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Ocular Differential Diagnosis 7th edition_Roy_2002

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cefotetan	dexchlorpheniramine	glutethimide
cefoxitin	diazepam	glyburide
cefsulodin	diazoxide	gold Au 198
ceftizoxime	dimethyl imidazole	gold sodium
	carboxamide (DIC)	thiomalate
ceftriaxone		gold sodium
		thiosulfate
cefuroxime	dichlorphenamide	halazepam
cephalexin	dicloxacillin	griseofulvin
cephaloglycin	dicumarol	guanethidine
cephaloridine	diethazine	haloperidol
cephalothin	dihydrotachysterol	heparin
cephapirin	diltiazem	heptabarbital
cephradine	dimercaprol	hetacillin
chlorambucil	dimethyl sulfoxide	hexethal
chloramphenicol	diphtheria and tetanus	hexobarbital
	toxoids and pertussis
chlordiazepoxide	vaccine	hydracarbazine
chloroquine		hydralazine
chlorothiazide	dimethindene	hydrochlorothiazide
chlorpheniramine	diphenadione	hydroflumethiazide
hydroxychloroquine	methyprylon	polio virus vaccine
hydroxyurea	metrizamide	polythiazide

hydralazine	metronidazole	potassium penicillin
		G
ibuprofen	mexiletine	potassium penicillin
		V
imipramine	mianserin	potassium
		phenethicillin
indapamide	minocycline	potassium
		phenoxymethyl
indomethacin	mitomycin	prazepam
interferon alpha, beta, or gamma	moxalactam	primidone
	mumps virus vaccine	probarbital
	(live)
iopamidol	nadolol	procaine penicillin
		G
isocarboxazid	nafcillin	procarbazine
isoniazid	nalidixic acid	prochlorperazine
ketoprofen	naproxen	promazine
labetalol	nialamide	promethazine
levodopa	nifedipine	propiomazine
lincomycin	nitrazepam	propylthiouracil
lithium carbonate	nitrofurantoin	protriptyline
lomustine	nitroglycerin	pyrimethamine
lorazepam	nortriptyline	quinacrine
loxapine	oral contraceptives	quinethazone

maprotiline	orphenadrine	quinidine
measles virus vaccine	oxacillin	quinine
mechlorethamine	oxazepam	ranitidine
mefenamic acid	oxyphenbutazone	rifampin
melphalan	oxytetracycline	rubella and mumps
		virus vaccine (live)
mephenytoin	paramethadione
mephobarbital	penicillamine	secobarbital
meprobamate	penicillin	semustine
mercaptopurine	pentobarbital	sodium
		antimonylgluconate
mesoridazine	perazine	stibocaptate
metolazone	pericyazine	stibophen
methacycline	perphenazine	streptomycin
methaqualone	phenacetin	streptozocin
metharbital	phenelzine	suramin
methazolamide	phenformin	temazepam
methdilazine	phenindione	sulfonamides
methicillin	pheniramine	talbutal
methimazole	phenobarbital	testolactone
methitural	phenoxymethyl	testosterone
methohexital	phenoxymethylpenicillin	tetracycline
methotrexate	phenprocoumon	thiabendazole

	methotrimeprazine	phensuximide	thiamylal
	methsuximide	phenylbutazone	thiethylperazine
	methyclothiazide	phenytoin	thioguanine
	methyldopa	pindolol	thiopental
	methylene blue	piperacetazine	thiopropazate
	methylphenidate	piperazine	thioproperazine
	methylthiouracil	pipobroman	thioridazine
	thiotepa	trifluoperazine	vancomycin
	thiothixene	trifluperidol	verapamil
	tocainide	triflupromazine	vidarabine
	tolazoline	trimeprazine	vinbarbital
	tranylcypromine	trimethadione	vinblastine
	trazodone	tripelennamine	vincristine
	triazolam	triprolidine	vitamin A
	tolazamide	uracil mustard	vitamin D
	tolbutamide	urethan	vitamin D2
	trichlormethiazide	valproate sodium	vitamin D3
	triethylenemelamine	valproic acid	warfarin

	P.208

	P.209

	P.210
3. Leukemia

4. Septicemias

5. Splenic disorders, such as Banti or Gaucher disease, Felty syndrome, and hemolytic icterus

6. *Systemic lupus erythematosus (Kaposiâ??Libmanâ??Sacks syndrome)

B.Ehlersâ??Danlos syndrome (fibrodysplasia elastica generalisata)

C.Hemochromatosis

D.Schomberg disease

E.Scurvy (avitaminosis C)

