Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002
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Scleritis
Scleritis involves a potentially destructive inflammatory process that may accompany severe systemic disease. Ocular pain occasionally radiates to the temple, jaw, or sinuses. Women are more frequently affected than men. Most cases begin with bilateral involvement. Early perforation of sclera is possible. The anterior portion of the eye is affected most severely. Posterior scleritis may be a diagnostic challenge.
1. Associated with systemic disease
A. Collagen diseases
1. *Dermatomyositis (Wagnerâ??Unverricht syndrome)
2. *Felty syndrome
3. *Giant cell (temporal) arteritis P.238
4. Juvenile rheumatoid arthritis (Still disease)
5. Polyarteritis nodosa (Kussmaul disease)
6. PSS; scleroderma
7. Relapsing polychondritis
8. Reiter syndrome (polyarteritis enterica)
9. Rheumatoid arthritis
10. Sjögren syndrome
11. Systemic lupus erythematosus (SLE)
12. Wegener granulomatosis (Wegener syndrome)
B.Metabolic diseases
1. Cretinism (hypothyroidism)
2. Gout
3. Porphyria cutanea tarda
C.Myeloproliferative diseases
1. Hodgkin disease (lymph node disease)
2. Mycosis fungoides syndrome (Sézary syndrome)
2. Infectious
A.Bacterial
1. Leprosy
2. Lymphogranuloma venereum (Nicholsâ??Favre disease)
3. Syphilis (acquired lues)
4. Tuberculosis
B.Viral infections
1. Herpes simplex
2. Herpes zoster
3. Influenza
4. Mumps
C.Fungalâ??aspergillosis
D.Helminth infectionâ??acanthamoeba
E.Protozoanâ??toxoplasmosis
F.Infections
1. Associated with skin disease or immunosuppressive status
2. Spreading directly from conjunctiva, cornea, uvea, periorbital tissues, nose, or sinuses
3. Miscellaneous
A.Cogan syndrome
B.Crohn disease (granulomatous ileocolitis)
C.Goodpasture syndrome (pulmonary hemosiderosis)
D.Erythema nodosum
E.Exogenous infection via penetration through conjunctiva
F.Hashimoto thyroiditis
G.Heerfordt disease (uveoparotid fever)
H.Necrobiotic xanthogranuloma (increased IgG/IgA)
I.Terrien marginal corneal disease
J.Uveitis
4. Drugs
A. Pamidronate disodium
5. *Traumaâ??following cataract or strabismus surgery
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Heiligenhaus A, et al. Ultrasound biomicroscopy in scleritis. Ophthalmology 1998;105:527â??534.Bibliographic Links
Knox C, Michele MD, et al. Brief reports. Am J Opthalmol 1997;123:5,713â??714.
Maza MS, et al. Scleritis-associated uveitis. Ophthalmology 1997;104:58â??63.Bibliographic Links
Perry SR, et al. The clinical and pathologic constellation of Wegener granulomatosis of the orbit. Ophthalmology 1997;104:683â??694.Bibliographic Links
Riono WP, et al. Scleritis. Ophthalmology 1999;106:1328â??1333.Bibliographic Links
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Tuft SJ, Shah P, et al. Posterior scleritisâ??an unusual manifestation of Cogan's syndrome.
Br J Rheumatol 1994;33:774â??775.
Staphyloma (Stretching and Thinning of the Sclera with Incarceration of Uveal Tissue)
1. Collagen diseases
A.Felty syndrome
B.Rheumatoid arthritis (adult)
C.Wegener syndrome (Wegener granulomatosis)
2. Following trauma
A.Beta radiation
B.Deep scleral resection for episcleral malignancies
C.Pterygium excision and mitomycin therapy
D.*Scleral buckle removal
E.Subconjunctival injection of corticosteroids
F.Ultrasound treatment for glaucoma
3. Infectious
A.Aspergillosis
B.Herpes zoster (rare)
C.Plague (bubonic plague)
D.Syphilis
E.Tuberculosis
4. Ocular cause
A.Buphthalmos associated with increased intraocular pressure
B.Corneoscleral ectasia
C.Myopia with increased anteroposterior diameter
D.Scleritis (e.g., secondary to rheumatoid arthritis)
E.Uveitis
5. Miscellaneous
A.Ehlersâ??Danlos syndrome (fibrodysplasia elastica generalisata)
B.Endarteritis
C.Epidermolysis bullosa
D.Hyperparathyroidism
E.Meckel syndrome (dysencephalia syndrome)
F.Oculodental syndrome (Peter syndrome)
G.Porphyria cutanea tarda
Dunn JP, et al. Development of scleral ulceration and calcification after pterygium excision and mitomycine therapy. Am J Ophthalmol 1991;112:344.
