Pseudo-ophthalmology is the study of conditions that mimic eye diseases but have different underlying causes. The document discusses various "pseudo" conditions that resemble other true conditions, such as pseudoptosis resembling ptosis, pseudoproptosis resembling proptosis, and pseudopapilledema resembling papilledema. For each pseudo condition, the document provides the defining features and potential underlying causes that differentiate it from the true condition it mimics. In total, over 30 different pseudo-conditions are defined and compared to their true namesakes in the field of ophthalmology.

1. Pseudo-Ophthalmology !Pseudo-Ophthalmology !
By
Dr.Ahmed Alsherbiny
MSc. Ophth, FICO , FRCS Ophth (Glasg(

2. Chapter I

3. Pseudoptosis
A condition resembling ptosis, due to abnormalities other than those found in
the eyelid elevator muscles
Causes:
 Ipsilateral hypotropia  Enopthalmos  Dermatochalasis  Double elevator
palsy  Brow ptosis  Blepharospasm  Contralateral lid retraction 
Contralateral exopthalmos

4. Ptosis
is a drooping or falling of the upper eyelid
Causes:
 Myogenic Neurogenic  Mechanical  Apponeurotic (Involutional(

5. Pseudoproptosis
refers to the false impression of proptosis
Causes:
 Ipsilateral large globe (Buphthalmos/Myopia(  Ipsilateral lid retraction 
Shallow orbit  Facial asymmetry  Contralateral ptosis  Contralateral
enophthalmos

6. Proptosis
abnormal protrusion or displacement of an eye
Causes: (VEIN(
 Vascular  Endocrinal  Inflammatory  Neoplastic

7. Pseudopapilledema
(Optic Disc Drusen(
represent apparent optic disc swelling that simulates some features of
papilledema but is secondary to an underlying, usually benign process.
Other causes:
• Tilted optic disc • Peripapillary myelinated nerve fibres • Crowded disc
in hypermetropia

8. Pseudoexfoliation
a systemic disease with primarily ocular manifestations characterized by
deposition of whitish-gray protein on the lens, iris, ciliary epithelium, corneal
endothelium, zonule and trabecular meshwork.

9. True exfoliation
Superficial zonular lamella of the capsule splits off from the deeper layer. Is
caused by heat from glassblowing or infrared radiation exposure in the anterior
lens capsule.

10. Pseudophakia
The term pseudophakia refers to having an artificial lens implanted after the
natural eye lens has been removed

11. Phakia
The presence of the natural crystalline lens of the eye.
LOOK AGAIN!!

12. Pseudo-Strabismus
refers to a false appearance of strabismus caused by an optical illusion
Remember : Pseudo-esotropia in Myopia due to negative angle kappa
)angle formed by pupillary axis and visual axis at the pupil(
Pseudo-exotropia in Hypermetropia due to positive angle kappa

13. Pseudo Foster Kennedy
The presence of pallor in one eye and disc edema in the contralateral eye in the
absence of an intracranial mass is called pseudo-Foster Kennedy syndrome. Our
patient's presentation is consistent with bilateral sequential NAION, which is the
most common cause of pseudo-Foster Kennedy syndrome

14. Foster Kennedy Syndrome
True Foster Kennedy syndrome is the combination of papilledema in one eye and
pallor in the other eye due to a large mass lesion causing compressive optic
neuropathy and increasing intracranial pressure. True Foster Kennedy syndrome is
very rare, and is typically caused by an olfactory groove meningioma or frontal lobe
tumors

15. Orbital
pseudotumor
also known as Idiopathic Orbital
Inflammatory Syndrome )IOIS( is is an
uncommon disorder characterized by non-
neoplastic, non-infective, space occupying
orbital infiltration with inflammatory
features. The process may preferentially
involve any or all of the orbital soft tissues.

16. Pseudotumor cerebri
is a condition in which the pressure around your brain increases, causing
headaches and vision problems. The name means “false brain tumor”
because its symptoms are similar to those caused by brain tumors. It's also
known as idiopathic intracranial hypertension

17. Pseudoxanthoma elasticum (PXE(
also known as Grönblad–Strandberg syndrome, is a genetic disease that causes
fragmentation and mineralization of elastic fibers in some tissues. The most
common problems arise in the skin and eyes, and later in blood vessels in the
form of premature atherosclerosis.

