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

F. Psychogenic causes

3. Paralysis of one or more extraocular muscles

A.Fourth-nerve palsy (rare) (see p. 158)

B.*Sixth-nerve palsyâ??has no localizing value (see p. 161)

C.Third-nerve palsyâ??with isolated muscle paralysis one must suspect a nuclear lesion (hemorrhage, syphilis, multiple sclerosis) or myasthenia gravis (see p. 153)

P.639

Benegas NM, et al. Diplopia secondary to aniseikonia associated with macular disease. Arch Ophthalmol 1999;117:896â??899.Bibliographic Links

Norman ME, Dyer JA. Ophthalmic manifestations of narcolepsy. Am J Ophthalmol 1987;103:81â??86.Bibliographic Links

Schanzer B, Bordaberry M. The child with divergence paresis. Surv Ophthalmol 1998;42:571â??574.Bibliographic Links

Binocular Triplopia (Uniocular Diplopia)

1. Abnormal retinal correspondence with single image given two associations of direction so that the abnormal retinal point is brought into consciousness at the same time as the macula image

2. Central uniocular diplopia (rare)â??systemic or neurologic causes include cerebral aneurysm, abscess or gross degenerative lesions, encephalitis lethargica, postencephalitis, multiple sclerosis, basal meningitis, cerebellar tumor, and vertebrobasilar insufficiency

3. *Malingering, hysteria, or psychogenic causes

4. Optical causes external to the eye

A.Double or single prism placed in center of pupil before one eye

B.*Improper correction of a high astigmatism

C.*Looking through the edge of a bifocal or margin of lens

5. Optical causes in the eye

A.Air bubbles or transparent foreign bodies in aqueous or vitreous

B.Complete or partial contraction of the eyelids in which the eyelids impinge on the cornea (de Schweintz)

C.Dislocation of the lens or misalignment of corneal and lenticular optical axis

D.Double pupil

E.High myopia, probably because of irregular astigmatism

F.Irregular astigmatism, such as pressure on the globe

G.Irregular spasm of the ciliary muscle

H.Keratoconus (see p. 288)

I.Lens abnormalities, such as fluid clefts or incipient cataract

J.Looking through edge of intraocular lens

K.*Map-dot fingerprint dystrophy

L.Megalocornea (see p. 255)

M.Migration of filtering bleb into the cornea

N.Multifocal intraocular lens

O.Post iridectomy

P.*Refractive surgery

Q.Retinal detachment

R.Spherophakia (see p. 400â??401)

Coffeen P, Guyton DL. Monocular diplopia accompanying ordinary refractive errors. Am J Ophthalmol 1988;105:451â??459.Bibliographic Links

Ellingson FT. Explanation of 3M diffractive intraocular lenses. J Cataract Refract Surg 1990;16:697â??702.Bibliographic Links

Girard LJ. Monocular diplopia accompanying ordinary refractive errors. Am J Ophthalmol 1988;106:369.Bibliographic Links

Wyzinski P, O'Dell L. Subjective and objective findings after radial keratotomy. Ophthalmology 1989;96:1608â??1611.Bibliographic Links

Diplopia Following Head Trauma

1. Avulsion, contusion, or transection of extraocular muscles 2. Avulsion of the pulley of the superior oblique

P.640

3. Decompensation of a preexisting ocular phoria, becoming a tropia 4. Edema or detachment of the macula (monocular diplopia)

5. *Hematoma in the orbit or the ocular muscles

6. *Orbital fracture (particularly blowout fracture of the floor, causing restricted function of inferior rectus and inferior oblique muscles)

7. Subluxation of the lens (monocular diplopia)

8. Third, fourth, or sixth cranial nerve palsies (orbital or intracranial) (see pp. 158, 161, 153) 9. â??Whiplashâ? injury and the diplopias of obscure origin

Deutsch TA, Feller DB. Paton's and Goldberg's management of ocular injuries. Philadelphia:

4. Progressive cone-rod dystrophy

5. Refsum syndrome (heredopathia atactica polyneuritiformis syndrome)

6. Retinitis pigmentosa (see p. 497)

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

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

P.641

Astigmatism

In this condition, the refractive power of the eye varies along different meridians; its steepest meridian is vertical in â??with the ruleâ? (corrected with plus cylinder at 90 degrees) and horizontal in â??against the rule.â?

