{"Opthalmology": { "title": "Opthalmology","cellType": "simpleTitle", "Pages": [ { "1": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Funny looking eye (including proptosis ptosis), periorbital problems, eyelid problems, problem with tears", "LeadsTo":"45", "UID":" 3000001", "Image":"NONE" }, { "SymptomName":"Double vision (dipoplia)/ Eye movement problems", "LeadsTo":"109", "UID":" 3000002", "Image":"NONE" }, { "SymptomName":"Pupil problems", "LeadsTo":"98", "UID":" 3000003", "Image":"NONE" }, { "SymptomName":"Red eye", "LeadsTo":"11", "UID":" 3000004", "Image":"NONE" }, { "SymptomName":"Visual problems (including visual loss, visual phenomena eg flashes/floaters, changes to colour vision)", "LeadsTo":"2", "UID":" 3000005", "Image":"NONE" }], "Running Differentials": [ { "differential":"Blepharitis, Chalazion, Dacrocystitis, Dacroadenitis, Ectropion, Entropion, Endophthalmus, Exophthalmus, Lagophthalmus, pre septal cellulitis, orbital cellulitis, Ophthalmic shingles, Ptosis, Stye, Xanthelasma, Blephrochalasis,corneal pannus, pterygium; pinguecula,endophalmitis," }, { "differential":"Intraocular pathology, Cavernous sinus syndrome, CN 3,4,6 lesions" }, { "differential":"Cranial nerve 3 palsy, Horner's syndrome, Holmes Adie syndrome, Drugs/toxins, Trauma, Argyl Robertson, Ocular problems/ infections, Acute angle glaucoma" }, { "differential":"Vascular, Infections, Inflammation, Trauma, Autoimmune" } ] } } , { "2": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Visual loss", "LeadsTo":"3", "UID":" 3000006", "Image":"NONE" }, { "SymptomName":"Visual phenomena (flashes, floaters, halos)", "LeadsTo":"9", "UID":" 3000007", "Image":"NONE" }, { "SymptomName":"Colour vision (red colour) changes/ desaturation", "LeadsTo":"19", "UID":" 3000008", "Image":"NONE" }], "Running Differentials": [ { "differential":"Vascular, Infections/inflammation, Trauma, Autoimmune, Metabolic, Neoplastic" }, { "differential":"Posterior vitreous detachment, Vitreous haemorrhage, Retinal tear, Retinal detachment, Trauma, Infections, Neoplastic" } ] } } , { "3": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Sudden onset (within secs - hours) generalised/ global visual loss", "LeadsTo":"4", "UID":" 3000009", "Image":"NONE" }, { "SymptomName":"Slow onset/progressive (days/months) visual loss, generalised blurriness ", "LeadsTo":"16", "UID":" 3000010", "Image":"NONE" }, { "SymptomName":" Central visual field loss: Sudden (secs/hrs) or progressive (days/months)", "LeadsTo":"61", "UID":" 3000011", "Image":"NONE" }, { "SymptomName":"Peripheral visual loss / changes:1Sudden (secs/hrs) or progressive (days/months)", "LeadsTo":"18", "UID":" 3000012", "Image":"NONE" }], "Running Differentials": [ { "differential":"CVA posterior vetebrobasilar (basilar artery supply), Heamodynamic origin (TIA, emboli), Neurological (Migraine ,Epileptic seizure (occipital lobe siezure), Ischemic neuropathy (retinal vein / arterty occlusion), Vitreous heamorrhage, Retinal detachment (RF), Optic neuritis (acute), Giant cell arteritis, Trauma (surgery, foreign body), Corneal infection (acute), Glaucoma (acute) (RF), Uveitis, Endophtalmitis, Papilleadema" }, { "differential":"Cataract, Myopia, Macular degeneration, Retinopathy (Hypertensive, Diabetic), Punctate inner choroidopathy (PIC)" }, { "differential":"Macular oedema (Diabetic retinopathy), Macular degeneration, MS, Occipital lobe lesion (tip) (bilateral - homonymous scotoma), Lebers, Punctate inner choroidopathy (PIC)" } ] } } , { "4": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Sudden transient visual loss (within minutes) + self resolves within several hours (either monocular or binocular): amaurosis fugax", "LeadsTo":"7", "UID":" 3000013", "Image":"NONE" }, { "SymptomName":"Sudden painless binocular visual loss (within minutes/hours); +/- vertigo; +/- dysarthria;+/- dipoplia", "LeadsTo":"", "UID":" 3000014", "Image":"NONE" }, { "SymptomName":"Sudden painless monocular visual loss (within minutes / hours)", "LeadsTo":"5", "UID":" 3000015", "Image":"NONE" }, { "SymptomName":"Sudden painful monocular visual loss (within minutes / hours)", "LeadsTo":"65", "UID":" 3000016", "Image":"NONE" }], "Running Differentials": [ { "differential":"Vasovagal/Hypoperfusion (Hypotension, Anaemia), Migraine, Epileptic seizure, Embolic heamodynamic origin (TIA emboli), Papilloedema, Optic neuropathies, Optic nerve compression, Ocular causes" }, { "differential":"CVA posterior vetebrobasilar (basilar artery supplies both)," }, { "differential":"Ischemic neuropathy (retinal/ vein occlusion), Vitreous heamorrhage, Retinal detachment (RF), Optic neuritis (acute), CVA, Giant cell arteritis" } ] } } , { "5": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Myopia flashing lights; +/- floaters; +/- Ôlike a curtain coming down'; +/- starts at periphery _ wrks inwards; Risk factors: Hx of catract surgery/ trauma; myopia On examination: _ acuity (macular involved); +/- RAPD; +/- straight lines appear curved- firm diagnosis?", "LeadsTo":"6", "UID":" 3000017", "Image":"NONE" }, { "SymptomName":"Sudden (in seconds) unilateral, painless visual loss; +/- Hx of amaurosis fugax; +/- loss occurs often at night; Risk Factors: AF; heart valve defects; carotid atherosclerotic plaques On examination: VA _ to central field (CF); RAPD present; Rule out GCA - Auscultate for carotid bruit, HTN, T2DM etc; If young consider Thromobophilia screen + autoimmune workup.; Investigation (further examination): fundoscopy", "LeadsTo":"6", "UID":" 3000018", "Image":"NONE" }, { "SymptomName":"Sudden (in seconds) unilateral, painless visual loss/ severe _ VA; On examination: normal RAP response ", "LeadsTo":"6", "UID":" 3000019", "Image":"NONE" }, { "SymptomName":"Sudden (in seconds) unilateral, painless visual loss/ severe _ VA; On examination: RAPD severe; ", "LeadsTo":"6", "UID":" 3000020", "Image":"NONE" }, { "SymptomName":"Sudden loss of vision; numerous dark spots; floaters ( faint cobweb like shapes passing through visual field, often on temporal side); cloudy vision; dark streaks Causes: diabetes; bleeding disorders - small bleeds floaters - moderate bleeds: dark spots; Large bleeds: sudden visual loss Investigation: strip lamp", "LeadsTo":"6", "UID":" 3000021", "Image":"NONE" }, { "SymptomName":"Sudden loss of vision (over hours); +/- jaw claudication; +/- sub acute headache; Extra features: +/- pain over non pulsatile temporal arteries; +/- scalp sensitive / combing hair; +/- pain in jaw/mouth; +/- weight loss; +/- low grade fever at risk of permanent visual loss; Risk Factors: women;> 55 years old; Investigations: Full blood count, ESR, CRP", "LeadsTo":"6", "UID":" 3000022", "Image":"NONE" }, { "SymptomName":"Sudden visual loss over hrs/ days (peaking over a week); eye pain ,+/- photopsias (flashing of lights), both more on eye movement; +/- washing outt of colours (red desaturation); On examination: RAPD, central scotoma;Invetsigations: Fundocsopy, MRI, Lumbar puncture", "LeadsTo":"6", "UID":" 3000023", "Image":"NONE" }, { "SymptomName":"Nasal hemianopia", "LeadsTo":"", "UID":" 3000024", "Image":"NONE" }], "Running Differentials": [ { "differential":"Retinal detachment (RF)" }, { "differential":"Central retinal artery occlusion" }, { "differential":"Central retinal vein occlusion (non ischaemic)" }, { "differential":"Central retinal vein occlusion (ischaemic)" }, { "differential":"Vitreous heamorrhage" }, { "differential":"Giant cell arteritis" }, { "differential":"Optic neuritis (Multiple Sclerosis)," } ] } } , { "6": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Fundoscopy:+/- pale retina/ ground glass retina; +/- cattle trucking/box car (slow blood flow in capillary leading to sedimentation/agglutination); +/- cherry red spot of the centre of macula (supplied by underlying undamaged choroid/ (30% have ciliretinal artery which will give alernate supply to macular); , white swollen retina; visible emboli 25%.", "LeadsTo":"24", "UID":" 3000025", "Image":"NONE" }, { "SymptomName":"Fundoscopy: widespread dot, blot spots (microaneurysm in deeper layers of the retina (inner nuclear / outer plexiform layer, + flame heamorrhages (in nerve fibre layer superficial, like splinter heamorrhage either due to vasculitis or microemboli) throughout fundus; +/- disc oedema; dilated tortuous vein; +/- retinal haemorrhages all four quadrants mild disc oedema. ", "LeadsTo":"25", "UID":" 3000026", "Image":"NONE" }, { "SymptomName":"Fundoscopy: disc can be obscured by oedema/ heamorrhages; cotton wool spots (nerve fibre layer infarction from occlusion of precapillary arterioles)>10 ; dilated retinal veins; optic disc swelling; Investigation: BP FBC ESR U&E glucose lipids protein electrophoresis +/- ACE anticardiolipin, lupus anticoagulant, CXR, thrombophilia screen ", "LeadsTo":"25", "UID":" 3000027", "Image":"NONE" }, { "SymptomName":"Fundoscopy: (initially macular on) tobacco dust in viterous (2ary to U shape tear/Rhegmatogenous); +/- no tobacco dust, signs of pretretinal fibrosis (Tractional detachment); +/- no tobacco dust, vitreous cells present (Exudative detachment)", "LeadsTo":"26", "UID":" 3000028", "Image":"NONE" }, { "SymptomName":"Investigations: Full blood count: _ESR; _CRP ; _ALP; _Platelets; _Hb (normochromic normocytic anaemia); Histology: biopsy of temporal artery; Fundocscopy: normal; +/- swollen disc, +/- flame heamorrhages", "LeadsTo":"20", "UID":" 3000029", "Image":"NONE" }, { "SymptomName":"Investigations: Fundoscopy: optic disc swelling (papillitis)/normal (retrobulbar) MRI of brain / spine: demyelinated/ oedema plaques Note: >3 white matter lesions 5 yr risk of developing MS 50%; Lumbar Puncture CSF: oligoclonal band; spp immunoresponsive bands (_IgG)", "LeadsTo":"21", "UID":" 3000030", "Image":"NONE" }, { "SymptomName":"Fundoscopy: bilateral optic swelling; CT venogram + MRI brain/ orbits; +/- Lumbar puncture with opening pressures ( For definite diagnosis must prove _ ICP ( intracranial pressure) (LP with opening pressure >25); Full neruological examination. Check for history of sleep apnoea + recent weight gain", "LeadsTo":"27", "UID":" 3000031", "Image":"NONE" }], "Running Differentials": [ { "differential":"Central retinal artery occlusion" }, { "differential":"Central retinal vein occlusion (non ischaemic)" }, { "differential":"Central retinal vein occlusion (ischaemic)" }, { "differential":"Retinal tear, Retinal detachment (RF)" }, { "differential":"GCA" }, { "differential":"Optic neuritis (Multiple scelrosis)" } ] } } , { "7": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Sudden binocular transient visual loss; postural change (orthostatic) suddenly standing up';+/- light headedness; +/- pre-syncope Investigation: Blood pressure, Full Blood Count, Fundoscopy ", "LeadsTo":"66", "UID":" 3000032", "Image":"NONE" }, { "SymptomName":"Sudden binocular transient