhage
• Retinal detachment involving macula
• Central serous chorioretinopathy
• Optic neuritis
• Corneal hydrops in keratoconus
• Dislocation of lens

Sudden Painful Loss of vision

• Keratitis
• Acute iridocyclitis
• Acute congestive glaucoma
• Chemical injury
• Mechanical injury

Gradual painless loss of vision

• Cataract
• Keratoconus
• Corneal degeneration e.g. band karatopathy
• Corneal dystrophy e.g. macular dystrophy
• Optic atrophy
• Chorioretinal degeneration
• Age-related macular degeneration
• Diabetic retinopathy
• Progressive pterygium involving papillary area

Gradual painful visual loss

• Keratitis
• Chronic iridocyclitis
• Scleritis

Transient loss of vision (Amaurosis fugax)

• Carotid artery disease
• Prodromal symptom of CRAO
• Papilloedema
• Giant cell arteritis
• Migraine

Uniocular diplopia

• Dislocated lens
• Immature cataract
• Double pupil

Binocular diplopia (Triplopia)

• Paralytic squint

                -               Third nerve palsy

                -               Fourth nerve palsy

                -               Sixth nerve palsy

• Myasthenia gravis
• Thyroid opthalmopathy
• Blow out fracture

Colored halos

• Acute congestive glaucoma
• Early stage of cataract
• Mucopurulent conjunctivitis

Night blindness

• Vitamin A deficiency
• Retinitis pigmentosa and other tapetoretinal degeneration
• Congenital night blindness
• Primary open angle glaucoma advanced stage
• Peripheral cortical cataract
• Retinal Photo-coagulation

Day Blindness

• Central nuclear or polar cataract
• Central corneal opacity
• Central vitreous opacity
• Congenital deficiency of cones

Difficulty in near work

• Hypermetropia
• Presbyopia
• Dilated pupil
• Internal or total opthalmoplegia
• Insufficiency of accommodation

Floaters (black spots moving in front of the eye)

• Vitreous hemorrhage
• Vitreous degeneration
• Choroiditis (exudate in vitreous)
• Posterior vitreous detachment

Photopsia (Flashes of light in front of the eyes)

• Posterior vitreous detachment
• Prodromal symptom of retinal detachment
• Vitreous traction bands

Red Eye

• Conjunctives
• Keratitis
• Iridocyclitis
• Acute congestive glaucoma
• Episcleritis
• Scleritis
• Subconjunctival hemorrhage
• Corneal foreign body
• Endophthalmitis
• Panophthalmitis

Painful Red Eye

• Keratitis
• Iridocyclitis
• Acute congestive glaucoma
• Scleritis
• Corneal foreign body

Lacrimation

• Trichiasis
• Entropion
• Conjunctivitis
• Keratitis
• Iridocyclitis
• Acute congestive glaucoma

Epiphora

• Punctum block
• Canalicular block
• Nasolacrimal dust obstruction
• Ectropion

Circumcorneal congestion (ciliary injection)

• Keratitis
• Acute Iridocyclitis
• Acute glaucoma
• Corneal foreign body

Conjunctival Follicles

• Viral conjunctivitis
• Chlamydial conjunctivitis
• Hypersensitivity to topical medication

Conjunctival Papillae

• Trachoma
• Allergic conjunctivitis
• Contact lens wear

Superficial Corneal Vascularization

• Trachoma
• Phlyctenular keratoconjunctivitis
• Rosacea keratitis
• Superficial corneal ulcer

Deep Corneal Vascularization

• Interstitial keratitis
• Deep corneal ulcer
• Chemical burns
• After keratoplasty

Shallow Anterior Chamber

• Hypermetropia
• Primary angle-closure glaucoma
• Malignant glaucoma
• Postoperative shallow anterior chamber
• Corneal perforation
• Intumescent cataract

Deep Anterior Chamber

• Myopia
• Aphakia
• Keratoglobus
• Keratoconus

Rubeosis Iridis (Neovascularization of Iris)

