Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002
.pdfproparacaine |
sulfamethoxazole |
thiotepa |
propiomazine |
sulfamethoxypyridazine |
thiothixene |
propoxycaine |
sulfanilamide |
timolol |
propylthiouracil |
sulfaphenazole |
tobramycin |
quinacrine |
sulfapyridine |
trichloroethylene |
radioactive iodides |
sulfasalazine |
trifluoperazine |
rubella virus vaccine |
sulfathiazole |
trifluorothymidine |
(live) |
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smallpox vaccine |
sulfisoxazole |
triflupromazine |
sodium salicylate |
sulindac |
trimeprazine |
sulfacetamide |
suramin |
trimethoprim |
sulfachlorpyridazine |
tetracaine |
trioxsalen |
sulfacytine |
tetracycline |
tripelennamine |
sulfadiazine |
tetrahydrozoline |
triprolidine |
sulfadimethoxine |
thiethylperazine |
tropicamide |
sulfamerazine |
thimerosal |
vidarabine |
sulfameter |
thiopropazate |
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sulfamethazine |
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P.264 |
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10. Limbal conditions associated with punctate keratitis
A.Focal necrotic lesions
1. Herpes simplex
2. Phlyctenular disease
3. Vaccinia
B.Follicles
1. Acne rosacea (ocular rosacea)
2. Herpes simplex
3. Inclusion conjunctivitis
4. Molluscum contagiosum
5. Trachoma
6. Other viral infections
C.Nodules and plaques
1. Avitaminosis A (Bitot spots)
2. Bowen disease (dyskeratosis)
3. Intraepithelial melanoma
4. Limbal vernal conjunctivitis
11. Punctate keratitis preceded by lymphadenopathy
A.Adenovirus
B.Herpes simplex
C.Herpes zoster
D.Inclusion conjunctivitis
E.Trachoma
F.Vaccinia
12. Respiratory diseases
A.Adenovirus infections
B.Myxovirus infections (influenza, Newcastle disease, mumps)
C.Recurrent herpes complicating any fever
Ferreira RC, et al. Corneal abnormalities associated with incontinentia pigmenti. Am J Opthalmol 1997;123:549â??551.Bibliographic Links
Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.
P.265
Jones BR. Differential diagnosis of punctate keratitis. Int Ophthalmol Clin 1962;2:591â??611.Buy NowBibliographic Links
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Sachs R. Corneal complications associated with the use of crack cocaine. Ophthalmology 1993;100:187â??191.Bibliographic Links
Yang YF, et al. Epidemic hemorrhagic keratoconjunctivitis. Am J Ophthalmol
1975;30:192â??197.Bibliographic Links
Morphologic Classification of Punctate Corneal Lesions (Classification by Anatomic Location)
1. Punctate epithelial erosionsâ??fine, very slightly depressed spots scarcely visible without staining with fluorescein
A.Warts
B.Artificialâ??silk keratitis
C.Staphylococcal blepharoconjunctivitis (lower cornea)
D.*Keratoconjunctivitis sicca (interpalpebral area)
E.*Exposure keratitis (interpalpebral area)
F.Neuroparalytic keratitis (see p. 246)
G.Ocular medications (especially those with preservatives)
H.Trichiasis
I.Trauma, mild (e.g., eye rubbing)
2. Punctate epithelial keratitisâ??very small, whitish flecks on the surface of the epithelium
A.Fine
1. Scatteredâ??staphylococcal blepharitis; viral keratitis, especially trachoma and molluscum contagiosum, sometimes inclusion conjunctivitis, and not infrequently herpetic keratitis and rubeola and rubella
2. Confluentâ??keratitis sicca, exposure keratitis, vernal conjunctivitis, topical steroid-induced, and early viral keratitis
B.Coarse
1. *Thygeson superficial punctate keratitis (characteristic)
2. Herpes zoster
3. Adenovirus infections
4. Early herpes simplex
5. Acne rosacea (lower cornea)
6. Encephalitozoon hellum
C.Areolarâ??spots have enlarged to occupy a large area 1. Herpes simplex
2. Thygeson superficial punctate keratitis
3. Herpes zoster
4. Vaccinia
3. Filamentary keratitis or keratopathyâ??formation of fine epithelial filaments that are attached at one end
A.*Keratoconjunctivitis sicca (frequent)
B.Infections, such as that due to adenovirus, herpes, vaccinia, acne rosacea, molluscum
contagiosum, rubella, rubeola, and staphylococcus
C.Trauma, such as wounds, abrasions, exposure to shortwave diathermy, and prolonged eye patching
D.Edema of cornea, such as that due to recurrent erosions or wearing of contact lens
E.Sarcoid with infiltration of conjunctiva and lacrimal gland
F.Heerfordt syndrome and Mikulicz syndrome
G.After irradiation of the lacrimal gland
P.266
H.Keratoconus (see p. 288)
I.Neuropathic keratopathy (anesthesia of cornea, p. 246)
