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

Hyperchromic heterochromia (abnormal eye with iris of lighter color than fellow eye)

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P.373

IRIS Atrophy

1. Anterior segment ischemia syndrome

2. Arteriovenous fistula

3. Chandler syndrome (iridocorneal endothelial syndrome)

4. Complication of light coagulation and beta radiation

5. Complication of retinal detachment operation

6. *Congenitalâ??autosomal dominant

7. Crohn disease (granulomatous ileocolitis)

8. *Essential (progressive) atrophy

9. Glaucomatous atrophy

A.Acuteâ??atrophy or iridoschisis

B.*Chronicâ??stromal and epithelial

10. Hallermannâ??Streiffâ??François syndrome (dyscephalic mandibulooculofacial syndrome)

11. Hilding syndrome (destructive iridocyclitis and multiple joint dislocations) 12. Homocystinuria syndrome

13. Hypothermal injury

14. Iris nevus syndrome (Coganâ??Reese syndrome)

15. Ischemia

A.Acute angle-closure glaucoma

B.Carotidâ??cavernous fistula

C.Hemoglobin sickle cell C disease

D.Occlusive artery disease

E.Orbital irritation

F.Surgery angle-closure glaucoma

G.*Trauma

16. Krause syndrome (congenital encephalo-ophthalmic dysplasia)

17. Neurogenicâ??tabes with stromal atrophy

18. Norrie disease (fetal iritis syndrome)

19. *Old age

20. Pierre Robin syndrome (micrognathiaâ??glossoptosis syndrome)

21. Posterior pigment layer is swollen and degenerated

A.Diabetes mellitus (Willis disease)

B.Hurler syndrome (mucopolysaccharidoses Iâ??H)

22. Postinflammatoryâ??iritis because of diseases such as tuberculosis, syphilis (acquired lues), herpes zoster, herpes simplex, smallpox, leprosy (Hansen disease), onchocerciasis syndrome (river blindness), sporotrichosis

23. Shyâ??Mageeâ??Drager syndrome (orthostatic hypotension syndrome)

24. Spontaneous progressive

A.Congenital hypoplasia iris stroma

B.Rieger syndrome (dysgenesis mesostromalis)

25. Takayasu syndrome (aortic arch syndrome, pulseless disease)

26. Use of quinine, chloramine, mustard gas

27. Wagner syndrome (hyaloideoretinal degeneration)

28. Xeroderma pigmentosa, including skin lesions

Rodrigues MM, et al. Clinical electron microscopic, and immunohistochemical study of the corneal endothelium and Descemet's membrane in the iridocorneal endothelial syndrome. Am J Ophthalmol 1986;101:16â??27.Bibliographic Links

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

Shields MB, et al. The essential iris atrophies. Am J Ophthalmol 1978;85:749â??769.Bibliographic Links

P.374

Iridodonesis (Tremulous IRIS)

1. *Aphakia following cataract extraction 2. *Dislocation of the lens (see p. 405)

3. Hydrophthalmos or buphthalmos (see p. 222â??223) 4. Hypermature senile cataract

Filatov V, et al. Dislocation of the crystalline lens in a patient with Sturge Weber syndrome. Am J Ophthalmol 1992;24:260â??262.

Hornby SJ, et al. Visual acuity in children with coloboma. Ophthalmology 2000;107:511â??520.Bibliographic Links

Huggon IC, et al. Contractural arachnodactyly with mitral regurgitation and iridodonesis. Arch Dis Child 1990;65:317â??319.Bibliographic Links

Tumors Arising from Pigment Epithelium of IRIS

1. Hyperplasia

A.Primary (congenital) 1. At pupillary margin

2. At margins of colobomas

B.Acquired

1. Region of sphincterâ??migrating epithelial cells appear in stroma as clump cells (equivocal origin)

2. Cells can reach anterior surface of iris and proliferate (velvety black in appearance)

C.Secondary

1. Intraocular inflammationâ??pigmented cells proliferate around the pupillary margin onto anterior iris surface

2. Long-standing glaucoma

a.Proliferation around the pupillary margin onto the anterior iris surface

b.Migration through stroma to anterior surface at collarette

3. * Trauma (including operationâ??proliferation of pigment epithelium on anterior surface of iris, across pupil, or on posterior surface of cornea

