Ocular Differential Diagnosis Eighth Edition Ocular Differential Diagnosis



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THICKENED EYELIDS
1. Trachoma

2. Multiple chalazia

*3. Chronic conjunctivitis

*4. Blepharitis-lid margins thickened

5. Tarsitis-rare, such as in syphilis or tuberculosis

6. Trisomy (E syndrome)

7. Congenital hypothyroidism

8. Pheochromocytoma, medullary thyroid carcinoma, and neurofibromatosis


Baum JL, Adler ME. Pheochromocytoma, medullary thyroid carcinoma, and multiple mucosal neuroma. Arch Ophthalmol 1972; 87:574-584.
Gellis SS, Feingold M. Atlas of mental retardation. Washington, DC: US Government Printing Office, 1968.
BLEPHAROPHIMOSIS (SHORT PALPEBRAL FISSURE)
1. Blepharochalasis

2. Blepharofacioskeletal syndrome

3. Blepharophimosis-amenorrhea syndrome (blepharophimosis, ptosis, epicanthus inversus syndrome)

4. Carpenter syndrome (acrocephalopolysyndactyly II)

5. Clefting syndrome with anterior chamber and lid anomalies

6. Craniocarpotarsal syndrome (Freeman-Sheldon syndrome; whistling face syndrome)

7. Down syndrome (trisomy 21, mongolism)

8. Dubowitz syndrome

9. 18P syndrome

10. Kaufman oculocerebrofacial syndrome

11. Klein-Waardenburg syndrome

12. Komoto syndrome (congenital eyelid tetrad)

13. Marden-Walker syndrome

14. Meyer-Schwickerath and Weyers syndrome

15. Michel syndrome

*16. Microphthalmos

17. Mohr syndrome (orofaciodigital syndrome II)

18. Mohr syndrome

19. Oculopalatoskeletal syndrome

20. Ohdo blepharophimosis syndrome

21. Pena-Shokeir type II syndrome

22. Progeria (Hutchinson-Gilford syndrome)

23. Rieger syndrome (dysgenesis mesostromalis)

24. Ring chromosome in the D group (13-15) (ring D syndrome)

25. Schonenberg syndrome (dwarf cardiopathy syndrome)

26. Schwartz-Jampel syndrome (osteochondromuscular dystrophy)

27. Simosa syndrome

28. Syndrome of blepharophimosis with myopathy

*29. Traumatic

30. Trisomy (E syndrome) (Edward syndrome)

31. Waardenburg syndrome (embryonic fixation syndrome)

32. Young-Simpson syndrome

33. X-linked mental retardation syndrome

34. 3p- syndrome

35. 10q- syndrome
Bonthron DT, et al. Parental consanguinity in the blepharophimosis, heart defect, hypothyroidism, mental retardation syndrome (Young-Simpson syndrome). J Med Genet 1993; 30:255-256.
Melnyk AR. Blepharophimosis, ptosis, and mental retardation: further delineation of Ohdo syndrome. Clin Dysmorphol 1994; 3:121-124.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Suri M, et al. Blepharophimosis, telecanthus, microstomia, and unusual ear anomaly Simosa syndrome in an infant. Am J Med Genet 1994; 51:222-223.
EURYBLEPHARON
Euryblepharon is defined as a horizontally elongated palpebral aperture (normal, 30 mm) and may be associated with ectropion and present in other family members.
1. Excessive tension of skin

2. Defective separation of the lids

3. Excessive pull of the platysma

*4. Localized displacement of the lateral canthi

5. Hypoplasia of tarsus
Feldman E, et al. Euryblepharon: a case report with photographs documenting the condition from infancy to adulthood. J Pediatr Ophthalmol Strabismus 1980; 17:307-309.
Gupta AK, et al. Euryblepharon. J Pediatr Ophthalmol 1972; 9:173-174.
McCord CD, et al. Congenital euryblepharon. Ann Ophthalmol 1979; 11:1217-1224.
LID COLOBOMA
1. Amniogenic band syndrome (amniotic bands-Streeter anomaly)