J.Conjunctival cicatrization, such as that associated with ocular cicatricial pemphigoid, erythema multiforme, ocular psoriasis, and advanced trachoma
K.Degenerative condition of corneal epithelium, such as in advanced glaucoma
L.Superior limbic keratoconjunctivitis
M.Hereditary hemorrhagic telangiectasis (Renduâ??Oslerâ??Weber disease)
N.Aerosol keratitis
O.Diabetes mellitus
P.Ectodermal dysplasia
Q.Following cataract or corneal transplant surgery
R.Following patching
S.Use of diphenhydramine hydrochloride (Benadryl)
T.Idiopathic
4. Punctate subepithelial keratitisâ??punctate epithelial keratitis may progress to combine epithelial and subepithelial lesions followed by healing of the epithelial component, leaving a punctate subepithelial keratitis typical of viral punctate keratitis
A.Areolar or stellate lesionsâ??grayish white
1. Herpes simplex (usually)
2. Herpes zoster
3. Vaccinia
4. Infectious mononucleosis
5. Epsteinâ??Barr virus infection
6. Dimmer keratitis
7. Brucellosis
8. Onchocerciasis
B.Fine or medium-sized lesions, typically
1. Adenovirus, especially types 3 and 7â??grayish white
C.Yellowish tingeâ??typical of trachoma, inclusion conjunctivitis, acne rosacea, and marginal â??catarrhal infiltratesâ? associated with staphylococcal blepharitis, Neisseria conjunctivitis, and Reiter disease
5. Punctate opacifications of Bowman membraneâ??gray, homogeneous, thickened spots,
often with irregular edges
A.Salzmann degeneration
B.Punctate lesion of trachoma, measles, or phlyctenular disease
Jones BR. Differential diagnosis of punctate keratitis. Int Ophthalmol Clin 1962;2:591â??611.Buy NowBibliographic Links
Diesenhouse MC, et al. Treatment of microsporidial keratoconjunctivitis with topical fumagillin. Am J Ophthalmol 1993;115:293â??298.Bibliographic Links
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Seedor JA, et al. Filamentary keratitis associated with diphenhydramine hydrochloride. Am J Ophthalmol 1986;101:376â??377.Bibliographic Links
SICCA Keratitis (Dry Eye with Secondary Corneal Changes)
1. Boeck sarcoid (Schaumann syndrome)
2. Dermatitis herpetiformis
3. Diabetes mellitus (Willis disease)
4. Herpes simplex
5. Lye burns P.267
6. *Ocular cicatricial pemphigoid
7. Polychondritis
8. *Sjögren syndrome (secretoinhibitor syndrome)
9. Trachoma
10. Vitamin A deficiency (xerosis)
11. Stevensâ??Johnson syndrome
Arffa RC. Grayson's diseases of the cornea, 3rd ed. St. Louis: Mosbyâ??Year Book, 1991.
White Rings of the Cornea (Coats Disease)
These rings are made up of a series of tiny white dots that may coalesce at the level of Bowman membrane or just below it.
1. Congenital
2. Trauma
A.*Foreign body, usually metal
B.Occupationalâ??in working with limestone, there may be deposition of some of the substance's components, especially calcium oxide, in the cornea
3. Intraocular disease
4. Iron deposition
Miller EM. Genesis of white rings of the cornea. Am J Ophthalmol 1966;61:904.Bibliographic Links
Nevins RC, Elliott JH. White ring of the cornea. Arch Ophthalmol 1969;82:457.Bibliographic Links
Dry Spots of the Cornea (Precorneal Tear Film Drying in Spot-Wise Fashion)
The precorneal tear film is best examined by using fluorescein and cobalt-blue filtered light. Patients may have difficulty wearing contact lenses or may have corneal pain. Normal tear-film breakup time is greater than seconds and averages 25 to 30 seconds.
1. Associated with corneal dellen (see p. 280) 2. Chemical burns
3. Chronic bacterial or viral conjunctivitis
4. Congenital alacrima
5. Instillation of topical anesthetic
6. *Keratitis sicca
7. *Ocular cicatricial pemphigoid
8. Ocular pemphigus (chronic cicatricial conjunctivitis)
9. Sleep apnea syndrome
10. Sometimes in elderly persons without obvious pathology
11. Stevensâ??Johnson syndrome (erythema multiforme)
12. Vitamin A deficiency
Dohlman CH. The function of the corneal epithelium in health and disease. Invest Ophthalmol 1971;10:376â??407.
Lemp MA, Hamill JR. Factors affecting tear film break-up in normal eyes. Arch Ophthalmol 1973;89:103â??105.Bibliographic Links
Mojon DS, et al. Eyelid, conjunctival and corneal findings in sleep apnea syndrome.
Ophthalmology 1999;106:1182â??1185.Bibliographic Links
Anterior Embryotoxon (Arcus)
In this condition, white or gray substance is deposited at level of the Descemet membrane and Bowman membrane initially and then in the stroma with a clear limbal interval.