visual loss; Slowly expanding over 10 - 20 min, rarely >30 min; +/- positive phenomena (sparkling lights zig zag lines); +/- painful unilateral headache; Other features:headache worse on movement, behind the eye; +/- photophobia or phonophobia; +/- aura minutes prior to onset and may continue (visual eg jumbling of lines /dots - Ôscintillating scotoma Ôor somoatosensory eg parasthesiae spreading form fingers to face); +/- nausea/vomiting; +/- prodrome days/hrs before onset", "LeadsTo":"22", "UID":" 3000033", "Image":"NONE" }, { "SymptomName":"Sudden binocular transient visual loss; +/- duration of 2 -5 min; +/- positive phenomena (sparkling lights zig zag lines); +/- altered consciousness; +/- motor signs", "LeadsTo":"28", "UID":" 3000034", "Image":"NONE" }, { "SymptomName":"Sudden monocular visual loss (within secs,minutes, 2mn - 30 min) + self resolves within 30 min of onset (Transient monocular visual loss:TMVL) +/- Ôlike a curtain coming down'; +/- starts at periphery _ wrks inwards; ", "LeadsTo":"8", "UID":" 3000035", "Image":"NONE" }], "Running Differentials": [ { "differential":"Vasovagal/Hypotension (postural), hypoperfusion (eg anaemia), Papilloedema" }, { "differential":"Migraine" }, { "differential":"Epileptic seizure" } ] } } , { "8": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Sudden onset TMVL, lasts 2 -30 min painless monocular visual loss, resolves completely; +/- carotid bruits present; Risk Factors: >50 years old; Hx of vasculopathy (hypertension, hyperlipideamia, diabetes) or coagulopathy; Investigations: Fundoscopy, Full blood count, including ESR, CRP; if >50 or risk factors for ischemic event: Carotid imaging, Cardiac evaluation", "LeadsTo":"67", "UID":" 3000036", "Image":"NONE" }, { "SymptomName":"TMVL; +/- jaw claudication; +/- sub acute headache; Extra features: +/- pain over non pulsatile temporal arteries; +/- scalp sensitive / combing hair; +/- pain in jaw/mouth; +/- weight loss; +/- low grade fever at risk of permanent visual loss; Risk Factors: women;> 55 years old; A/W: PMR Investigations: Full blood count, ESR, CRP", "LeadsTo":"6", "UID":" 3000037", "Image":"NONE" }, { "SymptomName":"TMVL; post exercise, hot shower; Uhthoff's symptom; last several min or until body temp returns to normal; +/- Hx of MS; Extra features: Upper motor neuron muscle changes (UMN);sensory changes: +/- peripheral parathestsia (numbness; tingling) lasting minutes/ hours;+/- twisting/burning (dorsal columns); +/- changes to temp /pain due to spinothalamic involvement; Lhermitte sign: tingling in hands Ð from cervical dorsal column lesions; Motor changes: muscle weakness; dead arm: slurring speach; difficult swallowing; Other Visual: +/- optic neuritis (unilateral eye pain); disk swelling; blindness RAPD ; Eye movement: dipoplia;+/- nystagmus; +/- lateral rectus lesions; cerebellar: +/- ataxia; ; +/- recurrent episode over several months - Investigations: MRI; CSF", "LeadsTo":"6", "UID":" 3000038", "Image":"NONE" }, { "SymptomName":"TMVL triggered by specific eye position (gazed evoked amaurosis fugax); +/- Hx of headache; +/- Hx of Graves diseases; Field defect, dependent on location of compression and invovlement of chiasm(will be bilaterally affected)", "LeadsTo":"29", "UID":" 3000040", "Image":"NONE" }, { "SymptomName":"TMVL; +/- red eye; +/- pain; +/- coloured halos around lights", "LeadsTo":"30", "UID":" 3000041", "Image":"NONE" }, { "SymptomName":"TVML (seconds); +/- itchiness; +/- discharge", "LeadsTo":"68", "UID":" 3000042", "Image":"NONE" }, { "SymptomName":"TVML with associated spider floaters in the field of visions", "LeadsTo":"", "UID":" 3000043", "Image":"NONE" }], "Running Differentials": [ { "differential":"Ischemic event (Carotid narowing, Transient ischemic attack (most often carotid), coagulopathy (autoimmune, vasculitis), idiopathic retinal vasospasm" }, { "differential":"Giant cell arteritis" }, { "differential":"Multiple sclerosis" }, { "differential":"Optic nerve compression" }, { "differential":"Intermittent angle closure glaucoma" }, { "differential":"Dry eye, ocular infections" } ] } } , { "9": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Sudden onset (< 6 weeks) monocular floaters (entopsias); eg spots, threads, fragment cobweb like fragment that float across visual field (gel/cell debris floating in vitreous); +/- flashes (when retina tugged/torn from back eye produces electrical impulse transmitted/interpreted as flash of light - photopsias/phosphenes); +/- _ visual acuity (VA); +/- black spots (small retinal vessel avulsion)", "LeadsTo":"10", "UID":" 3000044", "Image":"NONE" }, { "SymptomName":"Sporadic monocular floaters; Risk Factors: myopia, diabetes, _ age (>50 yo); On examination: normal VA", "LeadsTo":"", "UID":" 3000045", "Image":"NONE" }, { "SymptomName":"Monocular floaters; Hx of trauma to the affected eye (eg eye surgery)", "LeadsTo":"", "UID":" 3000046", "Image":"NONE" }, { "SymptomName":"Floaters; +/- pain +/- a systemic inflammation / infection; On examination: white blood cells in vitreous or anteroir chamber ", "LeadsTo":"70", "UID":" 3000047", "Image":"NONE" }, { "SymptomName":"Bilateral flashes 10 - 20 mins; often at periphery ; +/- blurry central vision; +/- headache", "LeadsTo":"", "UID":" 3000048", "Image":"NONE" }, { "SymptomName":"Flashing lights (Photospia) + floaters; Investigation: Require dilated slit lamp examination", "LeadsTo":"26", "UID":" 3000049", "Image":"NONE" }, { "SymptomName":" halos around lights (coloured or white)", "LeadsTo":"", "UID":" 3000090", "Image":"NONE" }], "Running Differentials": [ { "differential":"Posterior vitreous detachment, Vitreous haemorrhage, Retinal tear, Retinal detachment, Trauma" }, { "differential":"Idiopathic vitreous floaters - vitreous syneresis" }, { "differential":"Trauma (eg recent eye surgery, cataract surgery)" }, { "differential":"Infection (Tuberculosis, Sarcoidosis, Syphilis, Toxoplasmosis), Tumor (primary or secondary eg lymphoma, leukemia), Uveitis" }, { "differential":"Migraine, vasovagal" }, { "differential":"Indicates retinal pathology (not entirely sure how to play this one as literally any retinal pathology could give this to you, I have linked this to the the crucial red flag, tear/detachment)" } ] } } , { "10": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Sudden large number of floaters, primarily in centre of visual axis; +/- flashes (photopsia) <1 sec, associated with eye movement (more apparent at night); +/- black spots (small retinal vessel avulsion);+/- circular floater (annular ring - 'weiss ring' detaching) On examination:+/- _ Visual acuity (VA)", "LeadsTo":"31", "UID":" 3000050", "Image":"NONE" }, { "SymptomName":"Sudden floaters and flashes; +/- _ visual acuity (VA) (cloudy irregular or curtain like vision) over hrs or days; +/- shadow in peripheral vision; +/- looks like 'curtain going up' (as tear often superior posterior) On examination: positive tobacco dust Shaffer's sign (red blood cells or retinal igment in retro; Investigation : dilated slit lamp examination +/- indirect opthalmoscpy. ", "LeadsTo":"32", "UID":" 3000051", "Image":"NONE" }, { "SymptomName":"Floaters and numerous darken haze/ vitreous haze; +/- flashes; +/- _ visual acuity (VA) (cloudy, hazy vision); +/- photophobia;A/W: retinal detachments; On examination: physical heammorrhage (water levels) seen in retina;(smoke signals)", "LeadsTo":"31", "UID":" 3000052", "Image":"NONE" }], "Running Differentials": [ { "differential":"Posterior vitreous detachment" }, { "differential":"Retinal tear/detachment, trauma (retinal surgery eg cataract)" } ] } } , { "11": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Unilateral, painless, circumscribed dense red eye; +/- Hx of trauma (coughing, vomiting); On examination: normal VA (visual acuity); +/- normal, reactive pupil; Slit lamp examination ", "LeadsTo":"43", "UID":" 3000053", "Image":"NONE" }, { "SymptomName":"Diffuse injected red eye; +/- unilateral or bilateral; +/- watery;+/- discharge; +/- pain; +/- itchy, grittiness sensation; On examination: normal VA (visual acuity); +/- normal, reactive pupil", "LeadsTo":"12", "UID":" 3000054", "Image":"NONE" }, { "SymptomName":"Diffuse injected red eye (pattern of dilated vessels);+/- usually unilateral; +/- watery; +/- discharge; +/- sensation of foreign body; +/- pain;+/- gritty, does NOT improve with wiping of eye;+/- photophobia; +/- blurry vision; Associated with: +/- Uveitis;Hx of contact lens use (especially relevant if sleeps or showers in contact lens and if has prolonge dwear (>12 hrs/day day); On penlight examination: _ Visual acuity (VA); +/- corneal opacification/ white spot; +/- circumlimbal injection (ciliary flush); fluorescein examination: +ve findings", "LeadsTo":"13", "UID":" 3000055", "Image":"NONE" }, { "SymptomName":"Unilateral red eye; +/- watery but NO discharge; +/- severe eye pain, made worse on reading; +/- blurred vision; +/- photophobia; On examination: ciliary flush present (ciliary vessels visible through white sclera); _ Visual acuity (VA); _ pupil response, +/- abnormal pupil shape", "LeadsTo":"14", "UID":" 3000056", "Image":"NONE" }, { "SymptomName":"Gradual or sudden; unilateral/bilateral, injected red eye; +/- localised; +/- moderate / severe pain; On examination: localised patch, deeper duller red/ purple", "LeadsTo":"15", "UID":" 3000057", "Image":"NONE" }], "Running Differentials": [ { "differential":"Subconjunctival heamorrhage" }, { "differential":"Allergic conjunctivitis (vernal), Dry eye, Blepharitis, Conjunctivitis, Scleritis" }, { "differential":"Corneal inflammation (keratitis)" }, { "differential":"Uveitis, iritis, aucute glaucoma, endopthalmitis" } ] } } , { "12": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Profuse water/mucoserous discharge ('white stringy discharge'); bilateral;+/- itchy +/- Hx of hayfever, asthma, other known allergens; +/- seasonal presentation; Associated with: +/- periorbital contact dermatitis", "LeadsTo":"33", "UID":" 3000058", "Image":"NONE" }, { "SymptomName":"Bilateral dry, watering eyes; +/- red eye; +/- frequent blinking +/- stinging +/- grittiness; visual blurring improved by blinking/ wiping eyes;+/- photophobia; +/- discharge/crust in eyelashes (particularly towards the end of day); Associated with: blepharitis often occurs with dry eye; Investigation: Normal ocular examination, assessment of tear film with fluroscien will show poor tear film with rapid breakdown", "LeadsTo":"44", "UID":" 3000059", "Image":"NONE" }, { "SymptomName":"Unilateral/bilateral irriated, red, sore eyes; > at the lid margins/corners of the eyes; +/- discharge/ crust in eyelashes; Investigation: Slit lamp examination", "LeadsTo":"13", "UID":" 3000060", "Image":"NONE" }, { "SymptomName":"Bilateral irritated, itchy, gritty, red eyes;+/- watery / painful eye; inflamed, greasy