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OP4 Ophthalmology
Differential Diagnoses of Common Presentations
Toronto Notes 2019
Table 2. Common Differential Diagnoses of Red Eye
Not every red eye has conjunctivitis
Discharge
Pain Photophobia Blurred Vision Pupil Injection
Cornea
IOP
Anterior Chamber Nausea and Vomiting Other
Conjunctivitis
Bacterial: purulent Viral: serous/mucoid Allergic: mucoid
±
No
No
Normal
Diffuse conjunctival injection involving the bulbar conjunctiva for 360 + palpebral or tarsal conjunctiva
Normal (subepithelial infiltrates in adenoviral conjunctivitis)
Normal
Normal No
Large, tender pre-auricular node(s) if viral
Acute Iritis
No
++ (dull/achy) +++
++
Smaller
Ciliary flush (peri-limbal)
Keratic precipitates
Varies
+++ Cells and flare No
Posterior synechiae
Acute Glaucoma
Clear
+++ (nausea)
+
+++
Fixed in mid-dilation Conjunctival injection
Cloudy
Increased markedly
Shallow +++
Coloured halos, nausea and vomiting
Keratitis (Corneal Abrasion/Ulcer)
++ (sharp)
++
Varies
Same or smaller
Possible conjunctival injection
Infiltrate, edema, and may have keratic precipitates
Normal or slightly decreased
Cells and flare or normal No
Vision Loss
Differential Diagnosis - Acute
• vitreous hemorrhage
• retinalartery/veinocclusion • RD
Differential Diagnosis - Chronic
• cataract
• refractiveerror
• cornealdystrophy • glaucoma
Ocular Pain
• differentiatefromeyefatigue(asthenopia) • ocularsurfacedisease
• herpeszosterprodrome
• trauma/foreignbody
• blepharitis • keratitis
Floaters
• AION
• opticneuritis
• amaurosisfugax/TIA/stroke
• AMD • DR
• cornealabrasion/ulcer • acuteglaucoma
• acuteuveitis
• scleritis
• episcleritis
• opticneuritis
• PVD(oftensecondarytoage-relatedvitreoussyneresis) • vitreoushemorrhage
• retinaltear/detachment
• intermediateuveitis(parsplanitis)
• posterioruveitis(chorioretinitis)
Flashes of Light (Photopsia)
• PVD(oftensecondarytoage-relatedvitreoussyneresis) • retinaltear/detachment
• migrainewithaura
Photophobia (Severe Light Sensitivity)
• cornealabrasion,cornealulcer • keratitis
• acuteangle-closureglaucoma • iritis
• meningitis/encephalitis
• migraine
• subarachnoidhemorrhage(SAH)