2. Epidermal nevus syndrome

3. Facial c1efting syndrome (Tessier syndromes)

4. Fraser syndrome

5. Frontonasal dysplasia syndrome

6. Goldenhar syndrome (oculoauriculovertebral dysplasia)

7. Miller syndrome

8. Nager syndrome

9. Nevus sebaceous of Jadassohn (linear sebaceous nevus syndrome)

10. Palpebral coloboma-lipoma syndrome

*11. Traumatic

12. Treacher Collins-Franceschetti syndrome (mandibulofacial dysostosis)


Braude LL, et al. Ocular abnormalities in the amniogenic band syndrome. Br J Ophthalmol 1981; 65:299-303.
Burch JV, et al. Ichthyosis hystrix (epidermal nevus syndrome) and Coats' disease. Am J Opthalmol 1980; 89:25-30.
Isenberg SJ. The eye of infancy. Chicago: Year Book Medical, 1989.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
NECROSIS OF EYELIDS
1. Drugs, including the following:

acenocoumarol

amphotericin B

anisindione

dicumarol

diphenadione

ethyl biscoumacetate

nafcillin

phenindione

phenprocoumon

tobramycin

warfarin

*2. Mechanical, electrical, or thermal trauma

3. Periorbital cellulitis-periorbital necrotizing cellulitis

4. Secondary to infection


Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.
Scott PM, Bloome MA. Lid necrosis secondary to streptococcal periorbital cellulitis. Ann Ophthalmol 1981; 13:461.
POLIOSIS (WHITENING OF HAIR, EYEBROWS, AND EYELASHES)
1. Albino

2. Alopecia areata

*3. Aging

4. Drugs, including the following:



amodiaquine

betamethasone

chloroquine

cortisone

cyclosporin A

dexamethasone

epinephrine

fluorometholone

hydrocortisone

hydroxychloroquine

medrysone

prednisolone

thiotepa

5. Leprosy (Hansen disease)

6. Radiation therapy

7. Rubinstein-Taybi syndrome

8. Severe dermatitis

9. Stress

*10. Unknown etiology

11. Vitiligo

12. Vogt-Koyanagi-Harada syndrome (uveitis-vitiligo-alopecia-poliosis syndrome)

13. Waardenburg syndrome (embryonic fixation syndrome)

14. Werner syndrome (progeria of adults)
Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.
Rosner F. Can hair turn white overnight? JAMA 1981; 246:2324.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Walsh FB, Hoyt WF. Clinical neuro-ophthalmology, 4th ed. Baltimore: Williams & Wilkins, 1985.
TRICHOMEGALY (LONG LASHES)
1. Associated with cataract and hereditary spherocytosis

2. Congenital with pigmentary retinal degeneration, dwarfism, and mental retardation

3. Cyclosporine induced

4. De Lange syndrome (congenital muscular hypertrophy-cerebral syndrome)

5. Ectodermal dysplasia (Curtius syndrome)

6. Human immunodeficiency virus (HIV)

7. Hypertrichosis (hirsutism)

8. Isolated adrenal malfunction and ovarian atrophy

9. Noonan syndrome (male Turner syndrome)

*10. Normal

11. Oliver-McFarlane syndrome

12. Rubinstein-Taybi syndrome (broad thumbs syndrome)

13. Schwartz syndrome
Chang TS, et al. Congenital trichomegaly, pigmentary degeneration of the retina and growth retardation Oliver-McFarlane syndrome year follow-up of the first reported case. Can J Ophthal 1993; 28:191-193.
Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
McKusick VA. Mendelian inheritance in man, 12th ed. Baltimore: Johns Hopkins University Press, 1998.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
MADAROSIS (LOSS OF EYELASHES)
1. Chronic skin diseases, including psoriasis, neurodermatitis, exfoliative dermatitis, ichthyosis, alopecia areata, acne, lichen planus, epidermolysis bullosa, lupus erythematosus, acanthosis nigricans, dermatophytosis, hereditary ectodermal dysplasia syndrome and acrodermatitis