eyelids; +/- discharge/ crust in eye lashes; +/- eyes stuck together on waking; +/- scales / flakes on eyelids/eye lashes; +/- Hx of seborrhoeic dermatitis / rosacea; Investigation: Slit lamp examination: anterior: skin flakes; posterior: blocked meboninam gland; examination of tear film; +/- look evidence of rosascia ", "LeadsTo":"34", "UID":" 3000061", "Image":"NONE" }, { "SymptomName":"Gradual or sudden onset; +/- severe boring eye pain, radiating to face / peri-orbital region; +/- pain worse at night 'sharp pain', waking patient up or unable to get to sleep ; +/- headache; +/- blurred vision; +/- photophobia; +/- watery; +/- Hx of systemic inflammatory disease, eg Rheumatoid Artheritis, Lupus; +/- systemic symptoms (eg fever vomiting) On examination: deep red/ purple engorged localised vessels in sclera/ episclera; +/- _ Visual acuity (VA); only moderate / no blanching of vessels with Phenylephrine ", "LeadsTo":"35", "UID":" 3000062", "Image":"NONE" }], "Running Differentials": [ { "differential":"Allergic conjunctivitis (including exposure to toxins, chemicals)" }, { "differential":"Dry eye" }, { "differential":"Conjunctivitis" }, { "differential":"Blepharitis" } ] } } , { "13": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Slit lamp examination + fluroscein and blue light: Purulent discharge (white, yellow or green), > at the lid margins/corners of the eyes; +/- eyelid stuck shut in mornings; more discharge appears minutes after eye being wiped; Conjunctival injections +/- chemosis", "LeadsTo":"33", "UID":" 3000063", "Image":"NONE" }, { "SymptomName":"Slit lamp examination + fluroscein and blue light: Mucoserous discharge; +/- bilateral; +/- gritty feeling in the eye; +/- choryzal, URTI symptoms; conjunctival injections +/- chemosis; +/- pre-auricular lymphadenopathy; +/- contact with others with similar signs; Associated with: +/- keratitis", "LeadsTo":"33", "UID":" 3000064", "Image":"NONE" }, { "SymptomName":"Discharge watery, mucoserous; Hx of trauma / defect: fluorescein:positive finding of trauma or normal", "LeadsTo":"36", "UID":" 3000065", "Image":"NONE" }, { "SymptomName":"Slit lamp examination: Conjunctival hyperemia, corneal lesion; Mucopurulent discharge; Fluorescein: white spot or opacity; +/- hypopyon (white cells in anterior chamber); +/- contact lens users; (bacterial look bad feels bad); lab analysis: corneal scrapes.", "LeadsTo":"36", "UID":" 3000066", "Image":"NONE" }, { "SymptomName":"Slit lamp examination: Conjunctival hyperemia, corneal lesionWatery discharge; Fluorescein: grayish branching opacity dendrite (dendritic ulcer)", "LeadsTo":"36", "UID":" 3000067", "Image":"NONE" }, { "SymptomName":"Slit lamp examination: Conjunctival hyperemia, corneal lesioncontact lens - spp wearing a lot showering or swimming overnight - fungal and aemebic; fungal look awful but more modest symptoms a bit sore", "LeadsTo":"36", "UID":" 3000068", "Image":"NONE" }, { "SymptomName":"aemebic v small ulcer but spreads v far -", "LeadsTo":"36", "UID":" 3000069", "Image":"NONE" }, { "SymptomName":"Slit lamp: anterior flare (_ aqueous humour cloudiness, + anterior chamber cells; +/- corneal keratic precipitates (yellow white precipitates on posterior (endothelial surface); +/- sterile hypopyon (white blood cells in anterior chamber), A/W:HLA- B27 diseases; IOP (intraocular pressire) abnormal", "LeadsTo":"37", "UID":" 3000070", "Image":"NONE" }], "Running Differentials": [ { "differential":"Conjunctivitis (bacterial)" }, { "differential":"Conjunctivitis (viral)" }, { "differential":"Corneal abrasion, foreign body" }, { "differential":"Keratitis, bacterial" }, { "differential":"Keratitis, viral (herpes simplex)" }, { "differential":"Keratitis (fungal)" }, { "differential":"Keratitis (amoeba)" } ] } } , { "14": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Unilateral dull ache/bruising around orbit or back of the eye - (not helped/relieved by topical anesthetic): +/- blurred vision; +/- photophobia/ pain on reading ( white cell infiltrates in anterior chamber/ ciliary muscles causing pain as muscles constrict); +/- watery but NO discharge; +/- Hx of HLA-B27 associated conditions eg ankylising spondylitis; constituional symptoms: myalgia, arthralgia, rash; ; On examination: ciliary flush present circumlimbal (ciliary vessels visible through white sclera), +/- small irregular, poorly responsive pupil (due to ciliary muscle spams) Further investigation: slit lamp: treatment with dilated drops irregular small pupil (iris gets stuck to lens)", "LeadsTo":"13", "UID":" 3000071", "Image":"NONE" }, { "SymptomName":"Unilateral diffuse injected, red eye; sudden onset; +/-severe eye pain; +/- blurred vision; Antecedent Hx: +/- headache + rainbow haloes around light in evening coloured halos, especially in evening/like through frosted glass (due to corneal oedema) +/- photophobia ;+/- sudden onset 10/10 severe headache; +/- nausea/vomiting; Penlight examination: oval fixed unresponsive mid dilated (typically 4 - 5mm in diameter); +/- ciliary flush present (ciliary vessels visible through white sclera); hazy cornea; _ Visual acuity (VA); clouded/hazy cornea", "LeadsTo":"30", "UID":" 3000072", "Image":"NONE" }], "Running Differentials": [ { "differential":"uveitis, iritis" } ] } } , { "15": { "Status": "", "Symptoms": [ { "SymptomName":"Unilateral severe loss of vision with very painful red eye +/- hypopyon +/- panuveitis; Hx of recent surgery or pentrating eye trauma; +/- Hx of immunospression, HIV, IVDU, subacute bacterial endocarditis + pyrexia. Investigation: Slit lamp exmamination. ", "LeadsTo":"79", "UID":" 3000039", "Image":"NONE" }, { "SymptomName":"Gradual onset; +/- severe boring eye pain, radiating to face / periorbital region; +/- pain worse on eye movement /at night 'sharp pain', waking patient up orunable to get to sleep ; +/- headache; +/- blurred vision; +/- photophobia; +/- watery; +/- Hx of systemic inflammatory disease, eg Rheumatoid Artheritis, Lupus; +/- systemic symptoms (eg fever vomiting) On examination: engorged localised vessels in sclera/ episclera; +/- _ Visual acuity (VA); only moderate / no blanching of vessels with Phenylephrine (as vessels are deeper within the eye)", "LeadsTo":"35", "UID":" 3000073", "Image":"NONE" }, { "SymptomName":"Acute onset; +/- mild pain/ discomfort; +/-watery; Normal visual acuity (VA); blanching of the vessels with Phenylephrine", "LeadsTo":"35", "UID":" 3000074", "Image":"NONE" }], "Running Differentials": [ { "differential":"Endophthalmitis (red flag)" }, { "differential":"Scleritis (anterior)" } ] } } , { "16": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Slow visual loss/ blurriness, +/- bilateral; _ difficulty driving at night, reading; +/- _ glare, white halo around lights, photophobia; +/- double vision from that eye (monocular dipoplia); Risk factors: _ age, smoking; ETOH, long term illnesses eg diabetes; Slit lamp examination : _ VA (myopic shift) ; +/- lens apocity; +/- _/absence of red reflex", "LeadsTo":"42", "UID":" 3000075", "Image":"NONE" }, { "SymptomName":"Slow visual loss/ blurriness, +/- bilateral; _ difficulty seeing road signs, distant objects clearly; reading computer screen normal; +/- squinting, eye strain, headaches; +/- tired/ headaches after driving/ playing sports", "LeadsTo":"38", "UID":" 3000076", "Image":"NONE" }, { "SymptomName":"Slow visual loss/ blurriness, +/- bilateral; _ difficulty seeing road signs, distant objects clearly; reading computer screen NOT normal; +/- squinting, eye strain, headaches; +/- tired/ headaches after driving/ playing sports", "LeadsTo":"16", "UID":" 3000077", "Image":"NONE" }, { "SymptomName":"No signs or symptoms until very late - importance of screening; Diabetic patient (usually poorly controlled) progressive visual blurring/ distortion over weeks /months; +/- sudden deterioration if haemorrhage occurs; Investigation: Dilated slit lamp exmaination, OCT, FFA if suspcious of new vessel formation; Fundoscopy examination: Dot, blot spots (capillary wall breakdowns / microaneurysms in inner nuclear layer of retina - tightly packed so heamorrhage can't spread); +/- cotton wool spots (ischemia/ infarct of superficial retinal nerve fibres); +/- hard exudates (lipid deposits post oedema/ leakage)", "LeadsTo":"39", "UID":" 3000078", "Image":"NONE" }, { "SymptomName":"Gradual unilateral or bilateral gradual (can be sudden) visual loss predominately visual distortion/ blurred vision; Risk factor: >50 yo; smokers; On examination: Amsler chart +/- distortion of straight lines; Investigation: Dilated slit lamp examination: multiple drusen, choroidal neovascular membrane, geographic atropy; perform OCT;+/- FFA if suspicious for a neovascular membrane.", "LeadsTo":"17", "UID":" 3000079", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cataract" }, { "differential":"Myopia" }, { "differential":"Refractive error" }, { "differential":"Diabetic retinopathy" } ] } } , { "17": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Gradual loss of vision; +/- unilateral or bilateral; +/- loss of central vision; Slit lamp examination: drusen; +/- areas of retina atrophy; Amsler chart +/- distortion of straight lines; Fluorescein dye staining", "LeadsTo":"40", "UID":" 3000080", "Image":"NONE" }, { "SymptomName":"Acute visual distortion; +/- loss of central vision; distortion of straight lines Slit lamp examination: subretinal fluid and/or heamorrhage; +/- grey / green patches (areas of neovascularisation) Amsler chart: distortion of straight lines; Fluorescein dye staining", "LeadsTo":"40", "UID":" 3000081", "Image":"NONE" }], "Running Differentials": [ { "differential":"Dry AMD" } ] } } , { "18": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Left or Right visual field loss - homonymous hemianopia; Investigation: Slit lamp examination + MRI Brain and orbits ", "LeadsTo":"41", "UID":" 3000082", "Image":"NONE" }, { "SymptomName":"Tunnel vision bitemporal heteronymous hemianopia, Bilateral slow peripheral field loss VA : +/- family Hx", "LeadsTo":"69", "UID":" 3000083", "Image":"NONE" }, { "SymptomName":"Altitudinal field defects - above or below", "LeadsTo":"70", "UID":" 3000084", "Image":"NONE" }], "Running Differentials": [ { "differential":"Optic tract lesion, Visual cortex PCA lesion" }, { "differential":"Pituitary tumour, open angle glaucoma, Retinitis pigmentosa" } ] } } , { "19": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Washed out' colours, especially red; On examination: ishahara chart; RAPD present; +/- normal VA; -donÕt agree with this one", "LeadsTo":"", "UID":" 3000085", "Image":"NONE" }, { "SymptomName":"Washed out' colours, especially red; +/- pain on eye movement, retroorbital pain; +/- unilateral; +/- blurriness, sudden partial / complete transient visual loss; On examination: ishahara chart; RAPD present; +/- normal