Differentials
Ischaemic optic neuropathy
SIGNS / SYMPTOMS
Ischaemic optic neuropathy is infrequently associated with intra-retinal haemorrhages and retinal thickening.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Retinal detachment (RD)
SIGNS / SYMPTOMS
Patients usually report photopsias and/or floaters.
Examination demonstrates an RD.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Choroidal neovascularisation (CNV)
SIGNS / SYMPTOMS
Examination demonstrates sub-retinal or sub-retinal pigment epithelium haemorrhage in addition to signs of diseases associated with CNV (e.g., age-related macular degeneration, pathological myopia, ocular histoplasmosis).
Intra-retinal and vitreous haemorrhages are infrequently related to CNV.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Central retinal artery occlusion
SIGNS / SYMPTOMS
Venous pathology, intra-retinal haemorrhages, and macular oedema infrequently seen on examination.
Affected retina is whitened.
Cilioretinal artery sparing and/or foveal sparing may be seen.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Branch retinal artery occlusion
SIGNS / SYMPTOMS
Venous pathology, intra-retinal haemorrhages, and macular oedema infrequently seen on examination.
Affected region of retina is whitened.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Ophthalmic artery occlusion
SIGNS / SYMPTOMS
Venous pathology, intra-retinal haemorrhages, and macular oedema infrequently seen on examination.
Entire retina is whitened.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Cerebral vascular accident
SIGNS / SYMPTOMS
Infrequently associated with any posterior segment findings.
Usually associated with other neurological signs (e.g., extremity numbness or weakness, slurred speech, confusion).
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Optic neuritis
SIGNS / SYMPTOMS
Frequently associated with pain and infrequently associated with retinal haemorrhages and thickening that are restricted to a single quadrant.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Diabetic retinopathy
SIGNS / SYMPTOMS
Examination demonstrates micro-aneurysms, haemorrhages, and neovascularisation that occur on both sides of the horizontal raphe in the absence of collateral vessels.
Cotton-wool spots and nerve fibre layer haemorrhages are less frequent in diabetic retinopathy than in RVO.
INVESTIGATIONS
Fluorescein angiogram less likely to show leakage from the optic nerve head. Areas of non-perfusion are multi-focal and not limited to a single quadrant as in RVO.
Ocular ischaemic syndrome
SIGNS / SYMPTOMS
Carotid occlusive disease may be present in patient's medical history. Retinal haemorrhages and neovascularisation tend to be in the mid-periphery.
Ocular ischaemic syndrome usually either unilateral or, at least, significantly asymmetrical.
INVESTIGATIONS
Fluorescein angiogram demonstrates delayed choroidal filling. Delayed venous filling, if present, is not limited to a single quadrant.
Radiation retinopathy
SIGNS / SYMPTOMS
History of radiotherapy to head, orbits, or globes.
Examination demonstrates micro-aneurysms, haemorrhages, and neovascularisation that occur on both sides of the horizontal raphe in the absence of collateral vessels.
INVESTIGATIONS
Fluorescein angiogram does not demonstrate delayed venous filling.
Sickle cell retinopathy
SIGNS / SYMPTOMS
History of sickle cell or sickle thalassaemia disease.
Areas of neovascularisation tend to be peripheral, 'sea-fan' shaped, and self-limited.
INVESTIGATIONS
Fluorescein angiogram does not demonstrate delayed venous filling.
Hypertensive retinopathy
SIGNS / SYMPTOMS
Attenuated arterioles, arteriovenous crossing changes seen throughout the fundus, but not necessarily associated with increased venous tortuosity, dilation, and retinal thickening.
INVESTIGATIONS
Fluorescein angiogram does not demonstrate delayed venous filling.
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