2. Congenital atrichia

3. Cryptophthalmos

4. Cutaneous T cell lymphoma

5. Demodicosis

6. Drugs, including the following:




acebutolol(?)

acenocoumarin(?)

acetazolamide(?)

acetohexamide(?)

acid bismuth sodium tartrate

actinomycin C(?)

alcohol(?)

allopurinol(?)

aluminum nicotinate

amantadine(?)

aminopterin(?)

aminosalicylate(?)

aminosalicylic acid(?)

amiodarone(?)

amithiozone(?)

amitriptyline(?)

amodiaquine(?)

amoxapine(?)

amphetamine(?)

anisindione(?)

aspirin(?)

atenolol(?)

auranofin(?)

aurothioglucose(?)

aurothioglycanide(?)

azathioprine(?)

benzphetamine(?)

betaxolol

bishydroxycoumarin(?)

bismuth oxychloride(?)

bismuth sodium tartrate(?)

bismuth sodium thioglycollate(?)

bismuth sodium triglycollamate(?)

bismuth subcarbonate(?)

bismuth subsalicylate(?)

bleomycin(?)

broxyquinoline(?)

busulfan(?)

cactinomycin

captopril(?)

carbamazepine(?)

carbimazole(?)

carmustine

CCNU


chlorambucil(?)

chloroquine(?)

chlorphenterrnine(?)

chlorpropamide(?)

cimetidine(?)

cisplatin

clofibrate(?)

clomiphene(?)

clonazepam(?)

colchicine(?)

cyclophosphamide(?)

cytarabine(?)

dacarbazine

dactinomycin(?)

danazol(?)

daunorubicin

desipramine(?)

dextroamphetamine(?)

dextrothyroxine(?)

diacetylmorphine(?)

DIC

dichlorphenamide(?)



dicumarol(?)

diethylcarbamazine

diethylpropion(?)

diltiazem(?)

diphenadione(?)

divalproex sodium(?)

doxepin(?)

doxorubicin

dromostanolone(?)

droperidol(?)

enalapril(?)

epinephrine

ergonovine(?)

ergotamine(?)

ethionamide(?)

ethotoin(?)

ethoxzolamide(?)

ethyl biscoumacetate(?)

etretinate(?)

fenfluramine(?)

fenoprofen(?)

flecainide(?)

floxuridine(?)

fluorouracil(?)

fluoxymesterone(?)

gentamicin

glyburide

glycopyrrolate(?)

gold au 198

gold sodium thiomalate(?)

gold sodium thiosulfate(?)

guanethidine(?)

haloperidol(?)

HCNU


heparin(?)

hydroxychloroquine(?)

hydroxyurea(?)

ibuprofen(?)

imipramine(?)

indomethacin(?)

interferon(?)

iodochlorhydroxyquin(?)

iodoquinol(?)

isotretinoin(?)

ketoprofen(?)

labetalol(?)

levobunolol

levodopa(?)

lithium carbonate(?)

lomustine

maprotiline(?)

mechlorethamine(?)

melphalan(?)

mephenytoin(?)

methamphetamine(?)

methazolamide(?)

methimazole(?)

methotrexate(?)

methylergonovine(?)

methylthiouracil(?)

methysergide(?)

metoprolol(?)

mexiletine(?)

mianserin(?)

minocycline(?)

minoxidil(?)

mitomycin

mitotane(?)

morphine(?)

nadolol(?)

naltrexone(?)

naproxen(?)

niacin(?)

niacinamide(?)

nicotinyl alcohol(?)

nifedipine(?)

nitrofurantoin(?)

nortriptyline(?)

opium(?)

oral contraceptives(?)

oxprenolol(?)

paramethadione(?)

penicillamine(?)

phendimetrazine(?)

phenindione(?)

phenmetrazine(?)

phenprocoumon(?)

phentermine(?)

pindolol(?)

pipobroman(?)