4. *Drugs, including the following: demecarium, echothiophate, edrophonium, isoflurophate, neostigmine, physostigmine, pilocarpine often associated with cystic formation

2. Neoplasia

A.*Benignâ??well-differentiated epithelial cells, usually pigmented, often with pseudoacinar arrangement and cysts; may have limited locally invasive properties

B.Malignant

1. Carcinoma

2. Local invasion, intraocular metastases

3. Medulloepithelioma, embryonal type (diktyoma)

4. Papillary cystadenoma

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

Morris PA, Henkind P. Neoplasms of the iris pigment epithelium. Am J Ophthalmol 1968;66:31.Bibliographic Links

Pigmented Lesions of IRIS

1. Adenoma of iris

2. Anterior chamber intraocular lens and segmental uveal ectropion P.375

3. Anterior staphyloma

4. Corneal or scleral perforation

5. *Cystâ??congenital, spontaneous, or traumatic, including pigmentation

6. Ectopic lacrimal gland tissue

7. *Ectropion uvea

8. Epithelioma of the ciliary body

9. Exudative mass in the anterior chamber

10. Foreign body of iris, including iron with siderosis

11. Fuchs syndrome of heterochromic cyclitis with the darker normal iris considered to contain a diffuse melanoma

12. Hemangioma of the iris with pigmentation because of hemorrhage

13. Hemosiderosis because of contusions with hyphema or injuries and disease in the posterior portion of the eye with recurrent bleeding

14. Juvenile xanthogranuloma (nevoxanthoendothelioma)

15. Leiomyoma or leiomyosarcoma of the iris

16. Leukemic infiltrates and malignant lymphomas

17. Malignant melanoma of the iris

18. Metastatic carcinomas arising in the lung, breast, gastrointestinal tract, thyroid gland, prostate gland, kidney, or testicle

19. Neurofibromatosis with increased pigmentation of the iris

20. *Nevi of the iris

21. Nodular thickening and scarring of the iris

22. Pigmentary glaucoma

23. Pigment epithelial tumors of the iris

24. Segmental melanosis oculi, including congenital melanosis

25. Stromal mass in the anterior chamber

26. Uveitis, such as that because of conglomerate tuberculous lesions of the stroma or sarcoid

involvement of the iris

27. Varix

Chang M, et al. Adenoma of the pigment epithelium of the ciliary body simulating a malignant melanoma. Am J Ophthalmol 1979;88:40â??48.Bibliographic Links

Lois N, et al. Primary cysts of the iris pigment epithelium. Ophthalmology 1998;105:1879â??1885.Bibliographic Links

Shields JA, et al. Iris varix simulating an iris melanoma. Arch Ophthalmol 2000;118:707â??709.Bibliographic Links

Shields CL, et al. Differentiation of adenoma of the iris pigment epithelium from iris cyst and melanoma. Am J Ophthalmol 1986;100:678â??681.Bibliographic Links

Nonpigmented Lesions of IRIS

1. Amelanotic melanoma

2. Atypical mycobacterial panophthalmitis

3. Endothelioma

4. Exudative mass in the anterior chamber

5. Fibrosarcoma

6. *Foreign body

7. Forward extension of diktyoma

8. Hemangioma of the iris

9. *Iris cyst

10. Iris lymphoma

11. Iris nodules P.376

A.Ectodermal (Koeppe nodules)â??pupillary margin and gray with ocular inflammation

B.Mesodermal (Busacca nodules)â??anterior surface of iris in collarette region

12. Juvenile xanthogranulomaâ??may be associated with diffuse infiltration of the iris 13. Lacrimal Gland Choristoma of the Iris

14. Leiomyoma or leiomyosarcoma of the iris

15. Leprosy (Hansen disease)

A.Lepromas of the iris

B.Leprotic pearlâ??minute white spots on the surface of iris

16. Metastatic carcinoma of the iris arising from the lungs, breast, gastrointestinal tract, thyroid gland, prostate gland, kidney, or testicle

17. Neurofibroma and neuroglioma

18. Sarcoid nodulesâ??multiple, discrete, irregularly distributed over the iris 19. Seeding of tumor, such as retinoblastoma, from the posterior segment 20. Syphilis (acquired lues)

