This document discusses various eye diseases and conditions that predominantly or commonly affect women: - Orbital capillary haemangioma is more common in girls than boys. Thyroid eye disease and cavernous haemangioma also have a female preponderance. - Optic nerve glioma, optic nerve sheath meningioma, superior limbic keratoconjunctivitis, Fuchs endothelial corneal dystrophy, and episcleritis may also affect women more commonly. - Conditions like normal-tension glaucoma, primary angle closure glaucoma, pseudoexfoliation glaucoma, and retinal artery macroaneurysm have a higher prevalence in females as well.

1. ♀♀ !!
By
Ahmed Alsherbeny
M.D. , FICO , MRCSEd Ophth , FRCS Ophth (Glasg(

2. It’s much easier to understand
diseases affecting women than
understanding women themselves !!

3. Capillary haemangioma is the most common
tumour of the orbit and periorbital area in
childhood. Girls are affected more
commonly than boys (3:1).
N.B. Consider systemic associations:
Kasabach–Merritt syndrome , high-output
cardiac failure and Maffuci syndrome.

4. Thyroid eye disease is more common in females and may be
associated with other autoimmune disorders
The most common cause of both bilateral and unilateral
proptosis in an adult.
Suspect thyroid-related ophthalmopathy (TRO) in patients with
nonspecific redness and inflammation of the eyes even if there
is no history of a systemic thyroid imbalance.
The major clinical risk factor for developing TED is smoking
In TED restrictive myopathy , a rectus muscle should never be
resected but only recessed

5. Cavernous haemangioma occurs in middle-aged adults, with a
female preponderance of 70%; growth may be accelerated by
pregnancy
It is the most common orbital tumour in adults

6. Optic nerve glioma typically affects
children (median age 6.5 years); girls
more affected than boys
Approximately 30% of patients have
associated neurofibromatosis type I.
Malignant glioma (glioblastoma) is
rare, has a very poor prognosis, and
usually occurs in adult males.

7. Optic nerve sheath meningioma is a benign tumour, typically affect
middle-aged women. The prognosis for life is good in adults, although
the tumour may be more aggressive in children.
They are more common in neurofibromatosis type II (NF2).

8. Superior limbic keratoconjunctivitis (SLK) is a relatively
uncommon chronic disease of the superior limbus and the
superior bulbar and tarsal conjunctiva. It affects one or both
eyes of middle aged women, approximately 50% of whom have
abnormal thyroid function (usually hyperthyroidism)

9. Fuchs endothelial corneal dystrophy is characterized
by bilateral accelerated endothelial cell loss. It is
more common in women and is associated with a
slightly increased prevalence of open-angle glaucoma

10. Episcleritis is a common, usually idiopathic and benign,
recurrent and frequently bilateral condition. Females may be
affected more commonly than males,
It’s important to exclude a local cause for an episcleral nodule
such as a foreign body or granuloma

11. Scleromalacia perforans is a specific type of progressive
scleral thinning without inflammation that typically affects
elderly women with longstanding rheumatoid arthritis, but has
also been described in association with other systemic
disorders. Despite the nomenclature, perforation of the globe
is extremely rare as integrity is maintained by a thin layer of
fibrous tissue.

12. Normal-tension glaucoma (NTG), also referred to as low-tension or
normal-pressure glaucom . Some studies have found a higher prevalence
in females (2:1).
Neurological lesions causing optic nerve or chiasmal compression can
produce visual field defects that may be misinterpreted as
glaucomatous, and neuroimaging should be performed if there is any
suspicion; some practitioners routinely perform a cranial MRI in all
cases of NTG

13. Primary angle closure glaucoma affects
females more than males by a ratio of
4:1
The question in acute angle closure
attack .. Is it angle closure glaucoma or
not ?! . Look for another pathology .
Check the other eye

14. PEX is more common in females but males
appear to be at higher risk of developing
glaucoma
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.

