DDx 2 Eye Complaints / Facial Pain (Quiz 1)

what is the most common cause of loss of central vision?

cataracts

what are causes of loss of central vision?

cataracts and retinal detachment

what are causes of loss of peripheral vision?

glaucoma and retinitis pigmentosa

what is glaucoma?

buildup of pressure in anterior chamber before canal of schlemm

what population is retinitis pigmentosa?

younger people

what are some symptoms of retinitis pigmentosa?

poor night vision, patients often present as “clumsy” or “accident prone”

what is usually a acute loss of vision due to?

vascular issue, trauma

what are conditions that cause chronic loss of vision?

macular degeneration and presbyopia

what may cause flashes of light?

migraines or vitreoretinal traction

what may cause halos around light?

glaucoma, corneal disease

what can cause transient loss of vision?

amaurosis fugax, MS and papilledema

what is amaurosis fugax?

thrombus in retinal artery

what does the patient describe with amaurosis fugax?

a “curtain goes up” when thrombus resolves

what causes monocular diplopia?

cataracts (unilateral) and refractive error

what causes binocular diplopia?

vascular, tumor, myasthenia gravis, MS

what causes distorted vision?

migraine and macular degeneration

what is trigeminal neuralgia also known as?

tic douloureux

how is trigeminal neuralgia pain described?

as 12/10 and patients may be suicidal

what divisions are typically impacted by trigeminal neuralgia?

mandibular and maxillary

what does glossopharyngeal neuralgia relate to?

swallowing and movement of pharynx

what is spenopalatine galngioneuralgia?

brain freeze or ice cream headache

what can cause dry gritty eye?

hyperthyroidism or sjögren’s syndrome

what can cause retro-orbital eye pain?

headache and tumor

if a patient is saying they have short, sharp recurrent face pain, what is likely?

neuralgias

if a patient reports they have deep dull pain that is worse with bending forward or with atmospheric changes, what facial pain cause are we thinking?

sinusitis

if a patient has pain radiating from the front of the ear to the opening of the mouth what is the likely diagnosis?

TMJ dysfunction

if a patient reports they have pain with chewing or hot/cold food, what is the likely cause?

dental problems or brain freeze

how does acute-angle closure glaucoma present?

severe pain, halos around light, blurred unilateral vision, nausea and vomiting

what percent of glaucoma cases is acute-angle closure glaucoma?

less than 10%

how will a senior present with acute-angle closure glaucoma?

will present with eye redness, cloudy looking cornea and possibly hyperopic

what is the etiology of acute angle closure glaucoma?

blockage of outflow of aqueous humor from the anterior chamber increasing pressure and pain

how does a patient describe the symptoms of open angle glaucoma?

the peripheral field of vision has been cut (usually the nasal half)

how does open angle glaucoma usually present?

bilaterally

when are patients often predisposed to open angle glaucoma?

after past eye surgery or trauma

what is dry age related macular degeneration?

slowly develops, painless, central vision loss

what is wet age related macular degeneration?

sudden, painless loss of vision caused by neovascularization

what is the leading cause of blindness in old people?

age related macular degeneration

what are the fundoscopic findings of age related macular degeneration?

drusen (yellow spots), hemorrhages, exudates

what population does retinitis pigmentosa affect?

children and young adults

what tpe of condition is retinitis pigmentosa?

hereditary

what is retinitis pigmnetosa?

dark pigmentation of central retina, yellow waxy disc observed on fundoscopy

how does a patient with amaurosis fugax present?

over the age of 50 and complain of vision loss (unilateral) that lasts just a few minutes

patients with amaurosis fugax often have a concurrent history of what?

diabetes, hypertension or smoking

upon evaluation, a patient with amaurosis fugax may have what?

ipsilateral carotid bruit

a fundoscopic exam on a patient with amaurosis fuggax may reveal what?

signs of hypertensive retinopathy

what is the treatment for amaurosis fugax?

anti-platelet therapy

a patient with optic neuritis complains of what?

abrupt unilateral loss of central vision

what is optic neuritis?

inflammation of the optic nerve usually due to demyelinating disorders or secondary to infection

which infections may lead to optic neuritis?

mumps, measles, influenza, varicella virus, meningitis

what is the treatment for optic neuritis?

oral prednisone

how does a patient with temporal arteritis present?

> 50, complains of unilateral temporal headache, generalized trunk muscle ache, and sudden vision loss

what is temporal arteritis?

generalized vasculitis affecting small and medium sized arteries

what will be revealed in evaluation of a patient with temporal arteritis?

jaw claudication, elevated C reactive protein and ESR

what is the treatment for temporal arteritis?

referral for corticoseroids

how does retinal detachment present?

sudden onset of central vision loss with a history of trauma

what may patients with retinal detachment complain of?

floaters or flashing lights in vision if there is not central loss

what is a retinoblastoma?

genetic deletion of long arm of chromosome 13 leading to deterioration of vision, red or irritated eyes, strabismus

what is the treatment for retinoblastoma?

enucleation and or chemo

how do cluster headaches present?

patient is a middle aged male that complains of pain over the orbit that is “clustering” over days or weeks

what is the average duration of cluster headaches?

30 minutes

what do patients with cluster headaches commonly have a history of?

smoking and or alcohol abuse

what will be revealed on evaluation in a patient with a cluster headache?

nasal lacrimation during attacks, horner’s syndrome, beats head against walls for relief

what is the treatment of cluster headaches?

similar to that of migraines