Differential diagnoses
A
B
Fig. 10.18: Choroidal neovascularization associated with a lacquer crack and high myopia.
■Familial dysautonomia.
■Mucopolysaccharidosis VI.
■Fabry’s disease.
■Hyperviscosity syndromes.
■Eales’ disease.
444 ■ Racemose angioma (Fig. 10.20).
RETINA MEDICAL 10 Chapter
Fig. 10.19: Idiopathic juxtafoveal telangiectasia.
Fig. 10.20: Racemose angioma.
Retinal deposits
■Exudates: diabetes, hypertension, macroaneurysm, retinal vein occlusion, vascular tumour, telangiectasia (Coats’
diagnoses |
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■ Drusen: age-related macular degeneration; basal laminar |
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drusen; dominant dystrophies (Doyne’s macular dystrophy/ |
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Mallatia Levantinese; Sorsby’s dystrophy; North Carolina |
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macular dystrophy). |
Differential |
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■ Crystals: juxtafoveal telangiectasia, talc, canthaxanthine, |
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tamoxifen, Bietti’s crystalline retinopathy. |
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■ White dots: multiple evanescent white dot syndrome |
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(MEWDS); birdshot chorioretinopathy; hereditary fundus |
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albipunctatus. |
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■ Flecks: Stargardt’s/fundus flavimaculatus; pattern |
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dystrophy. |
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■ Yellow lesions: Best’s macular dystrophy; pattern dystrophy |
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(adult vitelliform macular dystrophy form); pigment epithelial |
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detachment from central serous retinopathy; age-related |
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macular degeneration; Harada’s disease; metastasis. |
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Cherry-red spot at the macula |
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■ Central retinal artery occlusion (Fig. 10.21). |
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■ Sphingolipidoses, e.g. Tay-Sachs, Gaucher, and Niemann-Pick |
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disease. |
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■ Quinine toxicity. |
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■ Traumatic retinal oedema. |
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446 Fig. 10.21: Central retinal artery occlusion.
Differential diagnoses
Fig. 10.23: Macular star from hypertensive retinopathy.
Macular star
■Hypertension (Fig. 10.23).
■Retinal vascular occlusion.
■Papilloedema.
■Inflammation: choroiditis; posterior scleritis; vasculitis; toxoplasmosis; chronic infection, e.g. syphilis.
■Idiopathic.
Macular atrophy
■Age-related macular degeneration (Fig. 10.24).
■Pathological myopia.
■Stargardt’s disease.
■Cone dystrophy.
■Dominant retinal dystrophies, e.g. central areolar choroidal dystrophy.
■A3243G mitochondrial mutation (maternally inherited diabetes and deafness, MIDD).
■Best’s vitelliform macular dystrophy.
448 ■ Pattern dystrophy, e.g. adult vitelliform macular dystrophy.
RETINA MEDICAL 10 Chapter
Fig. 10.24: Geographic atrophy from age-related macular degeneration.
■X-linked retinoschisis.
■North Carolina macular dystrophy.
■Toxic, e.g. chloroquine.
■Acquired, e.g. after pigment epithelium detachment, subretinal haemorrhage.
■Infectious, e.g. onchocerciasis.
■Solar retinopathy.
Bull’s-eye maculopathy
■Macular, cone or cone/rod dystrophies, e.g. Stargardt’s disease (Fig. 10.25).
■Drug toxicity, e.g. chloroquine.
■Batten’s disease.
■Benign concentric annular macular dystrophy.
■Bardet-Biedl syndrome.
Angioid streaks
■ Pseudoxanthoma elasticum (Fig. 10.26).
Differential diagnoses
Fig. 10.25: Bull’s-eye maculopathy from Stargardt’s disease.
■Haemoglobinopathies, sickle cell disease.
■Ehlers-Danlos syndrome.
■Other rare associations, e.g. abetalipoproteinaemia.
Choroidal folds
■Idiopathic chorioretinal folds or hypermetropia (Fig. 10.27).
■Hypotony.
■Retrobulbar mass lesions.
■Thyroid eye disease.
■Scleral inflammation.
■Scleral buckle.
■Choroidal tumours.
■Choroidal neovascularization.
■Focal chorioretinal scars.
■Optic nerve head diseases associated with swelling.
■Papilloedema.
Pigmentary retinopathy
450 ■ See retinitis pigmentosa, page 496.
RETINA MEDICAL 10 Chapter
A
B
Fig. 10.26: Angiod streaks from pseudoxanthoma elasticum.
Vision loss with normal retina
■Exclude subtle abnormalities:
1.Angioid streaks.
2.Choroidal folds.
Differential diagnoses
A
B
Fig. 10.27: Choroidal folds in a hypermetropic patient.