15. Multiple evanescent white
dot syndrome (MEWDS (
Punctate inner choroidopathy Multifocal choroiditis and
panuveitis
White Dot Syndrome

16. Progressive subretinal
fibrosis and uveitis
syndrome (SFU (
Birdshot retinochoroidopathy
White Dot Syndrome

17. Acute zonal occult outer
retinopathy (AZOOR(
Acute macular
neuroretinopathy (AMN(
Idiopathic retinal vasculitis,
aneurysms and neuroretinitis
syndrome (IRVAN(
Miscellaneous Posterior Uveitis

18. Melanocytoma (magnocellular naevus) is a rare, distinctive, unilateral,
heavily pigmented congenital hamartoma seen most frequently in the
optic nerve head but that may arise anywhere in the uvea.
In contrast to choroidal melanoma, melanocytomas are relatively more
common in dark-skinned individuals and have a female predominance.
Most cases are asymptomatic, the condition being detected on routine
ophthalmoscopy (mean age 50 years). The tumour is generally
stationary, and treatment is not required except in the very rare
event of malignant transformation

19. Choroidal osteoma is a rare benign ossifying tumour that has a
strong female preponderance
Masquerading lesions include osseous metaplasia in association with
a choroidal haemangioma, and sclerochoroidal calcification, the
latter characterized by multiple geographical yellow–white fundus
lesions that usually involve both eyes of an older adult.

20. Incontinentia pigmenti is an X-linked dominant condition that is lethal in utero
for boys. It is characterized by a vesiculobullous rash on the trunk and
extremities that with time is replaced by linear pigmentation. Other features
include malformation of teeth, hair, nails, bones and CNS.
Ocular Features include: Vitreoretinal dysplasia is caused by faulty
differentiation of the retina and vitreous that results in a detached dysplastic
retina forming a retrolental mass with leukocoria

21. Retinal artery macroaneurysm
localized dilatation of a retinal
arteriole; it has a predilection for
older hypertensive (75%) women.

22. Functional Visual Loss (FVL) is a decrease in visual acuity and/or visual field not caused by any
organic lesion. It is therefore also called “nonorganic visual loss” (NOVL). This entity is
considered within the spectrum of “conversion disorder”, malingering, somatotropin disorder, and
“factitious disorder”
It more often occurs in females
The key to diagnosing NOVL is to first complete a full, dilated eye examination to rule out
organic causes of visual loss such as refractive error, dry eye, cataract, uveitis, maculopathy,
etc. Exam reveals findings that are internally inconsistent. Why does this patient have count
fingers vision in one eye and no relative afferent pupil defect? Why did the patient see 20/70
for the technician, but sees 20/30 at the physician’s repeat evaluation when encouraged to
respond? Your goal is to prove and document better vision than alleged.

23. Full-thickness macular hole (FTMH) is a relatively
common cause of central visual loss, with a
prevalence of approximately 3 : 1000; onset is
most common in females aged 60–70
Remember : The Watzke–Allen test

24. Idiopathic intracranial hypertension, previously
known as benign intracranial hypertension or
pseudotumour cerebri, is characterized by
elevated ICP that by definition has no
identifiable cause; obese young adult women
are the most commonly affected group.
Remember : MRI & MRV

25. Intracranial meningiomas
typically affect middle-
aged women. Visual field
defects and clinical signs
depend on the location of
the tumour

26. Migraine is characterized by recurrent headaches widely
variable in intensity, duration and frequency. Migrainous
headache is commonly unilateral, associated with nausea
and vomiting and may be preceded by, or associated
with, neurological and mood disturbances. Migrainous
aura can occur without headache, and isolated visual
aura in particular is a very common presentation to
ophthalmologists. A family history is frequent and more
common in females

27. Essential blepharospasm is an uncommon
but distressing idiopathic disorder that
often presents in the sixth decade and
affects women more commonly than men
Remember : Meige (not Meigs) &
Brueghel syndromes

28. Systemic diseases common in women
Rheumatoid arthritis
JIA (3:2)
SLE
Primary Sjogren syndrome
Scleroderma
Mucous membrane pemphegoid
Myasthenia gravis (2:1)
M.S optic neuritis (3:1)

29. Thank You