P.268
1. *Ageâ??may be present normally in a white patient older than 40 years of age or in a black patient older than 35 years of age
2. Alagille syndrome
3. Alport syndrome (hereditary nephritis)
4. Associated with corneal disease, such as interstitial keratitis 5. *Contralateral carotid occlusive diseaseâ??when unilateral
6. Familial hypercholesterolemia (type II, familial beta-lipoproteins and type III, familial hyper-beta and pre-beta lipoproteins [carbohydrate-induced hyperlipemia])
7. Hereditaryâ??autosomal dominant or autosomal recessive inheritance
8. Isolated phenomenon
9. Long exposure to irritating dust or chemicals
10. Ocular anomaly association, such as blue sclera (see p. 231), megalocornea (see p. 255), or aniridia (see p. 364â??365)
11. Secondary to ocular disease, such as large corneal scars, sclerokeratitis, limbal dermoid, nevus, or epithelial cyst
12. Schnyder crystalline dystrophy
Bagla SK, Golden RL. Unilateral arcus corneae senilis and carotid occlusive disease. JAMA 1975;233:450.Bibliographic Links
Chavis RM, Groshong T. Corneal arcus in Alport's syndrome. Am J Ophthalmol 1973;75:793â??794.Bibliographic Links
Hingorani M, et al. Ocular abnormalities in Alagille syndrome. Ophthalmology 1999;106:330â??337.Bibliographic Links
Bowman Membrane Folds
1. Bullous keratopathy
2. Idiopathic
3. Inflammation
4. Lowering of intraocular pressure, such as occurs in association with phthisis bulbi
Duke-Elder S, Leigh AG. Diseases of the outer eye. System of ophthalmology, Vol VIII, Part 2. St. Louis: CV Mosby, 1965.
P.269
Diagnostic table
Anterior corneal abnormalities
View Table
P.270
Delayed Corneal Wound Healing
Delayed corneal wound healing because of drugs, including the following:
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methylprednisolone |
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adrenal cortex injection |
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dexamethasone |
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paramethasone |
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aldosterone |
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dibucaine |
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penicillamine(?) |
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alpha chymotrypsin(?) |
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dyclonine |
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phenacaine |
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amphotericin B |
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F3T |
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phenylephrine(?) |
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arabinoside |
floxuridine |
piperocaine |
azathioprine |
fludrocortisone |
prednisolone |
bacitracin |
fluorometholone |
prednisone |
beclomethasone |
fluprednisolone |
proparacaine |
benoxinate |
flurbiprofen |
sulfacetamide |
benzalkonium |
fluorouracil |
sulfamethizole |
betamethasone |
ganciclovir |
sulfisoxazole |
butacaine |
gentamicin |
tetracaine |
chymotrypsin (?) |
hydrocortisone |
thiotepa |
cocaine |
idoxuridine |
triamcinolone |
colchicine |
iodine solution |
trifluorothymidine |
cortisone |
medrysone |
trifluridine |
cytarabine |
meprednisone |
vidarabine |
Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.
Anterior Corneal Mosaic
A pattern of fluorescein pooling in corneal epithelial grooves can be induced in any normal eye by pressure on the cornea.
1. Exophthalmos as in dysthyroid eye disease with corneal compression against the eyelids 2. Exposure to a high-pressure fire extinguisher jet
3. Pressure on the cornea, either directly on the cornea or indirectly through the lids
Bron AJ. Anterior corneal mosaic. Br J Ophthalmol 1968;52:659.Bibliographic Links
Frazer DG, et al. Compression keratopathy. Am J Ophthalmol
1986;102:208â??210.Bibliographic Links
Linear Opacity in Superficial Corneal Stroma
1. Arc-like at superior limbus
A.Poorly fit contact lens
B.Well-fitting soft contact lens with tight eyelids
2. Central
A.Amiodarone
B.Chloroquine and hydroxychloroquine
C.Microcystic epithelial dystrophy
D.Phenothiazine
Arffa RC. Grayson's diseases of the cornea, 3rd ed. St. Louis: Mosbyâ??Year Book, 1991.
Charles NC, et al. Band-shaped and whorled microcystic dystrophy of the corneal epithelium. Ophthalmology 2000;107:1761â??1764.Bibliographic Links
Horowitz GS, et al. An unusual corneal complication of soft contact lens. Am J Ophthalmol 1985;100:794â??797.Bibliographic Links
P.271
Superficial Vertical Corneal Striationsâ??Epithelial Wrinkles can be Accentuated with Fluorescein
1. Corneal surgery with corneal indentation or low intraocular pressure 2. Graves disease
3. Scarred lids
4. Soft contact lens
Blue PW, Lapiana FG. Superficial vertical corneal striations: a new eye sign of Graves' disease. Ann Ophthalmol 1980;12:635.
Mobilia EF, et al. Corneal wrinkling induced by ultra-thin soft contact lenses. Ann Ophthalmol 1980;12:371.Bibliographic Links
Dendritic Corneal Lesions (Area of Staining of Cornea in a