1. Adnexal masses

2. Anterior segment surgery for cornea, lens, or glaucoma 3. *Chalazion

4. *Contact lens wear

5. *Corneal scars

6. *Following refractive surgery

7. Keratoconus (see p. 288)

8. May be dominant inheritance with incomplete penetrance 9. Nuclear cataract with coloboma of lens, iris, and choroid 10. Oversized, rigid, anterior chamber, intraocular lens implant

11. Physiologicâ??about 0.5 diopters of â??with the ruleâ? 12. Retinal detachment procedures

13. Scleral infolding

14. Tilted intraocular lens

Abdel-Hakim AS. Corneal astigmatism induced by oversized rigid anterior chamber implants. Am Intra Implant Soc J 1985;11:474â??482.

Visual Acuity Loss After Glaucoma Surgery

1. Cystoid macular edema

2. *Hypotony maculopathy

3. Intraocular pressure spike

4. *Lens opacification

5. Postoperative capsule opacity

6. Retinal detachment

7. Suprachoroidal hemorrhage

8. Unknown

9. Vitreous hemorrhage

10. Wipeout (loss of central fixation)

Costa VP, et al. Loss of visual acuity after trabeculectomy. Ophthalmology 1993;100:599â??612.Bibliographic Links

Cristiansson J. Ocular hypotony after fistulizing glaucoma surgery. Acta Ophthalmol 1967;45:837â??845.Bibliographic Links

Watson RG, et al. The complications of trabeculectomy (a year follow-up). Eye 1990;4:425â??438.Bibliographic Links

Sudden Painful Loss of Vision

1. Acute-angle closure glaucoma

2. Fracture of the lesser wing of the sphenoid bone 3. Keratoconus

4. Optic neuritis

5. Temporal arteritis

6. Uveitis

Friedberg MA, Rapuano CJ. Office and emergency room diagnosis and treatment of eye disease. Philadelphia: JB Lippincott, 1990.

Sudden Painless Loss of Visionâ??Both Eyes

1. Brain injury

2. Brainstem arteriovenous malformations

3. Meningeal carcinomatosis

4. Quinine poisoning

5. Wood alcohol poisoning (methyl)

Friedberg MA, Rapuano CJ. Office and emergency room diagnosis and treatment of eye disease. Philadelphia: JB Lippincott, 1990.

Kerrison JB, Lee AG. Acute loss of vision during pregnancy due to a suprasellar mass. Surv Ophthalmol 1997;41:400â??401.

Gradual Painless Loss of Vision

1. Age-related macular degeneration

2. Bartonella henselae

3. Behcet disease

4. Cardiolipin antibody syndrome

5. Cataract

6. Chronic corneal disease

7. Diabetic retinopathy

8. Eales disease P.643

9. Glaucoma, open-angle

10. Herpetic viral infection

11. Idiopathic causes

12. Optic neuropathy/atrophy

13. Refractive error

14. Retinal disease, chronic

15. Systemic lupus erythematosus

16. Wegener granulomatosis

Friedberg MA, Rapuano CJ. Office and emergency room diagnosis and treatment of eye disease. Philadelphia: JB Lippincott, 1990.

Goldstein SM, et al. Cancer-associated retinopathy. Arch Ophthalmol 1999;117:1641â??1645.Bibliographic Links

2. Bilateral eye coveringâ??such as may be required after an eye operation, especially in older patients

3. Ocular lesions, such as retinal hemorrhage, glaucoma, optic atrophy of tertiary syphilis, and choroidal neovascularization.

4. Psychoses

5. Central nervous system lesions

A.Alzheimer disease

B.Diffuse irritative lesion of parietotemporal area, including uncinate seizures of the temporal lobe, stimulation of superior colliculus, and optic radiation

C.Encephalitis

D.Hippocampus lesions

E.Hypophyseal duct tumors

F.Measles

G.Medulloblastoma

H.Myxedema

I.Narcolepsy

J.Occipital lobe seizuresâ??moving lights and colors, visual and complex hallucinations with formed images

K.Papilledema (see p. 593)

L.Peduncular hallucinations with midbrain lesions from vascular, encephalitic, and mass lesions

M.Pellagra

N.Pituitary and optic chiasmal lesion

O.Vertebrobasilar insufficiency/basilar artery migraine

6. Chronic mountain sickness (Monge syndrome)

7. Malignant melanoma

8. Poisonings, such as mushroom, psilocin, cannabis, hashish, hemp, camphor, mescaline from peyote, myristica (nutmeg), gasoline, mullet (Hawaiian fish), and ololiuqui (morning-glory seeds)