piroxicam

prazosin(?)

procarbazine(?)

propranolol(?)

propylthiouracil(?)

protriptyline(?)

pyridostigmine(?)

ranitidine

semustine

sodium salicylate(?)

streptomycin(?)

streptozocin

sulfacetamide(?)

sulfachlorpyridazine(?)

sulfacytine(?)

sulfadiazine(?)

sulfadimethoxine(?)

sulfamerazine(?)

sulfameter(?)

sulfamethazine(?)

sulfamethizole(?)

sulfamethoxazole

sulfamethoxypyridazine(?)

sulfanilamide(?)

sulfaphenazole(?)

sulfapyridine(?)

sulfasalazine(?)

sulfathiazole(?)

sulfisoxazole

sulindac(?)

tamoxifen(?)

testolactone(?)

testosterone(?)

tetracycline(?)

thiotepa

timolol maleate

tocainide(?)

tolazamide(?)

tolbutamide(?)

triethylenemelamine(?)

trifluperidol(?)

trimethadione(?)

uracil mustard(?)

valproate sodium(?)

valproic acid(?)

verapamil(?)

vinblastine(?)

vincristine(?)

vitamin A

warfarin(?)


7. Ehlers-Danlos syndrome, unspecified type

*8. Endocrine disease, including hypothyroidism, hyperthyroidism, pituitary insufficiency, hypoparathyroidism, and pituitary necrosis syndrome (Simmonds-Sheehan syndrome)

9. Following eyelid tattooing

10. Generalized hypotrichosis

11. HIV (human immunodeficiency virus)

12. Hypocalcemia

13. Hypothermal injury

*14. Idiopathic

15. Inflammation and infection of the lids, including seborrheic blepharitis, squamous blepharitis, herpes zoster, sebaceous gland carcinoma, vaccinia, mycotic infection, furuncles, and erysipelas

16. Intoxication with arsenic, bismuth, thallium, gold, quinine and vitamin A

17. Isolated madarosis

18. Keratosis decalvans

19. Keratosis follicularis

20. Keratosis spinulosa

21. Lid colobomas

22. Leprosy

23. Lipoid proteinosis (Urbach-Wiethe syndrome)

24. Polymorphous light eruption

25. Pseudoprogeria syndrome

26. Radiation

27. Severe debilitating systemic diseases, including tuberculosis, syphilis, sickle cell anemia, cholera, and Hansen disease (leprosy)

28. Trauma

29. Vogt-Koyanagi-Harada disease (uveitis-vitiligo-alopecia-poliosis syndrome)


Extracted Table Madarosis (loss of eyelashes)
Dana MR, et al. Ocular manifestations of leprosy in a noninstitutionalized community in the United States. Arch Ophthalmol 1994; 112:626-629.
Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 200l.
Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
DISTICHIASIS (ACCESSORY ROW OF LASHES GROWING FROM OPENINGS OF MEIBOMIAN GLAND)
1. Acquired

A. Chemical

B. Immunologic

C. Physical

*2. Congenital

A. Anodontia-hypotrichosis syndrome

B. Distichiasis, lymphedema syndrome

C. Ectropion and distichiasis

D. Idiopathic eyelid edema

E. Pierre Robin syndrome

F. Tristichiasis

3. Hereditary-autosomal dominant


Fraunfelder FT, Roy FH. Current ocular therapy, 5th ed. Philadelphia: WB Saunders, 2000.
Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
Kolin T, et al. Hereditary lymphedema and distichiasis. Arch Ophthalmol 1991; 109:980-982.
Temple IK, Collin JR. Distichiasis-lymphoedema syndrome: a family report. Clin Dysmorphol 1994; 3:139-142.
COARSE EYEBROWS

1. Congenital hypothyroidism (cretinism)

2. CPD syndrome (chorioretinopathy and pituitary dysfunction)

3. Hunter syndrome [mucopolysaccharidosis (MPS II)]

4. Hurler syndrome (MPS I)

*5. Normal variation

6. Rubinstein-Taybi syndrome (broad thumbs syndrome)

7. Sanfilippo syndrome (MPS III)


Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
SYNOPHRYS (CONFLUENT EYEBROWS EXTENDING TO MIDLINE)
1. Basal cell nevus syndrome (Gorlin syndrome)