VA;", "LeadsTo":"63", "UID":" 3000086", "Image":"NONE" }, { "SymptomName":"Male; Hx of familial (eg maternal grandfather) colour blindness; Investigation: Ishara Positive", "LeadsTo":"94", "UID":" 3000092", "Image":"NONE" }], "Running Differentials": [ { "differential":"Papilloedema ( _ ICP)" }, { "differential":"Optic neuritis (Multiple Scelorosis, Infection (Syphilis, Lyme disease, Herpes Zoster), Autoimmune disorders (Lupus, Sarcoidosis, IBD, RA?), Drug induced/Toxins (Chloramphenical ethambutol), B12 deficiencies, Diabetes" } ] } } , { "20": { "Status": "Diagnosis", "DiagnosisUID" : " 3000001", "DiagnosisFile": "Giant cell arteritis", "Symptoms": [ { "SymptomName":"Giant cell arteritis", "LeadsTo":"999", "UID":" 3000087", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "21": { "Status": "Diagnosis", "DiagnosisUID" : " 3000002", "DiagnosisFile": "Multiple Sclerosis", "Symptoms": [ { "SymptomName":"Multiple Sclerosis", "LeadsTo":"999", "UID":" 3000088", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "22": { "Status": "Diagnosis", "DiagnosisUID" : " 3000003", "DiagnosisFile": "Migraine", "Symptoms": [ { "SymptomName":"Migraine", "LeadsTo":"999", "UID":" 3000089", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "23": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"d lasting 3 - 5 secs; visual obscuration; +/- pulsatile tinnitus; +/- on movement, moving head / standing up; Investigations: fundocscopy", "LeadsTo":"6", "UID":" 3000039", "Image":"NONE" }, { "SymptomName":"Blood pressure reading:É Blood test>>>", "LeadsTo":"", "UID":" 3000091", "Image":"NONE" }], "Running Differentials": [ { "differential":"Papilloedema" } ] } } , { "24": { "Status": "Diagnosis", "DiagnosisUID" : " 3000004", "DiagnosisFile": "Central retinal artery occlusion", "Symptoms": [ { "SymptomName":"Central retinal artery occlusion", "LeadsTo":"", "UID":" 3000092", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "25": { "Status": "Diagnosis", "DiagnosisUID" : " 3000005", "DiagnosisFile": "Central retinal vein occlusion", "Symptoms": [ { "SymptomName":"Central retinal vein occlusion", "LeadsTo":"", "UID":" 3000093", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "26": { "Status": "Diagnosis", "DiagnosisUID" : " 3000006", "DiagnosisFile": "Retinal tear/detachment", "Symptoms": [ { "SymptomName":"Retinal tear/detachment", "LeadsTo":"", "UID":" 3000094", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "27": { "Status": "Diagnosis", "DiagnosisUID" : " 3000007", "DiagnosisFile": "Papilloedema", "Symptoms": [ { "SymptomName":"Papilloedema", "LeadsTo":"", "UID":" 3000095", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "28": { "Status": "Diagnosis", "DiagnosisUID" : " 3000008", "DiagnosisFile": "Epilepsy", "Symptoms": [ { "SymptomName":"Epilepsy", "LeadsTo":"", "UID":" 3000096", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "29": { "Status": "Diagnosis", "DiagnosisUID" : " 3000009", "DiagnosisFile": "Optic nerve compression", "Symptoms": [ { "SymptomName":"Optic nerve compression", "LeadsTo":"", "UID":" 3000097", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "30": { "Status": "Diagnosis", "DiagnosisUID" : " 3000010", "DiagnosisFile": "Glaucoma", "Symptoms": [ { "SymptomName":"Glaucoma", "LeadsTo":"", "UID":" 3000098", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "31": { "Status": "Diagnosis", "DiagnosisUID" : " 3000011", "DiagnosisFile": "Vitreous heamorrhage, vitreous detachment", "Symptoms": [ { "SymptomName":"Vitreous heamorrhage, vitreous detachment", "LeadsTo":"", "UID":" 3000099", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "32": { "Status": "Diagnosis", "DiagnosisUID" : " 3000012", "DiagnosisFile": "Retinal tear/detachment", "Symptoms": [ { "SymptomName":"Retinal tear/detachment", "LeadsTo":"", "UID":" 3000100", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "33": { "Status": "Diagnosis", "DiagnosisUID" : " 3000013", "DiagnosisFile": "Conjunctivitis", "Symptoms": [ { "SymptomName":"Conjunctivitis", "LeadsTo":"", "UID":" 3000101", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "34": { "Status": "Diagnosis", "DiagnosisUID" : " 3000014", "DiagnosisFile": "Blepharitis", "Symptoms": [ { "SymptomName":"Blepharitis", "LeadsTo":"", "UID":" 3000102", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "35": { "Status": "Diagnosis", "DiagnosisUID" : " 3000015", "DiagnosisFile": "Scleritis, Episcleritis", "Symptoms": [ { "SymptomName":"Scleritis, Episcleritis", "LeadsTo":"", "UID":" 3000103", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "36": { "Status": "Diagnosis", "DiagnosisUID" : " 3000016", "DiagnosisFile": "Keratitis", "Symptoms": [ { "SymptomName":"Keratitis", "LeadsTo":"", "UID":" 3000104", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "37": { "Status": "Diagnosis", "DiagnosisUID" : " 3000017", "DiagnosisFile": "Uveitis, iritis", "Symptoms": [ { "SymptomName":"Uveitis, iritis", "LeadsTo":"", "UID":" 3000105", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "38": { "Status": "Diagnosis", "DiagnosisUID" : " 3000018", "DiagnosisFile": "Myopia, Refractive error, Ametropia, Astigmatism", "Symptoms": [ { "SymptomName":"Myopia, Refractive error, Ametropia, Astigmatism", "LeadsTo":"", "UID":" 3000106", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "39": { "Status": "Diagnosis", "DiagnosisUID" : " 3000019", "DiagnosisFile": "Diabetic retinopathy", "Symptoms": [ { "SymptomName":"Diabetic retinopathy", "LeadsTo":"", "UID":" 3000107", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "40": { "Status": "Diagnosis", "DiagnosisUID" : " 3000020", "DiagnosisFile": "Macular degeneration", "Symptoms": [ { "SymptomName":"Macular degeneration", "LeadsTo":"", "UID":" 3000108", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "41": { "Status": "Diagnosis", "DiagnosisUID" : " 3000021", "DiagnosisFile": "Optic tract lesion, pituitary lesion", "Symptoms": [ { "SymptomName":"Optic tract lesion, pituitary lesion", "LeadsTo":"", "UID":" 3000109", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "42": { "Status": "Diagnosis", "DiagnosisUID" : " 3000022", "DiagnosisFile": "Cataract", "Symptoms": [ { "SymptomName":"Cataract", "LeadsTo":"", "UID":" 3000110", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "43": { "Status": "Diagnosis", "DiagnosisUID" : " 3000023", "DiagnosisFile": "Subconjunctival heamorrhage", "Symptoms": [ { "SymptomName":"Subconjunctival heamorrhage", "LeadsTo":"", "UID":" 3000111", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "44": { "Status": "Diagnosis", "DiagnosisUID" : " 3000024", "DiagnosisFile": "Dry eye", "Symptoms": [ { "SymptomName":"Dry eye", "LeadsTo":"", "UID":" 3000112", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "45": { "Status": "pre", "Symptoms": [ { "SymptomName":"Entire eye (eg protruding, sunken)", "LeadsTo":"46", "UID":" 3000113", "Image":"NONE" }, { "SymptomName":"Eyelids problems (swollen, crusty, inflammed, rectraction)", "LeadsTo":"52", "UID":" 3000114", "Image":"NONE" }, { "SymptomName":"Droopy eylid (ptosis)", "LeadsTo":"", "UID":" 3000115", "Image":"NONE" }, { "SymptomName":"Changes to the surface of the eye (eg specs/ dots/ swelling)", "LeadsTo":"60", "UID":" 3000116", "Image":"NONE" }], "Running Differentials": [ { "differential":"Exophthalmus, Endophthalmus, Pre septal Cellulitis, Orbital Cellulitis, Ophthalmic Shingles," }, { "differential":"Ectropion, Entropion, dacrocystitis, Dacroadenitis, Lagopthalmus, orbital cellulitis, preseptal cellulitis, Ptosis, Stye, Xanthelasma, Blephrochelasis. Chalazion" }, { "differential":"" } ] } } , { "46": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Eye protruding, proptosis, Bilateral or unilateral; Investigation: Measure with Exophthalmometer", "LeadsTo":"47", "UID":" 3000117", "Image":"NONE" }, { "SymptomName":"Eye sunken; Investigation: Measure with Exophthalmometer ", "LeadsTo":"50", "UID":" 3000118", "Image":"NONE" }, { "SymptomName":"Eyelids and/ or Eye swollen + inflamed; Investigations: Take temperature, set of observations.", "LeadsTo":"51", "UID":" 3000119", "Image":"NONE" }], "Running Differentials": [ { "differential":"Thyroid eye disease (Grave's ophthalmopathy - exophthalmos), Cushing's syndrome, Orbital apex lesions, Cavernous sinus lesion" }, { "differential":"Congenital enophthalmus, Trauma, Prostaglandin associated periorbitopathy, Pseudoenophthalmus" } ] } } , { "47": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Bilateral proptosis; stare + lid lag (from lid retraction due to contraction of levator palpebrae eyelid muscles - signs of thyroid hormone excess); +/- Signs of thyroid disease: resting tachycardia (often AF), fine tremor, pretibial myoxedema, thyroid acropachy, thyroid gland enlargement, brisk reflexes; +/- Complex ophthalmoplegia (not related to CN III, IV, VI), pain on eye movement; +/- soft tissue involvement: periorbital oedema, chemosis, conjunctival injections, lagophthalmus; Investigation: _ eye pressure on upgaze; Thyroid function test: _ TSH, _ _ TSH receptor (TSHR) antibodies, thyroid autoantibodies +ve; CT orbits: _ retroorbital fat; _ extraocular muscle swelling", "LeadsTo":"72", "UID":" 3000120", "Image":"NONE" }, { "SymptomName":"Angled proptosis looking to right / left not in primary position", "LeadsTo":"", "UID":" 3000091", "Image":"NONE" }, { "SymptomName":"Unilateral or bilateral proptosis; Signs of other cranial nerve palsies; +/- visual loss; +/- ocular/conjunctival congestion; +/- pain; Ophthalmoplegia, Ptosis, _ corneal sensation (CNV 1 - ophthalmic branch), optic nerve swelling (direct fundoscopy); +/- Hx of trauma; +/- Hx of autoimmune/vasculitis; Investigation: MRI orbit/ brain (with contrast). If trauma Hx: CT orbits 1st investigation Fracture; Blood tests: autoimmune/ vasculitis screen", "LeadsTo":"48", "UID":" 3000121", "Image":"NONE" }, { "SymptomName":"Sudden, or slow progressing unilateral massive, pulsatile proptosis, bruit over eye (ocular / cranial), chemosis (triad);+/- visual loss; +/- optic neuropathies; +/- drooping eyelid; red eye; +/- retinal haemorrhages;+/- >60 yo; Investigation: MR angiogram- what does it show?", "LeadsTo":"73", "UID":" 3000122", "Image":"NONE" }], "Running Differentials": [ { "differential":"Thyroid eye disease (Grave's opthalmopathy)" }, { "differential":"Malignancy/ Tumor (lymphoma, 2ary to prostate cancer), infections (poorlt controlled diabetic)" }, { "differential":"Orbital apex lesions Orbital apex syndrome: Orbital fractures, Orbital malignancy (usually lymphoma), Inflammation (Sarcoidosis, GPA, PAN), Infection (orbital cellulitis watch for fungal in diabetics), granuloma" } ] } } , { "50": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Disparity since early childhood; Investigation: Nil/ examination of childhood photos ", "LeadsTo":"76", "UID":" 3000128", "Image":"NONE" }, { "SymptomName":"Hx