F.Secondary, such as that because of nephritic, cardiac, or hepatic disease

G.Thrombocytopenia purpura

4. Fragility of vessel walls because of systemic vascular disease

A.Age

B.Arteriosclerosis

C.Diabetes

D.Hypertension

E.Nephritis

5. Gravity inversion

6. Injury to orbital or adjacent structures, such as sinus, basal skull fracture, subarachnoid hemorrhage

7. Local acute inflammation, including, acute pneumococcal conjunctivitis, leptospirosis ictero-hemorrhagica, epidemic typhus, and scrub typhus

8. Local trauma, including surgical trauma

9. Remote injury associated with fractured bones and fat emboli following angiography or open heart operation causing â??splinterâ? subconjunctival hemorrhage

10. Spontaneous during menstruation

11. Spontaneous rupture of telangiectasis, varicosities, aneurysm, or angiomatous tumor (see p. 201)

12. *Sudden severe venous congestion of head, including that because of coughing, vomiting, epileptic fit, strangulation, or an orbital tumor (neuroblastoma)

13. Without apparent causeâ??most common

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.

Friberg TR, Weinreb RN. Ocular manifestations of gravity inversion. JAMA 1985;253.

Tasman W, Jaeger E, eds. Duane's clinical ophthalmology. Philadelphia: JB Lippincott, 1990.

Werblin TP, Peiffer RL. Persistent hemorrhage after extracapsular surgery associated with

excessive aspirin ingestion. Am J Ophthalmol 1987;104:426.Bibliographic Links

P.211

Tumors of the Conjunctiva

1. Epithelial tumors

A.Keratoacanthoma

B.Dyskeratosis

1. Epithelial plaquesâ??leukoplakia, hereditary benign intraepithelial dyskeratosis

2. Intraepithelial epithelioma (Bowen disease) (61N)

C.Metastatic uveal melanoma

D.*Papillomaâ??including virus types 11, 16, and 18

E.Epithelioma

F.Adenoma

1. Papillary cystadenoma lymphomatosum (Warthin tumor)

2. Oncocytoma (oxyphil-cell adenoma)

3. Pleomorphic adenoma of Krause glands

2. Mesoblastic tumors

A.Inflammatory hyperplasias

1. Granuloma

2. Plasmoma

B.Connective tissue tumors 1. Fibroma

2. Lipoma

3. Myxoma

3. The reticuloses

A.*Lymphoma

B.Lymphosarcoma

C.*Mycosis fungoides

4. Vascular tumorsâ??angiomas

A.Polymorphous hemangioma, telangiectatic granuloma, granuloma pyogenicum

B.Lymphangioma

C.Angiosarcoma monomorphous angioma, Kaposi (hemorrhagic) sarcoma

5. Pigmented tumors

A.*Nevus

B.Malignant melanoma

C.Intraepithelial melanomaâ??precancerous melanosis

6. Peripheral nerve tumors

A.Neurofibroma

1. *Neurilemmoma (neurinoma, schwannoma)

2. Malignant schwannoma (neurogenic sarcoma; neurofibrosarcoma)

3. Plexiform neurofibromatosis

B.Tuberous sclerosis (Bourneville disease)

C.*Intrascleral nerve loops

7. Amyloidosis

8. Metastatic renal cell carcinoma

9. Trematode-induced granulomas

10. Hypertrophic discoid lupus erythematosus

Crawford JB, et al. Combined nevi of the conjunctiva. Arch Ophthalmol 1999;117:1121â??1127.Bibliographic Links

Grossniklaus HE, et al. Hemangiopericytoma of the conjunctiva. Ophthalmology 1986;93:265â??267.Bibliographic Links

Jay V, Font RL. Conjunctival amelanotic malignant melanoma arising in primary acquired melanosis sine pigmento. Ophthalmology 1998;105:191â??194.Bibliographic Links

P.212

Marsh WM, et al. Localized conjunctival with amyloidosis associated with extranodal lymphoma. Ophthalmology 1987;94:61â??64.Bibliographic Links

Odrich MG, et al. A spectrum of bilateral squamous conjunctival tumors associated with the human papillomavirus type 16. Ophthalmology 1991;98:628â??635.Bibliographic Links

Peter J, Hidayat AA. Myxomas of the conjunctiva. Am J Ophthalmol 1986;102:80â??86.Bibliographic Links

Rathinam S, et al. An outbreak of trematode-induced granulomas of the conjunctiva. Ophthalmology 2001;108:1223â??1229.Bibliographic Links

Sagerman RH, Abramson DH. Tumors of the eye and ocular adnexae. New York: Pergamon Press, 1982.

Uy HS, et al. Hypertrophic discoid lupus erythematosus of the conjunctiva. Am J Ophthalmol 1999;127:604â??605.Bibliographic Links

Ware GT, et al. Renal cell carcinoma with involvement of iris and conjunctiva. Am J

Ophthalmol 1999;127,4:458â??459.