2. Cornelia De Lange syndrome (congenital muscular hypertrophy-cerebral syndrome)

3. Deletion 3p syndrome

4. Duplication 3q syndrome

5. Frontometaphyseal dysplasia

6. Hirschhorn-Cooper syndrome (chromosome partial deletion syndrome)

7. Labard syndrome

*8. Normal variation

9. Partial trisomy chromosome 15

10. Smith-Lemli-Opitz syndrome (cerebrohepatorenal syndrome)

11. Thirteen trisomy syndrome (Patau syndrome)

12. Waardenburg syndrome (interoculoiridodermatoauditive dysplasia)


Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Smith DW. Recognizable patterns of human malformation. Philadelphia: WB Saunders, 1970.
HERTOGH SIGN (LACK OF OUTER THIRD OF EYEBROWS)
1. Autonomic nervous system dysfunction

2. Diphtheria

*3. Endocrinopathies

4. Hypogonadism

5. Hypothyroidism

6. Neurodermatitis

7. Scleroderma (systemic scleroderma)
Pau H. Differential diagnoses of eye diseases, 2nd ed. New York: Thieme Medical, 1988.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
LID MYOKYMIA (SPONTANEOUS FASCICULAR EYELID TREMOR WITHOUT MUSCULAR ATROPHY OR WEAKNESS)
*1. Not associated with organic disease

A. Fatigue

B. Lack of sleep

C. Bright light dazzle



D. Irritative corneal or conjunctival lesions

E. Debility or anemia

F. Excessive alcohol or smoking

G. Overwork

2. Followed by spastic paretic facial contracture-in dorsal pons in adult and children

3. Multiple sclerosis (disseminated sclerosis)

4. Trigeminal neuralgia

5. Myasthenia gravis (pseudoparalytic syndrome)

6. Familial occurrence

7. Autosomal dominant familial dystonia


Fraunfelder FT, Roy FH. Current ocular therapy, 5th ed. Philadelphia: WB Saunders, 2000.
PRESEPTAL CELLULITIS OF EYELID
1. Eczema

*2. Hordeolum

3. Neonatal conjunctivitis

4. Otitis media

5. Sinusitis

6. S. aureus

7. Toxic shock syndrome

8. Trauma

9. Upper respiratory tract

10. Varicella


Brower MF, et al. Preseptal cellulitis complicated by toxic shock syndrome. Arch Ophthalmol 1987; 105: 1631-1632.
Weiss A, et al. Bacterial periorbital and orbital cellulitis in childhood. Ophthalmology 1983; 90:195- 203.
TELECANTHUS (DISPROPORTIONATE INCREASE IN DISTANCE BETWEEN MEDIAL CANTID; MEASUREMENTS IN INFANTS ARE 18 TO 22 MM)
*1. Primary

2. Secondary-may occur secondarily to an increased distance between the bony orbits (see hypertelorism)

A. Aarskog syndrome

B. Blepharonasofacial syndrome

C. Blepharophimosis syndrome

D. Camptomelic dysplasia

E. Carpenter syndrome

F. Cerebrofacioarticular syndrome of van Maldegem

G. Coffin-Lowry syndrome

H. de Lange syndrome

I. Deletion 5g syndrome

J. Dubowitz syndrome

K. Facial-renal acromesomelic syndrome

L. Faciooculoacousticorenal syndrome

M. Fetal alcohol syndrome

N. Fetal hydantoin syndrome

O. Frontonasal dysplasia

P. Lambotte syndrome

Q. KBG syndrome (initials of family studied)

R. Michel syndrome

S. Nasopalpebral lipoma-coloboma syndrome

T. Oculodentodigital syndrome

U. Orofaciodigital (OFD) type I and type II (Mohr syndrome)

V. Prader-Willi syndrome

W. Rieger syndrome

X. Simosa syndrome

Y. Tetra-X syndrome

Z. Trisomy syndrome

AA. Toriello-Carey syndrome

BB. Trauma

CC. Waardenburg syndrome

DD. Williams syndrome

EE. 5p- syndrome (Cri-du-chat)

