Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002

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1. *Delayed hypersensitivity to bacterial protein, particularly tuberculoprotein and staphylococci; lymphopathia venereum and coccidioidomycosis may also be allergens

2. Malnutrition

3. Secondary infection of the conjunctiva, especially from Staphylococcus aureus, pneumococcus, Kochâ??Weeks bacillus, chlamydia, coccidioidomycosis, and gonorrhea

4. Systemic infection

A.Bang disease (Brucellosis)

B.Candidiasis

C.Neurodermatitis

D.Mikuliczâ??Radecki syndrome (dacryosialoadenopathy)

E.Trachoma

F.Sjögren syndrome (secretoinhibitor syndrome)

Newell FW. Ophthalmology, principles and concepts, 7th ed. St. Louis: CV Mosby, 1991.

Corneal Ring Lesion

1. Acanthamoebic keratitis

2. Associated with rheumatoid arthritisâ??inferior P.281

3. Associated with Sjögren syndrome (secretoinhibitor syndrome) 4. Capnocytophaga ochracea

5. Double-ring formationâ??allergic keratitis

6. Marginal dystrophyâ??degenerative chronic corneal lesion with stromal thinning and intact epithelium

7. Marginal ulcerationâ??secondary to massive granuloma of sclera or necrotizing nodular scleritis (see p. 237)

8. Mooren ulcerâ??deeply undermined central edges and chronic course with inflammation, painful

9. Ring abscessâ??rapidly destructive purulent lesion in the deepest parts of the cornea 10. Ring ulcerâ??see marginal corneal ulcers (p. 283â??286)

11. Steroid use in furrow dystrophy

12. Terrien marginal degenerationâ??usually begins superiorly

13. Wegener granulomatosis (Wegener syndrome)

Daut PM, et al. Chronic exposure keratopathy complicating surgical correction of ptosis in patients with chronic progressive external ophthalmoplegia. Am J Ophthalmol 2000;130:519â??521.Bibliographic Links

Heidemann DG, et al. Necrotizing keratitis caused by Capnocytophaga ochracea. Am J Ophthalmol 1988;105:655â??660.Bibliographic Links

Theodore FH, et al. The diagnostic value of a ring infiltrate in acanthamoebic keratitis. Ophthalmology 1985;92:1471â??1480.Bibliographic Links

Corneoscleral Keratitis

1. Boeck sarcoid (Schaumann syndrome)

2. Gout (hyperuricemia)

3. Leprosy (Hansen disease)

4. Infections (e.g., pseudomonas)

5. Malformations, such as in sclerocornea (see p. 301) 6. Sarcoma

7. Syphilis (acquired lues)

8. Trisomy 13 (trisomy D)

9. Tuberculosis

10. Wegener granulomatosis

Arffa RC. Grayson's diseases of the cornea, 3rd ed. St. Louis: Mosbyâ??Year Book, 1991.

Central Corneal Ulcer

1. Bacterial origin

A.*Diplococcus pneumoniae (pneumococcus)â??infiltrated grayâ??white or yellow disc-shaped central ulcer typically associated with diffuse keratitis, severe iridocyclitis, and hypopyon; follows corneal abrasion; occurs especially in the presence of chronic dacryocystitis; enhanced by general debility

B.*Beta-hemolytic streptococcus and other streptococcus species

C.*Pseudomonas aeruginosa but may also have Pseudomonas acidovorans, Pseudomonas stutzeri, Pseudomonas mallei, and Pseudomonas pseudomalleiâ??primary corneal involvement, rapid spread often to panophthalmitis, large hypopyon, thick, greenish pus; may be contaminant of eserine and fluorescein often is associated with contact use.

P.282

D.Escherichia coli

E.Moraxella liquefaciens (diplococcus of Petit)â??morphologically resembles diplobacillus of Moraxâ??Axenfeld, which is never seen in central corneal ulcers

F.Klebsiella pneumoniae

G.Proteus vulgaris

H.Actinomyces

I.Tuberculousâ??secondary to conjunctival or uveal infections

J.Serratia marcescensâ??gram-negative coccobacillus

K.*Staphylococcus aureus, S. epidermidis, and other Staphylococcus species

L.Mima polymorpha

M.Dysgonic fermenter-2

N.Others

2. Viral origin

A.*Herpes simplex virus

B.Herpes zoster

C.Vaccinia virus

D.Variola

E.Others

3. Mycotic originâ??follows corneal trauma, such as foreign bodies in the cornea or corneal abrasions caused by vegetable matter, or diseases, such as radiation keratitis, exposure keratitis, herpes zoster, and ocular pemphigus; chronic course; shallow crater; absent corneal vascularization; may follow treatment with antibiotics or, more likely, treatment with steroidâ??antibiotic combinations