18. Pseudogerontoxon
In vernal keartoconjunctivitis , develop in recurrent limbal disease. It is
characterized by a paralimbal band of superficial scarring resembling arcus
senilis

19. Gerontoxon (arcus senilis(

20. Pseudoptrygiym
appears similar clinically but is caused by a band of conjunctiva adhering to
an area of compromised cornea at its apex. It forms as a response to an
acute inflammatory episode such as a chemical burn, corneal ulcer
)especially if marginal(, trauma and cicatrizing conjunctivitis.
A pseudopterygium is classically distinguished by both location away from
the horizontal )though this may also be seen with true pterygia( and firm
attachment to the cornea only at its apex )head(.

21. Pseudopolycoria
In Iridocorneal endothelial )ICE( , Progressive )essential( iris atrophy is
characterized by severe iris changes including corectopia )pupil
malposition( , pseudopolycoria )supernumerary false pupil(, ectropion
uveae, iris atrophy of varying severity

22. Pseudotrichiasis
The constant rubbing of the lashes on the cornea in long-standing entropion

23. Pseudohypopyon
B- Emusified Silicon in AC C- Phacolytic Glaucoma D- psuedohypopyon and
iris nodules in retinoblastoma

24. Pseudohypopyon
Pseudohypopyon formed by crystalline steroid following intravitreal
triamcinolone injection

25. Pseudohypopyon
Pseudohypopyon formed by in leukemia

26. Pseudohypopyon
In Best Macular dystrophy , Stage 3 ; RPE break leads to accumulation of
yellow substance in subretinal space

27. Pseudoenophthalmos
may be caused by a small or shrunken eye (microphthalmos or phthisis
bulbi), by ptosis, or by contralateral proptosis or pseudoproptosis

28. Pseudomembrane
consist of coagulated exudate adherent to the inflamed conjunctival
epithelium. They can be peeled away leaving the underlying epithelium
intact.

29. True membrane
involve the superficial layers of the conjunctival epithelium so that
attempted removal leads to tearing. The distinction between a true
membrane and a pseudomembrane is rarely clinically helpful and both can
leave scarring following resolution
Causes include severe adenoviral conjunctivitis, gonococcal and some
other bacterial conjunctivitides (Streptococcus spp., Corynebacterium
diphtheriae), ligneous conjunctivitis and Stevens–Johnson syndrome.

30. Macular Pseudohole
This lesion mimics the clinical appearance of a FTMH, but is caused by
distortion of the perifoveal retina into heaped edges by ERM, without any
loss of retinal tissue, and near-normal foveal thickness; there is a central
defect in the membrane. VMT may be present.

31. Pseudo Graefe’s Sign
In III CN palsy, Aberrant regeneration may follow acute traumatic and
compressive, but not vascular, third nerve palsies ; elevation of the upper
eyelid on attempted adduction or depression (the pseudo-Graefe or pseudo-
von Graefe phenomenon), are caused by misdirected regenerating axons
that re-innervate the incorrect extraocular muscle.

32. Von Graefe’s Sign
Failure of the upper lid to follow a downward movement of the eyeball when
the patient changes his or her vision from looking up to looking down.

33. Pseudo Argyll Robertson pupil
In III CN palsy, Aberrant regeneration may follow acute traumatic and
compressive, but not vascular, third nerve palsies ; pupillary constriction
(Pseudo-Argyll Robertson Pupil) when the patient moved the eye by muscles
normally innervated by cranial nerve III

34. Argyll
Robertson
pupil
are bilateral small pupils that reduce
in size on a near object (i.e., they
accommodate), but do not constrict
when exposed to bright light (i.e.,
they do not react to light). They are a
highly specific sign of neurosyphilis

35. Pseudoepithelium
Posterior polymorphous corneal dystrophy
The pathological basis involves metaplasia of endothelial cells.
Multilayering of endothelium (pseudoepithelium)

36. Pseudo INO
In ocular myasthenia with defect at adduction

37. Pseudo Retinitis Pigmentosa

38. Pseudo VI CN palsy

39. Pseudodendrites
Acanthamoeba keratitis
aBrasions
Contact lenses
Drugs

40. Pseudoepitheliomatous Hyperplasia
Pseudoepitheliomatous hyperplasia (PEH) is a benign proliferation of the
conjunctival or corneal epithelium that occurs in response to inflammatory
conditions such as vernal keratoconjunctivitis (VKC)

41. Thank You