• Central retinal vein occlusion
• Diabetes mellitus
• Eale’s disease
• Sickle cell retinopathy
• Retinoblastoma

Hyphaema

• Ocular injury
• Postoperative
• Herpes zoster iritis
• Intraocular tumor
• Rubeosis iritis

Hypopyon

• Bacterial corneal ulcer
• Fungal corneal ulcer
• Iridocyclitis
• Endophthalmitis
• Panophthalmitis
• Pseudonymous

Miotic Pupil

• Pharmacological (Pilocarpine)
• Systemic use of morphine
• Horner's syndrome
• Head injury (pontine hemorrhage)
• Argyll Roberston pupil

Mydriatic pupil

• Sympathomimetic drugs (Phenylephrine, Adrenaline)
• Parasympatholytic drugs (Mydriacyl, Atropine)
• Traumatic iridoplegia
• Acute congestive glaucoma
• Third nerve paralysis

Leukoria (Whitish Reflex in papillary area)

• Congenital cataract
• Retinoblastoma
• Persistent hyperplastic primary vitreous
• Retrolental fibroplasia (retinopathy of prematurity)
• Retrolental fibroplasia
• Toxocara endophthalmitis
• Coat’s disease

Marcus Gunn Pupil (Afferent Pupillary Defect)

• Optic neuritis
• Optic atrophy
• Central retinal artery occlusion
• Central retinal vein occlusion
• Total retinal detachment

Sublexation of Lens

• Trauma
• Marfan’s syndrome
• Homocystinuria
• Weill – Marchesani syndrome

Cherry Red spot

• Central retinal vein occlusion
• Tay - Sachs’ disease
• Niemann - Pick’s disease
• Commotion retinae

Retinal Hemorrhage

• Diabetic retinopathy
• Hypertensive retinopathy
• Central retinal artery occlusion
• Central retinal vein occlusion
• Eale’s disease
• Sickle cell disease
• Retinopathy of AIDS
• Age related macular degeneration

Cotton Wool Spots (Soft exudate) in Retina

• Hypertensive retinopathy
• Diabetic retinopathy
• Central retinal vein occlusion
• Retinopathy of AIDS

Hard exudate on the Retina

• Diabetic retinopathy
• Hypertensive retinopathy
• Retinal vein occlusion (old)
• Papilloedema
• Coat’s disease

Neovascularization of Retina

• Diabetic retinopathy
• Central retinal artery occlusion
• Central retinal vein occlusion
• Branch retinal vein occlusion
• Sickle cell retinopathy
• Eale’s disease

Tubular Vision

• Glaucoma in advanced age
• Retinitis pigmentosa
• Pan-retinal photo-coagulation

Central Scotoma

• Optic neuritis
• Compressive optic neuropathy
• Tobacco amblyopia
• Macular hole

Bitemporal Hemianopia

• Pituitary tumor
• Suprasellar aneurysm
• Craniopharygioma
• Glioma of third ventricle

Homonymous Hemianopia

• Optic tract lesions
• Lateral geniculate body lesions
• Lesions involving total fibers of optic radiation
• Visual cortex lesions (usually sparing of macula)

Disc Edema

• Pappillitis
• Papilloedema
• Ocular hypotony
• Central retinal vein occlusion
• Tumors of optic nerve
• Thyroid opthalmopathy
• Metastasis – leukemia

Papilledema

• Intracranial space occupying lesions – tumor’ abscess and cyst
• Impaired CSF circulation – aqueduct stenosis
• Meningitis
• Benign intracranial hypertension
• Malignant systemic hypertension
• Vitamin A toxicity

Related key terms:
Differntial Diagnosis Of Ophthalmology Diseases
Differential Diagnosis Of eye Diseases

Posted in: Cotton Wool Spots,D/D of eye diseases,D/D of ophthalmology diseases,EYE AND RELATED DISEASES,Floaters,Fourth Year OSPE,Hyphaema,Hypopyon,Marcus Gunn Pupil,Red Eye,Retinal Hemorrhage