A.Absidia corymbifera

B.*Aspergillus species

C.Blastomyces dermatitidis

D.*Candida albicans

E.Cephalosporium species

F.*Fusarium solani

G.Nocardia species

H.Others

4. Acquired immune deficiency syndrome (AIDS) related

5. Atopic

6. Basement membrane abnormalities as microcysts, evidence of map, dot fingerprints, or anterior stromal dystrophies, trauma history, other dystrophy

7. Brittle cornea syndrome

8. Chemicalâ??latex keratitis, alkali/acid burn 9. *Dry eyes, including Sjögren syndrome

10. Exposure as lagophthalmos, lid abnormalities, inadequate blink, facial palsy, proptosis, thyroid disease

11. Extrusion of anterior chamber intraocular lens

12. Factitious

13. Hypogammaglobulinemia

14. Medicamentosus as drops

15. Neurotrophic

16. Thermal/radiation burns

17. Sjögren syndrome

18. Soluble tyrosine aminotransferase (STAT) deficiency

P.283

Akpek EK, et al. Bilateral consecutive central corneal perforations associated with hypogammaglobulinemia. Ophthalmology 2000;107:123â??126.Bibliographic Links

Alexandrakis G, et al. Capnocytophaga keratitits. Ophthalmology 2000;107:1503â??1506.Bibliographic Links

Kiel RJ, et al. Corneal perforation caused by dysgonic fermenter-2. JAMA 1987;257:3269â??3270.Bibliographic Links

Marshall DH, et al. Post-traumatic corneal mucormycosis caused by Absidia corymbifera. Ophthalmology 1997;104:1107â??1111.Bibliographic Links

McKnight GT, et al. Transcorneal extrusion of anterior chamber intraocular lenses. Arch Ophthalmol 1987;105:1656â??1664.Bibliographic Links

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Santos C, et al. Bilateral fungal corneal ulcers in a patient with AIDS-related complex. Am J Ophthalmol 1986;102:108â??109.

Marginal Corneal Ulcers

1. Ring ulcersâ??often bilateral, circumcorneal injection, and continuous ring or confluent multiple lesions

A.Acute leukemia

B.Bacillary dysentery

C.Brucellosis (Bang disease)

D.*Coalescence of several marginal ulcers

E.Dengue fever

F.Gold poisoning

G.Gonococcal arthritis

H.Following penetrating keratoplasty

I.Hookworm infestation

J.Influenza

K.Last stages of trachoma, secondary to small circumferential pannus

& Wilkins, 2002.

P.285

P.286

Diagnostic table

Marginal corneal ulcers

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P.287

Descemet Membrane Folds (Usually Following Hypotony; see p. 325)

1. *Trauma, such as that due to cataract or corneal surgery

2. Mechanical cause, such as firm, prolonged ocular bandaging or phthisis bulbi

3. Inflammatory condition, such as that following interstitial or herpes simplex keratitis 4. Diabetes (8%â??33%)

5. Ochronosis

6. Toxic

A.Quinone and hydroquinoneâ??vertical folds

B.Formaldehyde 26%

C.Experimental cold injury to cornea

D.Digitoxin

7. Idiopathic

Angell LK, et al. Visual prognosis in patients with ruptures in Descemet's membrane due to forceps injuries. Arch Ophthalmol1981;99:2137.Bibliographic Links

Descemet Membrane Tears (Haab Striae)

1. *Acute hydrops of the cornea, such as that due to keratoconus (see p. 288) 2. *Buphthalmos (e.g., from congenital glaucoma)

3. Conical cornea

4. Myopia with marked anteroposterior diameter 5. *Trauma, such as birth injury or contusion

posterior corneal surface; can follow operative or accidental ocular trauma

3. Status post hyphema

Snip RC, et al. Posterior corneal pigmentation and fibrous proliferation by iris melanocytes. Arch Ophthalmol 1981;99:1232.Bibliographic Links

Low Endothelial Cell Count (Diminished Number of Corneal

Endothelial Cells)

1. Acute and chronic uveitis

2. *Corneal endothelial dystrophy

3. Following cataract or other intraocular surgery

4. Cornea guttata, endothelial dystrophy, and Fuch dystrophy

Olsen T. Changes in the corneal endothelium after acute anterior uveitis as seen with the specular microscope. Acta Ophthalmol Scand 1980;58:250.