Winward KE, Curtin VT. Conjunctival squamous cell carcinoma in a patient with human immunodeficiency virus infection. Am J Ophthalmol 1989:554â??556.

Conjunctival Cysts

1. Congenital corneoscleral cyst (rare)

2. Epibulbar dermoids with cystic form

3. *Epithelial cyst

A.Apposition of folds of conjunctival mucosa (common)

B.*Downgrowth of epitheliumâ??chronic inflammatory conditions, such as that following inflammation of pterygium

C.Glandular retentionâ??involvement of Krause glands in chronic inflammatory conditions, including trachoma and pemphigus

D.Pigmented cyst appearing after prolonged topical use of cocaine or epinephrine

4. Limbal wounds with iris prolapse

5. Lymphatic cyst

6. *Muscle inclusion cyst/complication of strabismus surgery

7. Parasitic cyst such as filarial cyst

8. Traumatic cyst (epithelial implantation)

Cibis GW, Waeltermann JM. Muscle inclusion cyst as a complication of strabismus surgery. Am J Ophthalmol 1985;100:740â??741.Bibliographic Links

Jahnle RL, et al. Conjunctival inclusion cyst simulating malignant melanoma. Am J Ophthalmol 1985;100:483â??484.Bibliographic Links

Soong HK, et al. Corneal astigmatism from conjunctival cysts. Am J Ophthalmol 1982;93:118.Bibliographic Links

Limbal Mass

1. Allergic reaction

A.*Phlyctenules

B.Vernal limbal lesions

2. Amyloidâ??perilimbal

3. Associated with skin disease

A. *Acne rosacea (ocular rosacea)

B.Hereditary benign intraepithelial dyskeratosis

C.*Hodgkin disease

D.Limbal squamous carcinoma in xeroderma pigmentosa

E.Pityriasis rubra pilaris

F.Psoriasis (psoriasis vulgaris)

G.*Reticulum cell sarcomaâ??raised, pink, smooth lesions

4. Benign nodular fascitis P.213

5. *Dermoids

6. Ectopic lacrimal gland tissue

7. Epithelial hyperplasia

8. Fibrous histiocytoma

9. Fibroxanthoma

10. Granular cell tumor

11. Granulomas

12. Hemangioma

13. Intraepithelial epitheliomas (Bowen disease)

14. Lymphomas

15. Malignant melanomas

16. Mononucleosis (infectious)

17. *Nevi

18. Papillomas

19. Pterygia

20. Sarcomas

21. Salmon patch associated with relapsing polychondritis

22. Squamous cell carcinoma

23. Subconjunctival nodules associated with Crohn disease

24. Synthetic fiber granuloma

Charles NC, et al. Epibulbar granular cell tumor. Ophthalmology 1997;104:1454â??1456.Bibliographic Links

Engelbrecht NE, et al. Combined intraepithelial squamous neoplasia and atypical fibroxanthoma of the cornea and limbus. Am J Ophthalmol 2000;129:94â??95.Bibliographic Links

Ferry AP. Synthetic fiber granuloma `teddy bear' granuloma of the conjunctiva. Arch Ophthalmol 1994;112:1339â??1341.Bibliographic Links

Grewal RK, et al. Subconjunctival nodules: an unusual ocular complication of Crohn's disease. Can J Ophthalmol 1994;29:238â??239.Bibliographic Links

Urback SF. Infectious mononucleosis presenting as a unilateral conjunctival tumor. Acta Ophthalmol Scand 1993;72:133â??135.

Large, Flat, Fleshy Lesions of Palpebral Conjunctiva

1. Accidental or surgical injuries

2. Carthy disease (pyorhinoblepharostomatitis vegetans)

3. *Chalazion

4. *Embryonal rhabdomyosarcoma of children

5. *Granuloma pyogenicum

6. Ligneous conjunctivitis

7. Lymphogranuloma venereum

8. Meibomian cell carcinoma

9. Myopic infection

10. Papillary hyperplasia of vernal conjunctivitis

11. *Syphilis

12. Tuberculosis

13. Tularemia

Friedman AH, Henkind P. Granuloma pyogenicum of the palpebral conjunctiva. Am J Ophthalmol 1971;71:868â??872.Bibliographic Links

Pau H. Differential diagnosis of eye diseases, 2nd ed. New York: Thieme Medical, 1988.

P.214

Chronic or Recurrent Ulcers of the Conjunctiva

1. BehÃ§et disease

2. Crohn disease

3. Drugs, including the following:

allopurinol	ferrous succinate	iron sorbitex
amphotericin B	ferrous sulfate	phenytoin

aspirin

floxuridine

polysaccharideâ??iron complex

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