This document defines and describes phthisis bulbi, a condition where the eye shrinks and its contents become disorganized due to severe injury or disease damage. It outlines the causes of phthisis bulbi, including trauma, infection, inflammation, surgery, retinal detachment, and malignancy. A grading system is proposed based on clinical features, from atrophy without shrinkage to phthisis bulbi with intraocular ossification or calcium deposition. Signs, symptoms, pathophysiology, diagnosis, and management are discussed, with management focusing on alleviating pain and cosmetic rehabilitation rather than restoring vision.

1. PHTHISIS BULBI
ELIAST
JUDO-RESIDENT

2. OUTLINE
• Definition
• Causes
• Grading
• Pathophysiology
• Diagnosis
• Management

3. DEFINITION AND INTRODUCTION
• Phthisis bulbi is defined as atrophy, shrinkage, and disorganization of the eye and
intraocular contents
• Clinical condition representing end-stage ocular response to severe eye injury or disease
damage
• Not all eyes rendered sightless by trauma become phthisical
• A mnemonic rule used to describe phthisis bulbi is ''7S" referring to :
Soft - Shrunken - Shapeless - Sightless - Structureless - Squared - Sore.

4. CAUSES
• Trauma
• Infection
• Inflammations
• Surgery
• RD
• Malignancy
• Vascular causes

5. GRADING
Yanoff and Fine proposed the following descriptive grading system based on
clinicopathological features:
• Grade I : Atrophy bulbi without shrinkage
• Grade II : Atrophia bulbi with shrinkage
• Grade III : Atrophia bulbi with shrinkage and disorganization (phthisis bulbi)
• Grade IV : Phthisis bulbi with intraocular ossification
• Grade V : Phthisis bulbi with intraocular calcium deposition

6. ATROPHIA BULBI WITHOUT
SHRINKAGE.
• The size and shape of the eye are maintained despite the atrophy of intraocular tissues.
• The following structures are most sensitive to loss of nutrition
• The lens, which becomes cataractous;
• The retina,which atrophies and becomes separated from RPE by serous fluid
accumulation;
• The aqueous outflow tract, where anterior and posterior synechiae develop

7. ATROPHIA BULBI WITH
SHRINKAGE
• The eye becomes soft because of ciliary body dysfunction and progressive reduction of
IOP.
• The globe becomes smaller and assumes a squared-off configuration as a result of the
influence of the 4 EOM
• The anterior chamber collapses.
• Associated corneal endothelial cell damage initially results in corneal edema, followed by
opacification with degenerative pannus, stromal scarring, and vascularization.
• Most of the remaining internal structures of the eye will be atrophic but recognizable
histologically

8. PHTHISIS BULBI
• The size of the globe shrinks from normal average diam of 23–25 mm to an average diam
of 16–19 mm.
• Most of the ocular contents become disorganized.
• In areas of preserved uvea the RPE proliferates, and nodular drusen may develop.
• In addition, extensive dystrophic calcification of the Bowman layer, lens, retina, and drusen
usually occurs.
• Osseous metaplasia of the RPE with bone formation may be a prominent feature.
• Finally, the sclera becomes markedly thickened, particularly posteriorly

10. PATHOPHYSIOLOGY
• The major factors associated with the pathogenesis of phthisis are ocular hypotony,
deranged blood-ocular barriers, and intraocular inflammation.
• Hypotony causes alteration of oxygenation, nutrition and metabolism,
• Breakdown of the ocular blood barrier of the plasma proteins and release of cytokines,
chemotactic & angiogenetic factors

11. DIAGNOSIS
Physical examination
• Phthisical eyes can usually be easily detected by inspection of the patient’s face
• Diagnosis is simplified due to the unilaterality of the disease
• With asymmetry of the eyeballs and interpalpebral fissures.

12. SIGNS
• Microphthalmos
• Enophthalmos
• Lagophthalmos
• Reduced eyelid fissure
• Strabismus
• Conjunctival chemosis and hyperemia
• Corneoscleral scarring, thickening, vascularization, dystrophic
calcification and shrinkage
• Flattening of the anterior chamber with a narrow to closed
chamber angle
• Hypotony
• Neovascularization of the iris and chamber angle (rubeosis
iridis)
• Intraocular inflammation (uveitis/endophthalmitis)
• Synechia (peripheral/posterior)
• Cyclitic/epiretinal membranes (fibrous/fibrovascular)
• Cataract formation
• Phacodonesis (anterior displacement of the ciliary body)
• Choroidal or/and retinal detachment
• Epiretinal membranes
• Choroidal/ciliary body, retinal, and optic nerve
degeneration/atrophy
• Intraocular hemorrhages
• Dystrophic calcification and heterotopic ossification

13. SYMPTOMS
• vision loss
• blurry vision
• floaters
• photophobia
• ocular pain
• redness
• periorbital edema
• visual loss

14. MANAGEMENT
• Treatment approach for a phthisic eye is often futile,
• Mainly aims at alleviating ocular pain and at cosmetic rehabilitation of the affected eye
• Not to restore vision.
• It can be removed, a procedure called enucleation of the eye.
• Sometimes, though, it is possible to transplant only parts of the eye, and some vision can
be restored.

15. REFERENCE
• https://eyewiki.aao.org/Phthisis_bulbi
• AAO_BCSC_2020_2021_4_Ophthalmic_pathology_and_intraocular_tumor