of orbital surgery", "LeadsTo":"95", "UID":" 3000129", "Image":"NONE" }, { "SymptomName":"Hx of trauma; Investigation: CT orbits", "LeadsTo":"95", "UID":" 3000130", "Image":"NONE" }, { "SymptomName":"Hx of Prostaglandin eye drops (History of Glaucoma)", "LeadsTo":"77", "UID":" 3000131", "Image":"NONE" }, { "SymptomName":"Contralateral Exophthalmus, ipsilateral horners; Investigation: Use Exophthalmometer, perform cranial nerve examination", "LeadsTo":"78", "UID":" 3000132", "Image":"NONE" }], "Running Differentials": [ { "differential":"Congenital enophthalmus" }, { "differential":"Orbital expansion secondary to surgery" }, { "differential":"Blow fracture of orbital skeleton" }, { "differential":"Prostaglandin associated periorbitopathy" } ] } } , { "51": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Evidence of Cranial nerve palsies, painful ophthalmoplegia; +/- optic nerve invovlement ( _ Ishihara) optic disc swelling on direct fundoscopy ", "LeadsTo":"48", "UID":" 3000133", "Image":"NONE" }, { "SymptomName":"Diffuse Erythema and swelling of eyelid +/- surronding orbit, no rash, preauricular or anterior cervical chain lymphadenoapthy. Pyrexia. Normal ocular examintion ", "LeadsTo":"96", "UID":" 3000134", "Image":"NONE" }, { "SymptomName":"Red eye, pain, severe loss of vision +/- hx recent trauma or systemic infection, IVDU, immunosupressed; Investigations: Slit lamp examination, urgent referral to Ophthalmology ", "LeadsTo":"79", "UID":" 3000135", "Image":"NONE" }, { "SymptomName":"Dermatonally distrubuted vesicular rash +/- pyrexia +/- preauricular lymphadenopathy; Investigation: Dilated slit lamp examination", "LeadsTo":"97", "UID":" 3000136", "Image":"NONE" }, { "SymptomName":"Bilateral invovlement +/- red conjunctivia +/- recent viral illness +/- history of atopy; Investigation: Slit lamp examination", "LeadsTo":"13", "UID":" 3000137", "Image":"NONE" }], "Running Differentials": [ { "differential":"Orbital apex, Cavernous sinus syndrome" }, { "differential":"Pre septal Cellulitis" }, { "differential":"Endophthalmitis" }, { "differential":"Ophthalmic Shingles" } ] } } , { "52": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Eyelid turned outwards or inwards, aberrant eyelash growth; Investigation: Slit lamp examination ", "LeadsTo":"53", "UID":" 3000138", "Image":"NONE" }, { "SymptomName":"Droopy eyelid, Ptosis Investigation: Slit lamp examination ", "LeadsTo":"54", "UID":" 3000139", "Image":"NONE" }, { "SymptomName":"Lid retraction", "LeadsTo":"", "UID":" 3000249", "Image":"NONE" }, { "SymptomName":"Lesion on eyelid (eg swelling , redness); Investigation: Slit lamp examination", "LeadsTo":"57", "UID":" 3000140", "Image":"NONE" }, { "SymptomName":"Lid distortion (eg due to underlying lumps/ bumps)", "LeadsTo":"", "UID":" 3000000", "Image":"NONE" }], "Running Differentials": [ { "differential":"Ectropion, Entropion, Trichiasis" }, { "differential":"Lorin" }, { "differential":"" }, { "differential":"Chalazion, Styx, Blepharitis, Xanthelasma, malignancy, dacrocystitis, dacroadenititis" } ] } } , { "53": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Eyelid everted; Usually secondary to ageing or trauma ", "LeadsTo":"80", "UID":" 3000141", "Image":"NONE" }, { "SymptomName":"Eyelid inverted; Usually secondary to ageing or trauma", "LeadsTo":"80", "UID":" 3000142", "Image":"NONE" }, { "SymptomName":"Aberrant eyelash growth; Idiopathic or due to recurrent trachoma infection", "LeadsTo":"80", "UID":" 3000143", "Image":"NONE" }], "Running Differentials": [ { "differential":"Ectropion" }, { "differential":"Entropion" } ] } } , { "54": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Lesion on/in eyelid +/- eyelid swelling and/or redness; Investigation: Slit lamp examination ", "LeadsTo":"57", "UID":" 3000144", "Image":"NONE" }, { "SymptomName":"Old age, Hx of atopy, contact lens wearer, previous eyelid surgery; Investigation: Measure levator function - will be normal (measure elevation of both superior eyelid)creases from down to upgaze will both be the same)", "LeadsTo":"95", "UID":" 3000145", "Image":"NONE" }, { "SymptomName":"Ptosis +/- pupil abnormaility +/- abnormal ocular movement; Investigation: Cranial nerve examination, cover test, alternating cover test ", "LeadsTo":"55", "UID":" 3000146", "Image":"NONE" }, { "SymptomName":"Ptosis, +/- fatiguable; Associated with: muscular weakness bilateral or unilateral) invovlement; can be intermittent; Invetsigation: Full neurological examinations (peripheral + cranial nerve)", "LeadsTo":"56", "UID":" 3000147", "Image":"NONE" }, { "SymptomName":"Sunken eye or prominent eye; Investigation: Measure with Exophthalmometer ", "LeadsTo":"81", "UID":" 3000148", "Image":"NONE" }], "Running Differentials": [ { "differential":"Chalazion, Styx, Blepharitis, Xanthelasma, malignancy, dacrocystitis, dacroadenititis" }, { "differential":"Levator disinsertion" }, { "differential":"Neurogenic Ptosis, Cn III palsy, Horners syndrome, orbital apex, cavernous sinus syndrome" }, { "differential":"Myogenic Myasthenia gravis, myotonic dystrophy, Kearns sayres syndrome, glycogen storage disorders, paraneoplastic process" } ] } } , { "55": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Ptosis +/- mydriasis +/- down and out eye position; Investigation: Orthoptist review. MRI brain and orbits ", "LeadsTo":"", "UID":" 3000149", "Image":"NONE" }, { "SymptomName":"Partial Ptosis +/- miosis +/- anhidrosis; Investigation: MRI Orbtis and Brain, cervical spine and MRA carotids", "LeadsTo":"", "UID":" 3000150", "Image":"NONE" }, { "SymptomName":"Ptosis + other cranial nerve palsies; Investigation: Full cranial nerve exam. Mri brain and orbits ", "LeadsTo":"48", "UID":" 3000151", "Image":"NONE" }], "Running Differentials": [ { "differential":"Oculomotor nerve palsy" }, { "differential":"Horners syndrome" } ] } } , { "56": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Fatiguable ptosis +/- diplopia +/- bulbar/generalised muscular weakness. Can be intermittent and variable, Ptosis often worse in evenings; Investigation: Full cranial+ peripheral nervous system exam; Blood test: Thyroid autoantibodies + thyroid function tests. CT mediastinum (looking for thymoma) single fibre EMG, aceyl chol recpertor antibodies, anti musk antiboide anti striated muscle antibodies ", "LeadsTo":"", "UID":" 3000152", "Image":"NONE" }, { "SymptomName":"Bilateral non fatiguable ptosis, moyotonic facies, +/- adduction deficit ocular movments; Investigation : EMG", "LeadsTo":"", "UID":" 3000153", "Image":"NONE" }, { "SymptomName":"Young (early 20's) unilateral ptosis progressing to bilateral, worsening ophthalmoplegia (not related to cranial nerves), abnormal head posture; Investigation: MRI to exclude other causes of complex ophthalmoplegia and ptosis. Muscle biopsy showing red ragged fibres ", "LeadsTo":"82", "UID":" 3000154", "Image":"NONE" }], "Running Differentials": [ { "differential":"Myasthenia Gravis" }, { "differential":"Myotonic dystrophy" } ] } } , { "57": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Bilateral redness and swelling at eyelash insertion +/- bilateral redunant folds in eyelids +/- epiphoria; Investigation: Slit lamp examination ", "LeadsTo":"58", "UID":" 3000155", "Image":"NONE" }, { "SymptomName":"Unilateral red inflammed lump (painful); Investigation: Slit lamp examination", "LeadsTo":"59", "UID":" 3000156", "Image":"NONE" }, { "SymptomName":"Single non inflammed lump +/- pigment +/- scaling +/- indurated; Investigation: Slit lamp examination", "LeadsTo":"", "UID":" 3000157", "Image":"NONE" }, { "SymptomName":"Bilateral yellow/white plaques, non painful not itching; Investogation: Slit lamp examination potentially arcus", "LeadsTo":"84", "UID":" 3000158", "Image":"NONE" }], "Running Differentials": [ { "differential":"Blepharitis, Blepharochalasis" }, { "differential":"Styx, Dacrocysitits, Dacroadenitits, Chalazion" }, { "differential":"Melanoma, squamous cell carcinoma, basal cell carcinoma" } ] } } , { "58": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Redundant skin fold with Hx of intermittent eyelid swelling; Investigation: Slit lamp examination", "LeadsTo":"83", "UID":" 3000159", "Image":"NONE" }, { "SymptomName":"Bilateral irritated, itchy, gritty, red eyes;+/- watery / painful eye; inflamed, greasy eyelids; +/- discharge/ crust in eye lashes; +/- eyes stuck together on waking; +/- scales / flakes on eyelids/eye lashes; +/- Hx of seborrhoeic dermatitis / rosacea; Investigation: Slit lamp examination: anterior: skin flakes; posterior: blocked meboninam gland; examination of tear film; +/- look evidence of rosascia ", "LeadsTo":"34", "UID":" 3000160", "Image":"NONE" }], "Running Differentials": [ { "differential":"Blepharochalasis" } ] } } , { "59": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Painful lump with white head at lid margins; Investigation: Slit lamp examination", "LeadsTo":"85", "UID":" 3000161", "Image":"NONE" }, { "SymptomName":"Smooth lump subacute onset intermittently red and painful, not on lid margin; Investigation: Slit lamp examination", "LeadsTo":"", "UID":" 3000162", "Image":"NONE" }, { "SymptomName":"Pain + swelling inner aspect lower eyelid with associated epiphoria; Investigation: Slit lamp examination. ", "LeadsTo":"86", "UID":" 3000163", "Image":"NONE" }], "Running Differentials": [ { "differential":"Styx" }, { "differential":"Chalazion, Styx, Blepharitis, Xanthelasma, malignancy, dacrocystitis, dacroadenititis" } ] } } , { "60": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Wedge shaped area of tissue medial part of conjnctiva +/- moves onto cornea; Investigation: Slit lamp examination", "LeadsTo":"87", "UID":" 3000164", "Image":"NONE" }, { "SymptomName":"Discrete white/brown papule commonly medial part of conjunctiva between palepbral fissure; Investigation: Slit lamp examination", "LeadsTo":"88", "UID":" 3000165", "Image":"NONE" }, { "SymptomName":"White haze (with blood vessel within it) surrounding cornea; Hx of contact lens wear or long term inflammation; Investigation: Slit lamp examination", "LeadsTo":"89", "UID":" 3000166", "Image":"NONE" }, { "SymptomName":"", "LeadsTo":"", "UID":" 3000250", "Image":"NONE" }, { "SymptomName":"chemosis - presentatiob", "LeadsTo":"", "UID":" 3000251", "Image":"NONE" }], "Running Differentials": [ { "differential":"Pterygium" }, { "differential":"Pinguecula" }, { "differential":"Corneal Pannus" }, { "differential":"Racial pigmentation" } ] } } , { "61": { "Status": "", "Symptoms": [ { "SymptomName":"Sudden onset bilateral painless central homonymous heminaopia. Previous CVA, TIA, IHD, Htn, Hypercholesterolemia: Investigation: Cranial and peripheral nervous system exam. MRI brain with diffusion weighting ", "LeadsTo":"", "UID":" 3000167", "Image":"NONE" }, { "SymptomName":"Subacute painless (days to weeks) unilateral