Fraunfelder FT, Roy FH. Current ocular therapy, 5th ed. Philadelphia: WB Saunders, 2000.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
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Episcleral and Scleral Tumors
1. Carcinomas
2. Choroidal melanomas
3. *Epibulbar tumor
4. Fibromas
5. Hemangiomas
6. Histiocytosis
7. Lymphomas
8. Leiomyoma (transscleral)
9. Melanoblastoma (spread from choroid)
10. Retinoblastoma
Ireland KC, et al. Sinus histiocytosis presenting as bilateral epibulbar masses. Am J Ophthalmol 1999;127,3:360â??361.
Pau H. Differential diagnosis of eye diseases, 2nd ed. New York: Thieme Medical, 1988.
Perry HD. Isolated episcleral neurofibroma. Ophthalmology 1982;89:1095.Bibliographic Links
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Cornea
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Crystals of the Cornea (Deposition of Crystalline Substances in the Cornea)
1. Bietti marginal crystalline dystrophy
2. Calcium oxalateâ??dieffenbachia and other plants
3. Cholesterol crystalsâ??primary or secondary with corneal neovascularization
4. *Crystalline dystrophy of Schnyder
5. Crystalline retinopathy
6. Cystinosis syndrome (Lignacâ??Fanconi syndrome)
A.Benign adult
B.Congenital
7. Drugs, such as indomethacin (Indocin), chloroquine, thioridazine (Mellaril), and clofazimine 8. Dysproteinemia
A.Cryoglobulinemia
B.*Multiple myeloma
9. Elevated bilirubin with crystalline dystrophy
10. Fine, multicolored glittering crystals following successful transplant that later underwent graft rejection and was treated with steroids
11. Gout (hyperuricemia)
12. Hyperparathyroidism
13. Immunoglobulin G (IgG) K monoclonal gammopathy
14. *Infectious crystalline retinopathy, usually with more indolent streptococcal and staphylococcal species
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15. Post keratoplasty (Kaye dots)
16. Renal failure
17. Subconjunctival 5-fluorouracil
18. Uremia
19. Waldenström syndrome (macroglobulinemia syndrome)
Font RL, et al. Polychromatic corneal and conjunctival crystals secondary to clofazimine
therapy in a leper. Ophthalmology 1989;96:311â??315.Bibliographic Links
Ormerod LD, et al. Paraproteinemic crystalline keratopathy. Ophthalmology 1988;95:202â??212.Bibliographic Links
Rothman RF, et al. Noninfectious crystalline keratopathy after postoperative subconjunctival 5-fluorouracil. Am J Ophthalmol 1999;128,2:236â??237.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Vesaluoma MH, et al. In vivo confocal microscopy of a family with Schnyder crystalline corneal dystrophy. Ophthalmology 1999;106:944â??951.Bibliographic Links
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Diagnostic table
Crystals of the cornea (deposition of crystalline substance in the cornea)
View Table
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Anesthesia of the Cornea (Hypesthesia or Diminished Corneal Sensation in Trigeminal Distribution)
1. Cornea
A.*Cerebellopontine angle tumors
B.Congenital
C.Corneal dystrophyâ??granular, lattice, macular, and crystalline
D.Dysautonomia
E.*Infections, including herpes zoster, herpes simplex, leprosy, and malaria
F.Inflammations, including that occurring after electrocautery of Bowman membrane, stromal edema, vascularized scars, congestive glaucoma, exposure keratitis, radiation damage, and vitamin A deficiency
G.Trauma, including constant wearing of contact lenses and postoperatively, including cataract extraction and within corneal transplant, following operation for detached retinaâ??from an encircling band or, less frequently, a circumscribed buckle; from refractive surgery
2. Maxillary division
A.Congenital
B.Facial trauma
C.Interruption of trigeminal nerve or gasserian ganglion, including cerebellopontine angle tumor or other space-occupying lesion in the region of the superior orbital fissure
D.Maxillary antrum carcinoma
E.Neoplasm, foramen rotundum, sphenopterygoid fossa
F.Orbital floor fracture
G.Perineural spread of skin carcinoma
H.Surgery for trigeminal neuralgia
3. Ophthalmic division
A.Aneurysm, cavernous sinus
B.Neoplasm, cavernous sinus
C.Neoplasm, middle fossa
D.Neoplasm, orbital apex
E.Neoplasm, superior orbital fissure
4. Syndromes and diseases
A.Adie syndrome
B.Anhidrotic ectodermal dysplasia
