Differentials
Ischemic optic neuropathy
SIGNS / SYMPTOMS
Infrequently associated with intraretinal hemorrhages and retinal thickening.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Retinal detachment (RD)
SIGNS / SYMPTOMS
Patients usually report photopsias and/or floaters.
Exam demonstrates an RD.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Choroidal neovascularization (CNV)
SIGNS / SYMPTOMS
Exam demonstrates subretinal or subretinal pigment epithelium hemorrhage in addition to signs of diseases associated with CNV (e.g., age-related macular degeneration, pathologic myopia, ocular histoplasmosis).
Intraretinal and vitreous hemorrhages are infrequently related to CNV.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Central retinal artery occlusion
SIGNS / SYMPTOMS
Venous pathology, intraretinal hemorrhages, and macular edema infrequently seen on exam.
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, intraretinal hemorrhages, and macular edema infrequently seen on exam.
Affected region of retina is whitened.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Ophthalmic artery occlusion
SIGNS / SYMPTOMS
Venous pathology, intraretinal hemorrhages, and macular edema infrequently seen on exam.
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 neurologic 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 hemorrhages and thickening that are restricted to a single quadrant.
INVESTIGATIONS
Clinical diagnosis; no differentiating tests.
Diabetic retinopathy
SIGNS / SYMPTOMS
Exam demonstrates microaneurysms, hemorrhages, and neovascularization that occur on both sides of the horizontal raphe in the absence of collateral vessels.
Cotton-wool spots and nerve fiber layer hemorrhages are less frequent in diabetic retinopathy than in RVO.
INVESTIGATIONS
Fluorescein angiogram less likely to show leakage from the optic nerve head. Areas of nonperfusion are multifocal and not limited to a single quadrant as in RVO.
Ocular ischemic syndrome
SIGNS / SYMPTOMS
Carotid occlusive disease may be present in patient's medical history. Retinal hemorrhages and neovascularization tend to be in the mid-periphery.
Ocular ischemic syndrome usually either unilateral or, at least, significantly asymmetric.
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 radiation therapy to head, orbits, or globes.
Exam demonstrates microaneurysms, hemorrhages, and neovascularization 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 thalassemia disease.
Areas of neovascularization 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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