or bilateral central visual distortion +/- scotoma. Dilated slit lamp examination with OCT +/- FFA +/- ICG", "LeadsTo":"62", "UID":" 3000168", "Image":"NONE" }, { "SymptomName":"Painless unilateral or bilateral central visual deterioation +/- distortion +/- blurring (weeks to months) Dilated slit lamp examination with OCT +/- FFA", "LeadsTo":"63", "UID":" 3000169", "Image":"NONE" }, { "SymptomName":"Painful unilateral loss of vision with associated loss of colour vision. Check for RAPD, direct opthalmoscopy, Ishihiara plates ", "LeadsTo":"64", "UID":" 3000170", "Image":"NONE" }], "Running Differentials": [ { "differential":"Occipital lobe tip lesion" }, { "differential":"Leber Hereditary Optic Neuropathy, Punctate inner choroidopathy (PIC)" }, { "differential":"Age related macular degeneration, Diabetic macular oedema" } ] } } , { "62": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Myopic female (90%), 18-40 years, centrally blurred vision with floaters; Slit lamp examination - Bilateral white-yellow chorioretinal lesions usually 100-200 microns diameter FFA - early hyperfluorescence, variable late leakage/staining of acute lesions Visual fields - enlarged bliund spot (40%)", "LeadsTo":"90", "UID":" 3000171", "Image":"NONE" }, { "SymptomName":"Male (9:1) 10-30 years old intially unilateal progresing to bilateral central or cecocentral scotoma. May have family history of maternal relatives having loss of vision;Investigation: Exclude alterantive causes of optic neuropathy, genetic testing covers upto 70% population in europe T14484C and G11778A", "LeadsTo":"91", "UID":" 3000172", "Image":"NONE" }], "Running Differentials": [ { "differential":"Punctate inner chordiopathy" } ] } } , { "63": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Gradual unilateral or bilateral gradual (can be sudden) visual loss predominately visual distortion/ blurred vision; Risk factor: >50 yo; smokers; On examination: Amsler chart +/- distortion of straight lines; Investigation: Dilated slit lamp examination: multiple drusen, choroidal neovascular membrane, geographic atropy; perform OCT;+/- FFA if suspicious for a neovascular membrane.", "LeadsTo":"17", "UID":" 3000173", "Image":"NONE" }, { "SymptomName":"No signs or symptoms until very late - importance of screening; Diabetic patient (usually poorly controlled) progressive visual blurring/ distortion over weeks /months; +/- sudden deterioration if haemorrhage occurs; Investigation: Dilated slit lamp exmaination, OCT, FFA if suspcious of new vessel formation; Fundoscopy examination: Dot, blot spots (capillary wall breakdowns / microaneurysms in inner nuclear layer of retina - tightly packed so heamorrhage can't spread); +/- cotton wool spots (ischemia/ infarct of superficial retinal nerve fibres); +/- hard exudates (lipid deposits post oedema/ leakage)", "LeadsTo":"39", "UID":" 3000174", "Image":"NONE" }, { "SymptomName":"Unilateral progressive loss of central vision (days to weeks) +/- retrobulbar pain, decreased colour vision. +/- peripheral parathesiae, dizziness, Lehrmittes, uthoff pheonemna. Sponatenous improvement in symptom after 2-4 weeks of onset. Continued improvement over 6 months; Investigation: Fundoscopy, Full neurological examinations (peripheral and cranial nerve), routine inflammatory screen (crp, esr, anca) MRI brain and orbits with contrast (ideally before steroids)", "LeadsTo":"6", "UID":" 3000175", "Image":"NONE" }, { "SymptomName":"No improvement vision after 4 weeks, no pain, systemic symptoms (arthralgia, rash, myalgia, drenching night sweats) afro carribean or african american. Immunosuppresed, evidence of infection (pyrexia); Investigation : Full neurological examinations (peripheral and cranial nerve), inflammatory screen (crp, esr, anca, ACE, aNA) MRI brain and orbits with contrast (ideally before steroids) CXR", "LeadsTo":"71", "UID":" 3000176", "Image":"NONE" }], "Running Differentials": [ { "differential":"Age related macular degeneration," }, { "differential":"Diabetic macular oedema" }, { "differential":"Classic Optic neuritis (secondary to Multiple sclerosis)" } ] } } , { "65": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"History of trauma, red painful eye +/- flashing lights +/- floaters +/- photosensitvity; Investigation: Slit lamp examination. ", "LeadsTo":"95", "UID":" 3000177", "Image":"NONE" }, { "SymptomName":"Unilateral red painful eye, foreign body sensation, discharge, photosensiotvity +/- blurring of vision +/- floaters; Hx of contact lens use (especially relevant if sleeps or showers in contact lens and if has prolonge dwear (>12 hrs/day day); On penlight examination: _ Visual acuity (VA); +/- corneal opacification/ white spot; +/- circumlimbal injection (ciliary flush); fluorescein examination: +ve findingsInvestigation: Slit lamp examination.", "LeadsTo":"36", "UID":" 3000178", "Image":"NONE" }, { "SymptomName":"Unilateral sudden onset 10/10 pain with headache, nausea and vomitting; _ vision in affected eye; diffuse injected, red eye; +/- photospia. Hazy cornea with oval mid dilated pupil; +/- Antecedent Hx: headache + rainbow haloes around light in evening; Investigation: Slit lamp exmaination.", "LeadsTo":"14", "UID":" 3000179", "Image":"NONE" }, { "SymptomName":"Unilateral dull ache/bruising around orbit or back of the eye - (not helped/relieved by topical anesthetic): +/- blurred vision; +/- photophobia/ pain on reading ( white cell infiltrates in anterior chamber/ ciliary muscles causing pain as muscles constrict); +/- watery but NO discharge; +/- Hx of HLA-B27 associated conditions eg ankylising spondylitis; constituional symptoms: myalgia, arthralgia, rash; ; On examination: ciliary flush present circumlimbal (ciliary vessels visible through white sclera), +/- small irregular, poorly responsive pupil (due to ciliary muscle spams) Further investigation: slit lamp: treatment with dilated drops irregular small pupil (iris gets stuck to lens)", "LeadsTo":"13", "UID":" 3000180", "Image":"NONE" }, { "SymptomName":"Unilateral severe loss of vision with very painful red eye +/- hypopyon +/- panuveitis; Hx of recent surgery or pentrating eye trauma; +/- Hx of immunospression, HIV, IVDU, subacute bacterial endocarditis + pyrexia. Investigation: Slit lamp exmamination. ", "LeadsTo":"79", "UID":" 3000181", "Image":"NONE" }], "Running Differentials": [ { "differential":"Traumatic eye injury +/- penetration." }, { "differential":"Corneal ulcer (Keratitis)" }, { "differential":"Acute glaucoma (red flag)" }, { "differential":"Anterior Uveitis" } ] } } , { "66": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Bilateral visual loss, blackness encroaches from outer edge of vision; +/- faints. Complete restoration of sight within seconds;+/- Hx of shock, anaemia, dehydration, sudden change in postion from lying/siting to standing; Investigation: History, ECG to rule out cardiogenic syncope, DHx many drugs assoicated with postural hypotension", "LeadsTo":"", "UID":" 3000182", "Image":"NONE" }, { "SymptomName":"Bilateral visual obscuration (whiting/ greying out visual field) lasting 3-5 seconds; +/- on movement eg from bent position; +/- puslatile tinnitus (whooshing sounds); +/- pressure headache (worse in morning, frontal, excerbated by coughing or leaning forward); +/- recent weight gain +/- sleep apnoea and snoring; Investigation: Direct fundoscopy", "LeadsTo":"27", "UID":" 3000183", "Image":"NONE" }], "Running Differentials": [ { "differential":"Vasovagal" } ] } } , { "67": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Calculate ABCD2 score, refer urgently to TIA service. If not available then organise urgent carotid dopplers and start antiplatelet therapy. If young <50 withno vascular risk factors will need full thrombophilia screen, autoimmune and vasculitis screen.", "LeadsTo":"", "UID":" 3000184", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "68": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Bilateral dry watering eyes' +/- red eye; +/- frequent blinking +/- stinging +/- grittiness; visual blurring improved by blinking/ wiping eyes;+/- photophobia; +/- discharge/crust in eyelashes (particualrly towards the end of day); Associated with: blepharitis often occurs with dry eye; Investigation: Normal ocular examination, assessment of tear film with fluroscien will show poor tear film with rapid breakdown", "LeadsTo":"44", "UID":" 3000185", "Image":"NONE" }, { "SymptomName":"Unilateral/bilateral irriated, red, sore eyes; > at the lid margins/corners of the eyes; +/- discharge/ crust in eyelashes; Investigation: Slit lamp examination", "LeadsTo":"13", "UID":" 3000186", "Image":"NONE" }], "Running Differentials": [ { "differential":"Dry eye" } ] } } , { "69": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Bitemporal field loss +/- galactorrhoea +/- hypothyroid +/- erectile dysfunction; Investigation: Goldman Visual field, MRI Pituitary", "LeadsTo":"", "UID":" 3000187", "Image":"NONE" }, { "SymptomName":"Slow loss peripheral vision bilaterally, non painful, no associated symptoms; Risk factor: family Hx glaucoma (1:8 risk), age>40 yo; Investigation: Humphrey visual fields dilated fundus examiantion, OCT disc and nerve fibre layer ", "LeadsTo":"30", "UID":" 3000188", "Image":"NONE" }, { "SymptomName":"Nyctalopia, tunnel vision, progressive bilateral; Investigation: Slit lamp examination - mid peripheral 'bone spicule' retinal pigmentation, waxy pallor optic disc. ", "LeadsTo":"92", "UID":" 3000189", "Image":"NONE" }], "Running Differentials": [ { "differential":"Pituitary tumour" }, { "differential":"Primary open angle glaucoma" } ] } } , { "70": { "Status": "Investigation", "Symptoms": [ { "SymptomName":"Sudden painless unilateral altitudinal defect +/- photopsia +/- floaters;Investigation Slit lamp examination - tobacco dust and retinal detachment ", "LeadsTo":"32", "UID":" 3000188", "Image":"NONE" }, { "SymptomName":"Unilateral, sudden altitudinal defect. Investigation: Slit lamp examination ", "LeadsTo":"69", "UID":" 3000189", "Image":"NONE" }, { "SymptomName":"Sudden or subacute altitudinal field loss, often occurs overnight, occasionally painful, often inferior field defect; Investigation: Slit lamp examination Swollen disc, hypereamic +/- segemental telangectasia. Risk factors - T2DM, crowded disc, HTN or hypotension", "LeadsTo":"", "UID":" 3000190", "Image":"NONE" }, { "SymptomName":"Altitudinal field defect (commonly superotemporal) +/- metamorphosia; Investigation: Slit lamp examination - Acute - Haemorrhages (dot, blot, flame) Cotton wool spots, odeoema in distrubution of dilated tortous vein. Chronic venous sheathing, exudates, collateral vessels", "LeadsTo":"93", "UID":" 3000191", "Image":"NONE" }, { "SymptomName":"Altitudinal field defect. History of IHD, HTN, Hypercholesterleamia; Investigation: Slit lamp examination - White