A.Gummasâ??solitary, large, avascular, white lesions

B.Papules (condylomas)â??multiple, small, vascular, yellowish lesions

21. Teratoma

22. Tuberculosis

A.Acute miliaryâ??small grayish yellow or reddish nodules

B.Hyalinized or fibrotic scar (Michel flecks)

C.Tuberculomaâ??white-gray lesion

Chan SM, et al. Iris lymphoma in a pediatric cardiac transplant recipient. Ophthalmology 2000;107:1479â??1482.Bibliographic Links

Imamura Y, et al. Gastric signet ring cell adenocarcinoma metastatic to the iris. Am J Ophthalmol 2001;131:379â??381.Bibliographic Links

Kluppel M, et al. Lacrimal gland choristoma of the iris. Arch Ophthalmol 1999;117:110â??111.Bibliographic Links

Rosenbaum PS, et al. Atypical mycobacterial panophthalmitis seen with iris nodules. Arch Ophthalmol 1998;116:1524â??1527.Bibliographic Links

Victor V, et al. Surgical excision of iris nodules in the management of sarcoid uveitis. Ophthalmology 2001;108:1296â??1299.Bibliographic Links

Ware GT, et al. Renal cell carcinoma with involvement of iris and conjunctiva. Am J Ophthalmol 1999;127,4:458â??459.

Conditions Simulating Anterior Uveitis or IRITIS

1. Brushfield spots

2. Fuchs syndrome (II) (Stevensâ??Johnson syndrome)

3. Hereditary deep dystrophy of cornea

4. Hyalinized keratitic precipitate

5. Iridoschisisâ??splitting of iris

6. Juvenile xanthogranuloma of the iris (nevoxanthoendothelioma)

7. Malignant lymphomas or leukemia

8. Malignant melanoma

9. Metastatic tumor arising from the lungs, breast, gastrointestinal tract, thyroid gland,

prostate gland, kidney, or testicle

10. Neurofibromas of the iris

11. Pigment floaters in the anterior chamber, especially after mydriasis 12. *Pseudoexfoliation of the lens capsule (glaucoma capsulare)

13. Reticulum cell sarcoma

14. Retinoblastoma P.377

15. Scleroderma (progressive systemic sclerosis)

16. *Siderosis bulbi

Denslow GT, Kielar RA. Metastatic adenocarcinoma to the anterior uvea and increased carcinoembryonic antigen levels. Am J Ophthalmol 1978;85:378â??382.

Schlaegel TF. Essentials of uveitis. Boston: Little, Brown, 1969.

Syndromes and Diseases Associated with Iritis

1. Actinomycosis

2. Amebiasis (entamoeba histolytica)

3. Amendola syndrome (Brasilian pemphigus)

4. Andersonâ??Warburg syndrome (congenital progressive oculoacousticocerebral dysplasia)

5. Ankylosing spondylitis (von Beckterevâ??Strumpell syndrome)

6. Ascariasis

7. Aspergillosis

8. Beesting of the cornea

9. Behçet syndrome (oculobuccogenital syndrome)

10. Blastomycosis

11. Brucellosis (Bang disease)

12. Candidiasis

13. Charlin syndrome (nasociliary nerve syndrome)

14. Chlamydia pneumoniae

15. Coccidioidomycosis

16. Cryptococcosis

17. Cysticercosis

18. Cytomegalic inclusion disease (cytomegalovirus)

19. Dengue fever

20. Endophthalmitis phacoanaphylactica

21. *Following laser iridectomy

22. Fuchs syndrome (heterochromic cyclitis syndrome)

23. Henochâ??Schönlein purpura (anaphylactoid purpura)

24. Herbicide exposureâ??2,4-dichlorophenoxyacetic acid

25. *Herpes simplex

Nongranulomatous Uveitis

1. Physical insult

A.Endogenous

B.Exogenous

2. *Toxic insults

A.Autointoxicationâ??ptomaines, protein split products, and so forth from food poisoning

B.Bacterial endotoxins

C.Reticulum cell sarcoma of the brain

D.Toxins from disintegrating helminths

E.*Viral toxins

3. Immediate hypersensitive reaction

A.*Airborne allergens

B.Drugs, including the following: