ocular manifestations of disease

Acute onset of sectoral or diffuse eye redness, mild irritation, tenderness, or foreign-body sensation, normal vision, and superficial vessels that move over the sclera and blanch with topical phenylephrine

Episcleritis

Severe, deep boring or piercing eye pain that may awaken the patient from sleep and worsens with extraocular movements, accompanied by deep scleral injection with a bluish/violet hue and scleral tenderness

Anterior Scleritis

Deep ocular pain with decreased or blurred vision, pain with eye movement, possible proptosis, diplopia, optic disc edema, or T-sign on ultrasound, with a relatively normal-appearing external eye

Posterior Scleritis

Eye pain, prominent photophobia, red eye with ciliary flush, blurred vision, a constricted or irregular pupil (miosis/synechiae), and inflammatory cells and flare in the anterior chamber on slit-lamp exam

Anterior Uveitis

Floaters and decreased vision with minimal or no eye pain or redness

Intermediate/severe Posterior Uveitis

Sudden, painless, transient monocular vision loss lasting seconds to minutes, often described as a curtain or shade coming over the eye, with complete visual recovery

Amaurosis Fugax

Sudden, severe, persistent, painless monocular vision loss, relative afferent pupillary defect (RAPD / Marcus Gunn pupil), and fundoscopy showing diffuse retinal whitening with a cherry-red spot at the fovea and attenuated boxcarring retinal arteries

Central Retinal Artery Occlusion (CRAO)

Variable, painless vision loss with sectoral retinal hemorrhages, dilated tortuous veins, macular edema, and cotton-wool spots restricted to a single retinal sector or quadrant

Branch Retinal Vein Occlusion (BRVO)

Sudden, extensive, painless vision loss in all four quadrants with diffuse intraretinal hemorrhages giving a blood and thunder appearance, dilated tortuous retinal veins, cotton-wool spots, and optic disc/macular edema

Central Retinal Vein Occlusion (CRVO)

Asymptomatic or mild visual blurring with funduscopic findings of microaneurysms, dot-and-blot retinal hemorrhages, yellow hard exudates, and cotton-wool spots without neovascularization

Nonproliferative Diabetic Retinopathy (NPDR)

Progressive vision loss, floaters, or sudden severe visual decline due to neovascularization at the optic disc or retina, vitreous hemorrhage, and tractional retinal detachment

Proliferative Diabetic Retinopathy (PDR)

Asymptomatic retinal arteriolar narrowing, copper wiring (reddish-brown increased light reflex of arterioles), and AV nicking (thickened arteriole compressing an underlying vein)

Mild to Moderate Hypertensive Retinopathy

Flame-shaped hemorrhages in the superficial nerve fiber layer, cotton-wool spots, hard exudates, and optic disc edema (papilledema) in the setting of severe hypertension

Severe Hypertensive Retinopathy

Usually asymptomatic microvascular retinal changes in an advanced HIV patient showing cotton-wool spots, retinal hemorrhages, and microaneurysms

HIV Retinopathy

Floaters, flashes, blurred vision, or visual field loss in an immunocompromised patient (CD4 < 50 cells/mm³) with fundoscopy demonstrating yellow-white retinal necrosis and hemorrhage (pizza pie or cheese and ketchup appearance)

Cytomegalovirus (CMV) Retinitis

Retinal hemorrhages with or without cotton-wool spots in the setting of severe reduction in hemoglobin level

Retinal Manifestations of Anemia

Retinal hemorrhages secondary to severely low platelet counts

Retinal Manifestations of Thrombocytopenia

Retinal hemorrhages, cotton-wool spots, pale-centered Roth spots, and potential leukemic infiltrates

Retinal Manifestations of Leukemia

Peripheral retinal vascular occlusion leading to salmon-patch hemorrhages, black sunburst lesions, and peripheral neovascularization

Retinal Manifestations of Sickle Cell Disease

Retinal hemorrhages featuring pale or white central centers (Roth spots) in a patient with systemic bacteremia or fever

Infective Endocarditis (Roth Spots)

Acute or subacute unilateral vision loss, pain with eye movement, marked loss of color vision (red desaturation), RAPD, central visual field defect, and transient visual worsening with elevated temperature (Uhthoff phenomenon)

Optic Neuritis

Proptosis, upper eyelid retraction or lid lag, dry/gritty ocular irritation, conjunctival chemosis/injection, and restricted extraocular movements causing diplopia in a patient with thyroid disease

Thyroid Eye Disease (Graves Ophthalmopathy)

Bilateral elevated and swollen optic discs with blurred disc margins, venous congestion, and peripapillary hemorrhages accompanied by headaches, nausea, transient visual obscurations, and pulsatile tinnitus secondary to elevated intracranial pressure

Papilledema

Involuntary, rhythmic horizontal or torsional eye oscillations accompanied by vertigo that decrease with visual fixation

Peripheral Nystagmus

Involuntary, rhythmic eye oscillations that may be vertical, torsional, or direction-changing, not suppressed by visual fixation, and often accompanied by central neurologic deficits

Central Nystagmus

Age-related progressive difficulty focusing on near objects requiring reading material to be held farther away, while distance vision remains normal

Presbyopia