Differential Diagnosis: Causes of Symblepharon

Image from: University of Iowa, EyeRounds.org.

Symblepharon is an external eye finding in which an adhesion forms between the palpebral conjunctiva and bulbar conjunctiva.1  There are many causes of symblepharon, which is typically a response to trauma or inflammation.  In no particular order, here are some of those causes:

  • Ocular cicatricial pemphigoid
  • Pseudopemphigoid conditions
  • Stevens-Johnson syndrome
  • Trauma
  • Conjunctival burns
  • Atopic keratoconjunctivitis
  • Porphyria cutanea tarda
  • Rosacea
  • Epidemic keratoconjunctivitis
  • Xeroderma pigmentosum
  • Squamous papilloma of the conjunctiva

If anyone has a good mnemonic to help remember these causes, let us know!  If you’re studying for the OKAP or board exams, a sample question may look like this:

  1. Which of the following does NOT cause the condition shown below?
    1. Ocular cicatricial pemphigoid
    2. Stevens-Johnson syndrome
    3. Vernal keratoconjunctivitis
    4. Porphyria

The answer, of course, is C.  (Image credit:  mrcophth.com)

References and Additional Reading

  1. Basic and Clinical Science Course, Section 8:  External Disease and Cornea.  American Academy of Ophthalmology, 2015.

Do you have any other hints to help remember causes of symblepharon?  Did we leave anything out?  Do you have suggestions or ideas for other topics?  Leave a comment or e-mail us at:  ophthreview [at] gmail [dot] com!

The 7 Causes Of Tunnel Visual Fields

There are relatively few causes for tunnel visual fields (or “gun barrel” visual fields), which is a relatively common finding in neuro-ophthalmology.  There are 7 major categories of tunnel visual fields, which can be determined systematically through careful history and examination.  This differential diagnosis is adopted from Duane’s Clinical Ophthalmology.

2 Retinal Causes of Tunnel Fields

  • Retinitis Pigmentosa and RP-like conditions
  • Peripheral retinal scarring and degeneration (includes PRP scarring)

3 Optic Nerve Causes of Tunnel Fields

  • End-stage Glaucoma
  • End-stage Papilledema (post-papilledema optic atrophy)
  • End-stage Optic Nerve Drusen

1 Intracranial Cause of Tunnel Fields (Bilateral)

  • Bilateral Occipital Lobe Infarcts With “Macular Sparing”

Functional Vision Loss


Glaser J.  Chapter 5.  Topical Diagnosis:  Prechiasmal Visual Pathways.  In:  Duane’s Clinical Ophthalmology.  In:  Tasman W, Jaeger EA, eds.  Duane’s Ophthalmology on CD-ROM, 6th Ed.  Lippincott William & Wilkins, 2005.

Do you have any tips for how to remember this differential?  Leave a comment!

Causes of Leukocoria: CREAM PIGMENT

A child with esotropia and left leukocoria from retinoblastoma.  Image from Wikipedia.

There are TONS of causes of leukocoria (white pupil).  But this can be a very important differential, as it can be the presenting sign of some sight-threatening and life-threatening conditions (most obviously retinoblastoma).  Because of its clinical importance, it is essential to be able to not only recognize what it is, but to also have a decent differential diagnosis so that you don’t miss out on any key causes when conducting a history and physical.

Given the sizable list of causes (a very short list is listed on the AAPOS website), I created a mnemonic that I could at least use to recall at least 3-5 (or more) causes of leukocoria.  The mnemonic is “Leukocoria looks like CREAM PIGMENT“:

  • Coats / Coloboma / Cataract
  • Retinoblastoma / Retinal dysplasia / Retinoma / ROP / Retinal fold
  • Endophthalmitis
  • Astrocytic hamartoma / Anisometropia
  • Myelinated NFL
  • PFV
  • Incontinentia pigmenti / Inflammation (uveitis)
  • Granuloma
  • Melanoma / Myopia / Medulloepithelioma
  • FEVR
  • Norrie
  • Trauma / Toxocariasis

What do you think?  Do you have any other tips on how to remember the differential for leukocoria?  Leave a comment!