FF. 10q- syndrome

GG. Fetal hydantoin syndrome


Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
Suri M, et al. Blepharophimosis, telecanthus, microstomia, and unusual ear anomaly (Simosa syndrome) in an infant. Am J Med Genet 1994; 51:222-223.
Tasman W, Jaeger E, eds. Duane's clinical ophthalmology. Philadelphia: JB Lippincott, 1990.
ANKYLOBLEPHARON (PARTIAL OR COMPLETE FUSION OF UPPER TO

LOWER EYELIDS)
*1. Ablepharon, macrostomia syndrome

2. Ankyloblepharon ectodermal dysplasia, cleft lip and palate

3. Curly hair, ankyloblepharon, nail dysplasia syndrome (CHANDS)

4. Cryptophthalmos (complete fusion of lids)

5. Diphtheritic conjunctivitis

6. Ectodermal syndrome

7. Edward syndrome

8. Fraser syndrome

9. Gastrointestinal anomalies

10. Hay-Wells ectodermal pterygium syndrome

11. Popliteal pterygium syndrome

12. Smallpox

13. Trachoma

14. Trisomy 18

15. Ulcerative blepharitis
Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
Roy FH. Ophthalmic surgery: approaches by the masters. Philadelphia: Lea & Febiger, 1995.
FLARING OF NASAL PART OF EYEBROW

1. Blepharonasofacial syndrome

2. Partial trisomy 10q syndrome

*3. Waardenburg syndrome

4. Williams syndrome
Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
HIGH ARCHED BROW
1. Kabuki makeup syndrome

2. Shprintzen-Goldberg syndrome


Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
ABSENT BROW HAIR
1. Cryptophthalmos

2. Duplication 14q syndrome

3. Pallister-Killian syndrome

4. Pseudoprogeria syndrome


Isenberg SJ. The eye in infancy. Chicago: Year Book Medical, 1989.
TRICHIASIS (INWARD TURNING LASHES)
*1. Inflammation/infection

A. Chronic blepharitis

B. Herpes simplex or zoster

C. Trachoma

2. Lid Tumors

A. Basal cell carcinoma

B. Capillary hemangioma

C. Conjunctiva amyloidosis

3. Medications

A. Epinephrine

B. Idoxuridine

C. Phospholine iodide

D. Pilocarpine

E. Practolol

F. Trifluridine

G. Vidarabine

4. Systemic/Immunologic Disorders

A. Erythema multiforme

B. Ocular cicatricial pemphigoid

C. Stevens-Johnson syndrome

D. Toxic epidermal necrolysis

E. Vernal kertoconjunctivitis

5. Trauma

A. Chemical injury (lye)

B. Mechanical injury or repair of injury

(1) Lower lid transconjunctival approach for floor fracture repair or blepharoplasty



(2) After enucleation

(3) After ectropion repair

(4) Thermal bums to face/lids

C. Surgery


Byrnes GA. Congenital distichiasis. Arch Ophthalmol 199l; 109:l752-l753.
Foster CS. Cicatricial pemphigoid. Trans Am Ophthalmol Soc 1986; 84:527-663.
Roy FH. Ophthalmic surgery: approaches by the masters. Philadelphia: Lea & Febiger, 1995.
Udell IJ. Trifluridine-associated conjunctival cicatrization. Am J Ophthalmol 1976; 82:117-l21.

3

Lacrimal System
CONTENTS
Dacryoadenitis 110

Acute 110

Chronic 110

Diagnostic table 112

Mikulicz syndrome-Diagnostic table 113

Painless enlargement of lacrimal gland 111

Painful enlargement of lacrimal gland 111




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