[Haisook]

I tend to mix up between those 3, especially when not enough information is given in the question. Are there any defining features (symptoms, local exam, fundus exam) that would tell them apart, so that one can be completely sure of the right choice? :notsure:

 

[pakbrain]

patient with acute angle closure galucoma tends to present with nausea , vomiting and sudden painful loss of vision , pupil is oval , fixed and semi dilated , and anterior chamber is shallow and on gonioscopy there ll be angle closure

patient with optic neuritis will also present with sudden painful loss of vision but mostly central vision is affected due to central scotoma as compared to papilloedema where eventually complete blindness sets in , there ll be hyperemia and blurring of optic disc margin , vessels will be dilated and tortous , cotton wool spots or exudates might be evident ,

patient with orbital cellulitis will have marked swelling of both lids , there ll be vision loss but not as much as compared to above 2 , there ll be diplopia and i hope this info ll be helpful to u

 

[Mondoshawan]

One thing sort of unique to optic neuritis is loss of color vision, I think...

 

[tkourkou]

A unique feature of acute angle closure glaucoma is that the eye is "rock-hard", with fixed, dilated pupil, with conjuctival hyperemia and the patient sees hues around the objects.

 

[Haisook]

Thanks for your input. Here I'll try to list the most specific "keywords" to each disease (as UW really tries to confuse you about these, and I'm assuming the real exam will too).

• Acute closure-angle glaucoma: "rock hard eye".
• Optic neuritis: color vision affection/blindness, blurring of the optic disc margins.
• Orbital cellulitis: proptosis, diplopia (?)

I'm going to update it if we come up with other specific criteria.

 

[1TA2B]

that's useful!

3 confusing differential diagnoses-particularly first 2 can be difficult to differentiate-painful loss of vision is common feature

 

[Salvia]

more for orbital cellulitis: decreased motility, chemosis

and a nice case report: http://webeye.ophth.uiowa.edu/eyeforum/cases/103-Pediatric-Orbital-Cellulitis.htm

 

[ag2011n]

This is really good topic, let me just add little & put every thing together.

• Acute closure-angle glaucoma: Sudden, painful red eye, "rock hard", fixed mid-dilated pupil not reactive to light. Seeing halos around the lights. Sudden decrease vision.
• Optic neuritis & papillitis: inflammation of the optic nerve: sudden painful loss of vision (may be unilateral or bilateral) color vision affection/blindness, blurring of the optic disc margins. Always remember multiple sclerosis here.
• Orbital cellulitis: infection of the soft tissues of the orbit posterior to the orbital septum. Pain. Proptosis, ophthalmoplegia, diplopia and edema,erythema of the eyelids & decreased eye motility.