Murrell WJ, et al. The corneal endothelium and central corneal thickness in pigmentary dispersion syndrome. Arch Ophthalmol 1986;104:845â??846.Bibliographic Links

Snail Tracks of Cornea

This condition involves irregular, discontinuous grayish white streaks or patches, usually orientated horizontally and obliquely on the corneal endothelium.

1. Corneal buttons preserved in corneal storage medium

2. Following ocular surgery

3. Ocular trauma

Alfonso E, et al. Snail tracks of the corneal endothelium. Ophthalmology 1986;99:344â??349.

Keratoconus (Conical Cornea)

Keratoconus is characterized by noninflammatory ectasia of the cornea in its axial part, with considerable visual impairment because of development of a high degree of irregular myopic astigmatism. Keratoconus may be associated with

1. Acute hydrops of the cornea

2. Alagille syndrome

3. Anetoderma and bilateral subcapsular cataracts

4. Angelman syndrome

5. Aniridia

6. Apert syndrome (acrodysplasia)

7. Asthma, hay fever

8. *Atopic dermatitis, keratosis plantaris, and palmaris

9. Autographism

10. Avellino dystrophy P.289

11. Blue sclerotics, including van der Hoeve syndrome (osteogenesis imperfecta) (see blue sclera, p. 231)

12. Chandler syndrome (iridocorneal endothelial syndrome)

13. Congenital hip dysplasia

14. Wearing of contact lens

15. Crouzon syndrome

16. Deep filiform corneal dystrophy

17. Ehlersâ??Danlos syndrome (fibrodysplasia elastica generalisata, cutis hyperelastica)

18. Essential iris atrophy

19. Facial hemiatrophy

20. *Familial

21. False chordae tendineae of left ventricle

22. Fleck corneal dystrophy

23. Focal dermal hypoplasia (Goltz syndrome)

24. Fuchs corneal endothelial dystrophy

25. Grönbladâ??Strandberg syndrome (pseudoxanthoma elasticum)

26. Hereditary history

27. Hyperextensible joints and mitral valve prolapse

28. Hyperornithemia

29. Infantile tapetoretinal degeneration of Leber

30. Iridocorneal dysgenesis

31. Iridoschisis

32. Joint hypermobility

33. Kurz syndrome

34. Laurenceâ??Moonâ??Biedl syndrome (retinitisâ??polydactylyâ??adiposogenital syndrome)

35. Little syndrome (nailâ??patella syndrome)

36. Lymphogranuloma venereum

37. Marfan syndrome (arachnodactyly dystrophia mesodermalis congenita)

38. Measles retinopathy

39. Microcornea

40. Mongolism (Down syndrome)

41. Mulvihilâ??Smith syndrome

42. Neurocutaneous angiomatosis

43. Neurodermatitis

44. Neurofibromatosis (von Recklinghausen syndrome)

45. Noonan syndrome (male Turner syndrome)

46. Ocular hypertension

47. Pellucid marginal corneal degeneration

48. Posterior ectasia following laser in situ keratomileusis (generally if stromal bed less than 250 µ)

49. Posterior lenticonus

50. Posterior polymorphous dystrophy

51. Retinal disinsertion syndrome

52. Retinitis pigmentosa

53. Retinopathy of prematurity

54. Rieger syndrome

55. Tourette disease

56. Thalassemia syndrome

57. *Trauma, such as rubbing of eyes, birth injury, or contusion P.290

58. Vernal catarrh

59. Vernal conjunctivitis

60. 18q syndrome

Geggel HS, Talley AR. Delayed onset keratectasia following laser in situ keratomileusis. J Cataract Refract Surg 1999;25:582â??586.Bibliographic Links

Krachner JH, et al. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 1984;28:293â??322.Bibliographic Links

Lipman RM, et al. Keratoconus and Fuchs' corneal endothelial dystrophy in a patient and her family. Arch Ophthalmol 1990;108:993â??994.Bibliographic Links

Rabinowitz YS. Keratoconus. Surv Ophthalmol 1998;42:297â??319.Bibliographic Links

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Vinokur ET, et al. The association of keratoconus, hyperextensible joints, and mitral valve prolapse. Ophthalmology 1986;93:95.

Cornea Plana (Decreased Corneal Curvature)

1. Isolated

2. Marfan syndrome

3. *Sclerocornea