C.Barré Lieou syndrome (posterior cervical sympathic syndrome)
D.Diabetes mellitusâ??youth onset, more marked with age
E.Eatonâ??Lambert syndrome (myasthenic syndrome)
F.Familial corneal hypesthesia
G.Foix syndrome (cavernous sinus syndrome)
H.Gradenigo syndrome (temporal syndrome)
I.Hereditary fleck dystrophy of the cornea
J.Herpes zoster
K.Hunt syndrome (herpes zoster auricularis)
L.Hydroa vacciniforme (lower cornea)
M.Multiple sclerosis
N.Oculoauriculovertebral dysplasia (Goldenharâ??Gorlin syndrome)
O.Nephropathic cystinosis
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P.Passow syndrome (Bremer status dysraphicus)
Q.Psoriasis (lower cornea)
R.Rileyâ??Day syndrome (congenital familial dysautonomia)
S.Rochonâ??Duvigneaud syndrome (superior orbital fissure syndrome)
T.Rollet syndrome (orbital apexâ??sphenoidal syndrome)
U.Scholz subacute cerebral sclerosis (arylsulfatase A deficiency syndrome)
V.Temporal arteritis syndrome (cranial arteritis syndrome)
W. Tolosaâ??Hunt syndrome (painful ophthalmoplegia) X. Vitamin A deficiency
5. Toxins and drugs, including oleoresin capsicum (pepper spray)
amiodarone |
diazepam |
paraldehyde |
amitriptyline |
gentamicin (?) |
phencyclidine |
amodiaquine |
glutethimide |
pindolol (?) |
atenolol (?) |
hydrogen sulfide |
propanolol |
betaxolol |
hydroxychloroquine |
steladex |
bromide |
imipramine |
trifluoperazine (Stelazine) |
carbon dioxide |
levobunolol |
timolol |
carbon disulfide |
meprobamate |
trichloroethylene |
carisoprodol |
methyprylon |
vinblastine |
chloroquine |
metoprolol (?) |
vincristine |
clorazepate |
nadolol (?) |
|
desipramine |
nortriptyline |
|
Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA:
Butterworth-Heinemann, 2001.
Glaser JS. Neuro-ophthalmology, 2nd ed. Philadelphia: JB Lippincott, 1989.
Katz B, et al. Corneal sensitivity in nephropathic cystinosis. Am J Ophthalmol 1987;104:413â??416.Bibliographic Links
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Zollman TM, et al. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186â??2189.Bibliographic Links
Hyperplastic Corneal Nerves
This condition involves overgrowth of corneal nerves up to 20 times the normal number. This nonspecific change may occur in association with the following conditions:
1. Deep filiform dystrophy of Maeder and Danis
2. *Herpes simplex
3. *Herpes zoster
4. *Multiple endocrine neoplasiaâ??type II B
5. Neurofibromatosis (von Recklinghausen syndrome)
6. Neuroparalytic keratitis
7. Normal eyes at advanced age
8. Ocular pemphigus foliaceus (Cazenave disease)
9. Opaque corneal grafts
10. Phthisis bulbi
11. Posterior polymorphous dystrophy
Charlin R. Neoplasia endocrina multiple type II-B. Arch Chil Oftal 1981;38:21â??27.
Menshen JH. Corneal nerves. Surv Ophthalmol 1974;19:1â??18.Bibliographic Links
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
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Increased Visibility of Corneal Nerves
1. â??Colloidinâ? skin syndrome (bullous ichthyosiform erythroderma)
2. Congenital
3. Ectodermal dysplasia (Rothmund syndrome)
4. Fuchs dystrophy
5. Ichthyosis
6. Idiopathic
7. *Keratoconus
8. Leprosy (Hansen disease)
9. Neurofibromatosis (von Recklinghausen syndrome)
10. *Neurofibromatosis associated with pheochromocytoma and thyroid carcinoma (Sipple syndrome)
11. Posterior polymorphous dystrophy
12. Primary amyloidosis
13. Refsum syndrome (phytanic acid storage disease)
14. Siemens disease (keratosis follicularis spinulosa decalvans)
Arffa RC. Grayson's diseases of the cornea, 3rd ed. St. Louis: Mosbyâ??Year Book, 1991.
Pau H. Differential diagnosis of eye diseases, 2nd ed. New York: Thieme Medical, 1988.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Pigmentation of the Cornea
1. Melanin pigmentation
A.Epithelial melanosis
1. Congenital
2. Presence of limbal malignant melanoma
3. Sequela of trachoma and other inflammations
4. Melanocytic migration in heavily pigmented persons
B.Stromal pigmentation such as that in ochronosis
C.Endothelial melanosis
1. Congenital
2. Senile
3. Degenerative, including atrophic and inflammatory conditions (such as cornea guttata, herpes simplex, zoster keratitis, myopia, diabetes mellitus, senile cataract, chronic glaucoma, and melanoma)
4. *Krukenberg spindle, with or without pigmentary glaucoma, may be present in