9 Can’t-Miss Diagnoses - American Academy of Ophthalmology

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MAY 13, 2017

9 Can’t-Miss Diagnoses

By Purnima S Patel, MD, Evan Silverstein, MD

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You can save eyeballs, vision and lives if you know these diseases.

Compiled by Purnima S. Patel, MD, and Evan Silverstein, MD.

1. Sebaceous carcinoma
This is not a chalazion, but a potentially lethal cancer. Do not I&D this lesion. Perform a wide excision with sentinel conjunctival biopsies.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

Begin Slideshow

2. Macula-on rhegmatogenous retinal detachment
Complete a careful fundus examination to avoid missing this diagnosis. By definition, it’s in the periphery. Once you confirm the diagnosis, get the surgical retina service involved right away!
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

3. Giant cell arteritis
With anterior ischemic optic neuropathy in someone older than 50, you should always rule out giant cell arteritis (GCA). If the patient has GCA, s/he needs urgent treatment with steroids. You can start treatment before you take a temporal artery biopsy.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

4. Open globe
A peaked pupil points toward an open-globe injury. Rule out intraocular foreign body with a CT-orbits. B scan is contraindicated!
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

5. Endophthalmitis
Tap the anterior chamber or vitreous and give empiric intravitreal antibiotics. In severe cases, plan a vitrectomy.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

6. Acute third nerve palsy
Signs of palsy include ptosis, dilated pupil and an eye that is down and out. Rule out an intracranial aneurysm at the posterior communicating artery with a CTA or MRA, especially if this involves the pupil.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

7. Acute retinal necrosis
This condition presents as retinal whitening in a patient with pain, photophobia, decreased vision and floaters. Urgent treatment with systemic and/or intravitreal antivirals is essential.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

8. Retrobulbar hemorrhage
Patients can have ophthalmoplegia, relative afferent pupillary defect, decreased vision, very high IOP and tight lids. Save vision with an emergent canthotomy and cantholysis.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.

9. Pituitary apoplexy
Depending on severity, signs/ symptoms include multiple cranial nerve (CN) palsies (consider a visual field defect from CN II palsy), severe headache and altered mental status. Get a brain/pituitary MRI.
Image courtesy of AAO, Purnima S. Patel, MD, and Evan Silverstein, MD.
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YO Info

The American Academy of Ophthalmology's newsletter for young ophthalmologists (YOs) — those in training as well as in their first few years in practice.

YO Info Editorial Board

Evan Silverstein, MD — Chair
Sruthi Arepalli, MD
Grayson W. Armstrong, MD
Liane O. Dallalzadeh, MD
Cherie A. Fathy, MD
Bradley S. Henriksen, MD
L. Claire Peterson, FRCOphth, MBBS
Dagny C. Zhu, MD

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