swollen retina alonf branch retinal arteriole,+/- cattle trucking, visvible emboli in 60%", "LeadsTo":"93", "UID":" 3000192", "Image":"NONE" }], "Running Differentials": [ { "differential":"Retinal Detachment" }, { "differential":"Branch retinal artery/ vein occlusion (BRAO, BRVO)" }, { "differential":"NAION must rule out GCA before diagnosing" }, { "differential":"Branch retinal vein occlusion (BRVO)" } ] } } , { "71": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Rash+/-arthralgia+/-myalgia+/-drenching night sweats+/-cough+/-epistaxsis+/-sinus problems+/- chondral tenderness+/- weight loss+/- lymphadeonapthy; Investigation: Full examination CVS,RS,GIT,Neurological. Full autoimmune screen (ANCA, ANA, Complement, CRP, ESR, ACE.) CXR. Potential biopsy of lesions or lymph nodes ", "LeadsTo":"", "UID":" 3000193", "Image":"NONE" }, { "SymptomName":"Headache; +/- other cranial nerve palsies; Investigation: MRI brain Full neurological exam ", "LeadsTo":"48", "UID":" 3000194", "Image":"NONE" }, { "SymptomName":"History or long term malnutrition, alcohol and tobacco use; Investigation:Slit lamp exmaition - pale optic disc", "LeadsTo":"23", "UID":" 3000195", "Image":"NONE" }, { "SymptomName":"Visual loss; +/- pyrexia; +/- sexual exposure;+/- immunosuppressed +/- foreign travel/recent immigration;+/- camping;+/- pet exposure; Investigation: Septic screen if acutely unwell (CXR, urine dip, liver us and echo) Treponemal antibodies, borrelia, bartonella, mantoux, ", "LeadsTo":"97", "UID":" 3000196", "Image":"NONE" }, { "SymptomName":"Bilateral symptoms recent vasccination or viral illness ", "LeadsTo":"97", "UID":" 3000197", "Image":"NONE" }], "Running Differentials": [ { "differential":"Autoimmune (Sarcoidosis), Vasulitis (eg SLE)" }, { "differential":"Malignancy, Oribtal apex and Saggital sinus syndromes" }, { "differential":"Toxic optic neuropathy" }, { "differential":"Cat scratch, Lyme disease, Syphilis, TB," } ] } } , { "72": { "Status": "Diagnosis", "DiagnosisUID" : " 3000025", "DiagnosisFile": "Thyroid eye disease (Grave's opthalmopathy)", "Symptoms": [ { "SymptomName":"Thyroid eye disease (Grave's opthalmopathy)", "LeadsTo":"", "UID":" 3000198", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "73": { "Status": "Diagnosis", "DiagnosisUID" : " 3000026", "DiagnosisFile": "Carotid cavernous fistula (direct/ indirect)", "Symptoms": [ { "SymptomName":"Carotid cavernous fistula (direct/ indirect)", "LeadsTo":"", "UID":" 3000199", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "74": { "Status": "Diagnosis", "DiagnosisUID" : " 3000027", "DiagnosisFile": "Cavernous sinus syndrome (thrombosis, aneurysm, malignancy)", "Symptoms": [ { "SymptomName":"Cavernous sinus syndrome (thrombosis, aneurysm, malignancy)", "LeadsTo":"", "UID":" 3000200", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "75": { "Status": "Diagnosis", "DiagnosisUID" : " 3000028", "DiagnosisFile": "Cavernous sinus, inflammatory, Tolosa Hunt syndrome", "Symptoms": [ { "SymptomName":"Cavernous sinus, inflammatory, Tolosa Hunt syndrome", "LeadsTo":"", "UID":" 3000201", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "76": { "Status": "Diagnosis", "DiagnosisUID" : " 3000029", "DiagnosisFile": "Congenital enophthalmus", "Symptoms": [ { "SymptomName":"Congenital enophthalmus", "LeadsTo":"", "UID":" 3000202", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "77": { "Status": "Diagnosis", "DiagnosisUID" : " 3000030", "DiagnosisFile": "Prostaglandin associated periorbitopathy", "Symptoms": [ { "SymptomName":"Prostaglandin associated periorbitopathy", "LeadsTo":"", "UID":" 3000203", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "78": { "Status": "Diagnosis", "DiagnosisUID" : " 3000031", "DiagnosisFile": "Pseudoenophthalmus", "Symptoms": [ { "SymptomName":"Pseudoenophthalmus", "LeadsTo":"", "UID":" 3000204", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "79": { "Status": "Diagnosis", "DiagnosisUID" : " 3000032", "DiagnosisFile": "Endophthalmitis ", "Symptoms": [ { "SymptomName":"Endophthalmitis ", "LeadsTo":"", "UID":" 3000205", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "80": { "Status": "Diagnosis", "DiagnosisUID" : " 3000033", "DiagnosisFile": "Ectropion, Entropion, Trichiasis", "Symptoms": [ { "SymptomName":"Ectropion, Entropion, Trichiasis", "LeadsTo":"", "UID":" 3000206", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "81": { "Status": "Diagnosis", "DiagnosisUID" : " 3000034", "DiagnosisFile": "Pseudoptosis", "Symptoms": [ { "SymptomName":"Pseudoptosis", "LeadsTo":"", "UID":" 3000207", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "82": { "Status": "Diagnosis", "DiagnosisUID" : " 3000035", "DiagnosisFile": "Kearns - Sayres", "Symptoms": [ { "SymptomName":"Kearns - Sayres", "LeadsTo":"", "UID":" 3000208", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "83": { "Status": "Diagnosis", "DiagnosisUID" : " 3000036", "DiagnosisFile": "Blepharochalasis", "Symptoms": [ { "SymptomName":"Blepharochalasis", "LeadsTo":"", "UID":" 3000209", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "84": { "Status": "Diagnosis", "DiagnosisUID" : " 3000037", "DiagnosisFile": "Xanthelasma ", "Symptoms": [ { "SymptomName":"Xanthelasma ", "LeadsTo":"", "UID":" 3000210", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "85": { "Status": "Diagnosis", "DiagnosisUID" : " 3000038", "DiagnosisFile": "Styx", "Symptoms": [ { "SymptomName":"Styx", "LeadsTo":"", "UID":" 3000211", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "86": { "Status": "Diagnosis", "DiagnosisUID" : " 3000039", "DiagnosisFile": "Dacrocystitis ", "Symptoms": [ { "SymptomName":"Dacrocystitis ", "LeadsTo":"", "UID":" 3000212", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "87": { "Status": "Diagnosis", "DiagnosisUID" : " 3000040", "DiagnosisFile": "Pterygium", "Symptoms": [ { "SymptomName":"Pterygium", "LeadsTo":"", "UID":" 3000213", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "88": { "Status": "Diagnosis", "DiagnosisUID" : " 3000041", "DiagnosisFile": "Pinguecula", "Symptoms": [ { "SymptomName":"Pinguecula", "LeadsTo":"", "UID":" 3000214", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "89": { "Status": "Diagnosis", "DiagnosisUID" : " 3000042", "DiagnosisFile": "Corneal Pannus ", "Symptoms": [ { "SymptomName":"Corneal Pannus ", "LeadsTo":"", "UID":" 3000215", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "90": { "Status": "Diagnosis", "DiagnosisUID" : " 3000043", "DiagnosisFile": "Punctate inner chordiopathy", "Symptoms": [ { "SymptomName":"Punctate inner chordiopathy", "LeadsTo":"", "UID":" 3000216", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "91": { "Status": "Diagnosis", "DiagnosisUID" : " 3000044", "DiagnosisFile": "Leber Hereditary Optic Neuropathy ", "Symptoms": [ { "SymptomName":"Leber Hereditary Optic Neuropathy ", "LeadsTo":"", "UID":" 3000217", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "92": { "Status": "Diagnosis", "DiagnosisUID" : " 3000045", "DiagnosisFile": "Retinitis pigmentosa", "Symptoms": [ { "SymptomName":"Retinitis pigmentosa", "LeadsTo":"", "UID":" 3000218", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "93": { "Status": "Diagnosis", "DiagnosisUID" : " 3000046", "DiagnosisFile": "Branch retinal vein occlusion/artery occlusion (BRVO/BRAO)", "Symptoms": [ { "SymptomName":"Branch retinal vein occlusion/artery occlusion (BRVO/BRAO)", "LeadsTo":"", "UID":" 3000219", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "94": { "Status": "Diagnosis", "DiagnosisUID" : " 3000047", "DiagnosisFile": "Colour blindness", "Symptoms": [ { "SymptomName":"Colour blindness", "LeadsTo":"", "UID":" 3000220", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "95": { "Status": "Diagnosis", "DiagnosisUID" : " 3000048", "DiagnosisFile": "Orbital anatomy, trauma and surgeries(including Levator disinsertion)", "Symptoms": [ { "SymptomName":"Orbital anatomy, trauma and surgeries(including Levator disinsertion)", "LeadsTo":"", "UID":" 3000222", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "96": { "Status": "Diagnosis", "DiagnosisUID" : " 3000049", "DiagnosisFile": "Cellulitis (pre septal)", "Symptoms": [ { "SymptomName":"Cellulitis (pre septal)", "LeadsTo":"", "UID":" 3000223", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "97": { "Status": "Diagnosis", "DiagnosisUID" : " 3000050", "DiagnosisFile": "Infections ophthalmic (singles, cat scratch, lyme disease,Syphilis, TB)+ Post viral demyelination", "Symptoms": [ { "SymptomName":"Infections ophthalmic (singles, cat scratch, lyme disease,Syphilis, TB)+ Post viral demyelination", "LeadsTo":"", "UID":" 3000224", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "23": { "Status": "Diagnosis", "DiagnosisUID" : " 3000051", "DiagnosisFile": "Toxic optic neuropathy", "Symptoms": [ { "SymptomName":"Toxic optic neuropathy", "LeadsTo":"", "UID":" 3000225", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "98": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Pupil size asymmetry (aniscoria): asymmetric >0.4mm between pupils, dilated or constricted", "LeadsTo":"99", "UID":" 3000226", "Image":"NONE" }, { "SymptomName":"Bilateral small pupils (miosis) despite darken room (unresponsive/ slow to light reflex)", "LeadsTo":"", "UID":" 3000227", "Image":"NONE" }, { "SymptomName":"Bilateral dilated pupils (myadrisis) despite light room (unresponsive/ slow to light reflex)", "LeadsTo":"", "UID":" 3000228", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cranial nerve 3 palsy (Diabetes, Giant cell arteritis, Syphilis; Cerebrovascular event, Tumor) Argyll Robertson, Holmes Adie syndrome (Tonic pupil), Eye trauma/ surgery, Toxins/ pharmaceutical agents," }, { "differential":"Lorin" } ] } } , { "99": { "Status": "", "Symptoms": [ { "SymptomName":"Unilateral mydriasis (enlarged, dilated pupil - unresponsive/ slow to light reflex)", "LeadsTo":"100", "UID":" 3000229", "Image":"NONE" }, { "SymptomName":"Unilateral miosis (small, constricted pupil - even in darken rooml)", "LeadsTo":"101", "UID":" 3000230", "Image":"NONE" }, { "SymptomName":"Unilateral miyadrisis or miosis,; no other associated symptoms; no dilation lag (with exposure to light/dark); Long standing Hx of aniscori; Typically <2mm difference", "LeadsTo":"104", "UID":" 3000231", "Image":"NONE" }, { "SymptomName":"Unilateral fixed oval unresponsive mid dilated (typically 4 - 5mm in diameter)", "LeadsTo":"14", "UID":" 3000232", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cranial nerve 3 palsy (Diabetes, Giant cell arteritis, Syphilis; Cerebrovascular event, Tumor) Argyll Robertson, Holmes Adie syndrome (Tonic pupil), Eye trauma/ surgery, Toxins/ pharmaceutical agents," }, { "differential":"Eye inflammation / infection (iritis), Toxins/ pharmaceutical agents, Horner's syndrome" }, { "differential":"Physiological, congenital" } ] } } , { "100": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Mydriasis (pupil dilated, fixed to light + convergence); Ptosis (eyelid droop); +/- eye down and out; +/- dipoplia (double vision) +/- unilateral", "LeadsTo":"105", "UID":" 3000233", "Image":"NONE" }, { "SymptomName":"Mydriasis (dilated pupil); +/- unilateral; __ consensual,+ direct light reflex; +/- _ accomodation (near) reflex; +/- _ tendon reflexes; F>M", "LeadsTo":"102", "UID":" 3000234", "Image":"NONE" }, { "SymptomName":"Mydriasis, No constriction to light; Anticholinergic pupil dilated>8mm __ consensual??,+ direct light reflex, Symptomimetic drugs >1-2 mm; bilateral???", "LeadsTo":"103", "UID":" 3000235", "Image":"NONE" }, { "SymptomName":"Myadrisis, +/- irregular shape; +/- _direct light reflex, consensual reflex, accomodation (near) reflex; NO ptosis; +/- no dipoplia", "LeadsTo":"95", "UID":" 3000236", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cranial nerve 3 palsy (mydriasis due to parasympathetic fibre compression vascular (diabetes, atherosclerosis, aneurysm) ; motor fibre damage to eye position - Multiple Scelrosis, Trauma, Autoimmune diseases, Myastenia gravis, Thyroid eye disease, Space occuping lesion" }, { "differential":"Holmes Adie syndrome" }, { "differential":"Topical medications antiparasympathetic drugs eg atropine, tropicamide); symptomimetics (adrenaline phenylephrine; autonomic drugs scopolaime; anticholinergic drugs (eg ipatropium); plants containing anticholinergic properties eg jimson weed" } ] } } , { "101": { "Status": "Presentation", "Symptoms": [ { "SymptomName":"Miosis (pupil constriction), worse in dark; +/- dilation lag >15-20s to light response; +/- partial ptosis (upper eyelid droop) _ palpebral fissure; +/- hemifacial anhidrosis (absence of sweating); misois/palpebral fissure droop partly reversed by apraclonidine", "LeadsTo":"106", "UID":" 3000237", "Image":"NONE" }, { "SymptomName":"Miosis, +/- pain, red eye; +/- Hx of surgery trauma; +/- Hx of drugs/toxins", "LeadsTo":"", "UID":" 3000238", "Image":"NONE" }, { "SymptomName":"Miosis (small pupil); +/- unreactive to light but constricts to accomodation: +/- bilateral", "LeadsTo":"107", "UID":" 3000239", "Image":"NONE" }, { "SymptomName":"Eye drifts upwards; +/- vertical dipoplia; +/- headed tilted to one side + chin tuked in to compensate; +/- often noticed on going down stairs (Cranial nerve IV)", "LeadsTo":"95", "UID":" 3000240", "Image":"NONE" }, { "SymptomName":"Horizontal dipoplia on looking out; +/- limited abduction of affected eye ", "LeadsTo":"108", "UID":" 3000241", "Image":"NONE" }], "Running Differentials": [ { "differential":"Horner's syndrome" }, { "differential":"Ocular problmes (iritis, iridocyclitix, ocular surgery pseudofoliation syndrome), toxins/ drugs (pilocarpine drugs)" }, { "differential":"Argyll Roberston (neurosyphilis)" }, { "differential":"Trauma to orbit (damage to the Trochlear nerve)" } ] } } , { "102": { "Status": "", "Symptoms": [ { "SymptomName":"Holmes Adie syndrome", "LeadsTo":"", "UID":" 3000242", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "103": { "Status": "", "Symptoms": [ { "SymptomName":"Drugs (Topical medications antiparasympathetic drugs=, symptomimetics anticholinergic drugs", "LeadsTo":"", "UID":" 3000243", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "104": { "Status": "Diagnosis", "DiagnosisUID" : " 3000052", "DiagnosisFile": "Physiological, congenital myadrisis/miosis", "Symptoms": [ { "SymptomName":"Physiological, congenital myadrisis/miosis", "LeadsTo":"999", "UID":" 3000244", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "105": { "Status": "Diagnosis", "DiagnosisUID" : " 3000053", "DiagnosisFile": "Cranial nerve 3 palsy", "Symptoms": [ { "SymptomName":"Cranial nerve 3 palsy", "LeadsTo":"999", "UID":" 3000245", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "106": { "Status": "Diagnosis", "DiagnosisUID" : " 3000054", "DiagnosisFile": "Horner's syndrome", "Symptoms": [ { "SymptomName":"Horner's syndrome", "LeadsTo":"999", "UID":" 3000246", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "107": { "Status": "Diagnosis", "DiagnosisUID" : " 3000055", "DiagnosisFile": "Argyll Roberston (neurosyphilis)", "Symptoms": [ { "SymptomName":"Argyll Roberston (neurosyphilis)", "LeadsTo":"999", "UID":" 3000247", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "108": { "Status": "Diagnosis", "DiagnosisUID" : " 3000056", "DiagnosisFile": "Cranial nerve 6 ", "Symptoms": [ { "SymptomName":"Cranial nerve 6 ", "LeadsTo":"999", "UID":" 3000248", "Image":"NONE" }], "Running Differentials": [ { "differential":"Placeholder" } ] } } , { "109": { "Status": "", "Symptoms": [ { "SymptomName":"Monocular dipoplia (double vision remains when one eye is closed)", "LeadsTo":"110", "UID":" 3000252", "Image":"NONE" }, { "SymptomName":"Binocular dipoplia (double vision with both eyes open, absent when one eye closed), ", "LeadsTo":"111", "UID":" 3000253", "Image":"NONE" }], "Running Differentials": [ { "differential":"High ametropia, astigmatism, edge effect corrective lens, abnormal cornea (scarring, oedema, altered shape) abnormal lens (cataract, lenticonus, subluxation of lens), abnormal iris." } ] } } , { "110": { "Status": "", "Symptoms": [ { "SymptomName":" Abnormal refraction", "LeadsTo":"38", "UID":" 3000254", "Image":"NONE" }, { "SymptomName":"Abnormal cornea - slit lamp examination showing scarring +/- odema +/- deposition +/-altered shape", "LeadsTo":"", "UID":" 3000255", "Image":"NONE" }, { "SymptomName":"Abnormal lens - slit lamp examination catarct, subluxation of lens (congenital -ectopic lentis or acquired history of complicated surgery)", "LeadsTo":"", "UID":" 3000256", "Image":"NONE" }, { "SymptomName":"Abnormal iris - slit lamp exmiantion - defect in iris ", "LeadsTo":"", "UID":" 3000257", "Image":"NONE" }, { "SymptomName":"Normal examination ", "LeadsTo":"", "UID":" 3000258", "Image":"NONE" }], "Running Differentials": [ { "differential":"High ametropia, astigmatism possible edge effect of contact lens" }, { "differential":"Scarring (previous trauma or infection), keratoconus," }, { "differential":"Cataract. Lenticonus. Subluxation of lens" }, { "differential":"Polycoria, peripheral iridotomy." } ] } } , { "111": { "Status": "", "Symptoms": [ { "SymptomName":"Diplopia intermittent/ variable", "LeadsTo":"112", "UID":" 3000259", "Image":"NONE" }, { "SymptomName":"Diplopia persistent.", "LeadsTo":"113", "UID":" 3000260", "Image":"NONE" }], "Running Differentials": [ { "differential":"Decompensating phoria, myasthenia, INO, GCA" } ] } } , { "112": { "Status": "", "Symptoms": [ { "SymptomName":"Intermittent but usually predictable (when fatigued) + constant pattern (eg only in the distance) orhtoptic examination - phoria with poor recovery", "LeadsTo":"", "UID":" 3000261", "Image":"NONE" }, { "SymptomName":"Intermittent diplopia variable pattern and severity. Fatiugable +/- ptosis +/- generalised muscular +/- bulbar weakness", "LeadsTo":"", "UID":" 3000262", "Image":"NONE" }, { "SymptomName":"Diplopia only noticed during saccade (quick conjugage eye movement betwenn two points of fixation)", "LeadsTo":"", "UID":" 3000263", "Image":"NONE" }, { "SymptomName":"Intermittent diplopia +/- visual loss +/- temporal pain +/- jaw/tongue claudications +/- history of polymyalgia Rheumatica ", "LeadsTo":"", "UID":" 3000264", "Image":"NONE" }], "Running Differentials": [ { "differential":"Decompensation Phoria" }, { "differential":"Myasthenia Gravis" }, { "differential":"INO" } ] } } , { "113": { "Status": "", "Symptoms": [ { "SymptomName":"Horizontal dipoplia on looking out; +/- limited abduction of affected eye (Cranial nerve V1)", "LeadsTo":"", "UID":" 3000265", "Image":"NONE" }, { "SymptomName":"Eye drifts upwards; +/- vertical//torsional dipoplia; +/- headed tilted to one side + chin tuked in to compensate; +/- often noticed on going down stairs (Cranial nerve IV)", "LeadsTo":"", "UID":" 3000266", "Image":"NONE" }, { "SymptomName":"Mixed dipoplia (+/- +/- eye down and out); +/- ptosis +/- pupillary abnormasl dilation", "LeadsTo":"", "UID":" 3000267", "Image":"NONE" }, { "SymptomName":"Complex diplopia not following above patterns - will need imaging (MRI)", "LeadsTo":"", "UID":" 3000268", "Image":"NONE" }, { "SymptomName":"Generally unilateral (rarely can be bilateral) proptosis, + painful dipoplia/ophthalmoplegia; +/- visual loss; +/- ocular/conjunctival congestion; On examination: +/- CNV1 (ophthalmic), CNV2 (maxillary branch), _ or absent corneal reflex; +/- sympathetic disturbance (Horners) as sympathetic fibren join the abducens nerve whilst it runs through cavernous sinus); Investigation: MRI of orbits with contrast; Blood tests: autoimmune/vasculitis screen", "LeadsTo":"114", "UID":" 3000123", "Image":"NONE" }, { "SymptomName":"diplopia + pain wil need MRI", "LeadsTo":"", "UID":" 3000269", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cranial nerve VI palsy causes vascular (diabetes, hypertension, atherosclerosis, Pontine stroke ), Infections/ inflammations increased ICP, Giant cell arteritis, Wernickes encephalopathy), Trauma, Autoimmune (Multiple Sclerosis, Sarcoidosis) Neoplastic (Gliomas)" }, { "differential":"Cranial nerve IV lesion" }, { "differential":"Cranial Nerver III lesions" }, { "differential":"brainstem lesions (infectious, inflammatory, vascular,infiltrative), orbital pathology, myasthenia gravis , mechanical lesions, CVA" }, { "differential":"Cavernous sinus syndrome" } ] } } , { "114": { "Status": "", "Symptoms": [ { "SymptomName":"Generally unilateral (rarely can be bilateral) proptosis; Hx of infection (sinus, orbital cellulitis, midface) fever+ malaise precede neurology; Unilateral eye swellling/ oedema spreads to other eye within 24 - 48 hrs (via intercavernous sinuses; +/- painful ophthamoplegia; +/- retrobulbar pain; +/- dropping upper eyelid; +/- sharp and progressing headache around CNV 1/2 (ophthamimic/ maxiallary) area;. Investigation: MRI Orbtis and Brain", "LeadsTo":"74", "UID":" 3000124", "Image":"NONE" }, { "SymptomName":"Slow progressive painful ophthalmoplegia, dipoplia; Past medical Hx of malignancy; +/- signs of other endocrinopathie + bitemporal hemianopia if pituitary adenoma; Investigation: MRI brain and orbits with contrast ", "LeadsTo":"74", "UID":" 3000125", "Image":"NONE" }, { "SymptomName":"Most often unilateral proptosis; __ retroorbitla/periorbital pain -'boring' pain; +/- dipoplia painful ophthamaplegia; Symptoms of vasculitis or autoimmune conditions; Constitutional symptoms, myalgia, arthralgia, epistaxsis, rash; Investigation: Full autoimmune/ vasculitis screen", "LeadsTo":"75", "UID":" 3000126", "Image":"NONE" }], "Running Differentials": [ { "differential":"Cavernous sinus thrombosis" }, { "differential":"Cavernous sinus malignancy" } ] } } ] ,"Differentials": { "NONE": "NONE" } } }