1. Many ocular conditions are more common in males or affect males more severely than females. These include vernal keratoconjunctivitis, Mooren's ulcer, spheroidal degeneration, Terrien's marginal degeneration, myopic disc with glaucoma, pigment dispersion syndrome, Posner-Schlossman syndrome, primary congenital glaucoma, acute retinal necrosis, Coats' disease, central serous chorioretinopathy, and cluster headaches. 2. Certain conditions have specific characteristics in males, such as vernal keratoconjunctivitis primarily affecting boys ages 5-teens, Mooren's ulcer more aggressively affecting younger males, myopic disc with glau

1. ♂!
By
Ahmed Alsherbeny
MD, CABOphth, MRCSEd Ophth, FRCS Ophth (Glasg), FICO

2. Being male is a matter of birth, being
a man is a matter of age, being a
gentleman is a matter of choice.

3. Vernal keratoconjunctivitis (VKC) is a
recurrent bilateral disorder in which both
IgE- and cell-mediated immune
mechanisms play important roles. It
primarily affects boys and onset is
generally from about the age of 5 years
onwards. There is remission by the late
teens in 95% of cases.

4. Mooren ulcer is a rare autoimmune disease characterized by
progressive circumferential peripheral stromal ulceration with
later central spread. There are two forms: the first affects
mainly older patients, often in only one eye, and usually
responds well to medical therapy. The second is more
aggressive and likely to need systemic immunosuppression,
carries a poorer prognosis, may be bilateral and associated
with severe pain, and tends to occur in younger patients,
including widespread reports in men

5. Spheroidal degeneration (Labrador keratopathy, climatic
droplet keratopathy) typically occurs in men whose working
lives are spent outdoors. Ultraviolet exposure is likely to be an
aetiological factor. The condition is relatively innocuous but
visual impairment may rarely occur. A secondary form can
follow inflammation or injury.

6. Terrien marginal degeneration is an uncommon idiopathic thinning of
the peripheral cornea occurring in young adult to elderly patients.
Although usually categorized as a degeneration, some cases are
associated with episodic episcleritis or scleritis. About 75% of
affected patients are male and the condition is usually bilateral
but may be asymmetrical.

7. Lowe (oculocerebrorenal) syndrome is an X-linked recessive (gene:
OCRL1) inborn error of amino acid metabolism with neuromuscular,
renal and other manifestations. Cataract is universal, and microphakia
may also be present. Congenital glaucoma is present in about half of
patients. Female carriers may have visually insignificant cortical lens
opacities

8. Myopic disc with glaucoma refers to a tilted
(obliquely inserted), shallow disc with a temporal
crescent of parapapillary atrophy, together with
features of glaucomatous damage. Dense superior
or inferior scotomas threatening fixation are
common. This morphology is most common in
younger male patients.

9. Pigment dispersion syndrome and Pigmentary glaucoma are
more common in males, particularly young myopic white men;
there is also a cluster of disease in older hypermetropic black
women. About a third of patients with PDS will have developed
elevated IOP or glaucoma after 15 years. Although PDS is
rare in black individuals, PG tends to be more severe than in
whites

10. Posner-Schlossman Syndrome (glaucomatocyclitic crisis) is a rare condition
characterized by recurrent attacks of unilateral acute raised IOP associated
with mild anterior uveitis. The mechanism is speculated to be acute
trabeculitis. PSS typically affects young to middle-aged adults. Males are
affected more frequently than females. Episodes are unilateral, although 50%
of patients have involvement of the other eye at different times.

11. Primary congenital glaucoma (PCG) is rare, with an
incidence of 1 : 10 000 in many populations; boys
are more commonly affected
in most surveys. Involvement is more often
bilateral, but frequently asymmetrical.

12. 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.

13. Acute retinal necrosis
It typically affects otherwise healthy individuals of all ages.
Males are more frequently affected than females by a 2 : 1
ratio
ARN is a biphasic disease which tends to be caused by herpes
simplex virus (HSV) in younger patients and VZV in older
individuals

14. Combined hamartoma of the retina and RPE is a rare lesion that is
probably congenital. It may be more common in males. It typically
occurs sporadically in normal individuals but sometimes in association
with a systemic disorder, particularly neurofibromatosis type 2, which
should be considered particularly in children or if bilateral lesions are
present

15. Type 1: aneurysmal
telangiectasia may be
closely related to
Coats disease, or
more specifically the
milder form of Coats
previously known as
Leber miliary
aneurysms; it
generally involves only
one eye, and both the
peripheral retina and
macula can be
affected. Patients are
typically middle aged
males.

16. Coats disease is an idiopathic retinal telangiectasia that is
generally of onset in early childhood. It is associated with
intraretinal and subretinal exudation, and frequently
exudative retinal detachment, without signs of vitreoretinal
traction. About 75% of patients are male and 95% have
involvement of only one eye

17. Central serous chorioretinopathy (CSR) is an idiopathic disorder characterized by a
localized serous detachment of the sensory retina at the macula secondary to
leakage from the choriocapillaris through one or more hyperpermeable RPE sites.
CSR typically affects one eye of a young or middle-aged Caucasian man; women
with CSR tend to be older. Imperfectly defined risk factors include steroid
administration (including intravitreal), Cushing syndrome, Helicobacter pylori
infection, pregnancy, psychological stress and sleep apnoea syndrome.

18. The uveal effusion syndrome is a rare idiopathic, often
bilateral, condition that most frequently affects middle-
aged hypermetropic men but can occur in association with
nanophthalmos. The cause is thought to be impairment of
normal fluid drainage from the choroid via the sclera
(which is sometimes of abnormal thickness and
composition) or vortex veins.

19. Ocular albinism, involvement is predominantly ocular, with normal skin and hair,
although occasionally hypopigmented skin macules may be seen. Inheritance is
usually XLR but occasionally AR. Female carriers are asymptomatic, but may
show partial iris translucency, macular stippling and mid-peripheral scattered
areas of depigmentation and granularity. Affected males have hypopigmented
irides and fundi.

20. Leber hereditary optic neuropathy (LHON) is a rare ganglion cell
degeneration; the papillomacular bundle is particularly affected. The
condition is caused by maternally inherited mitochondrial DNA point
mutations. The condition
typically affects males between the ages of 15 and 35 years, although in
atypical cases the condition may affect females and present at any age
between 10 and 60 years. The diagnosis of LHON should therefore be
considered in any patient with bilateral optic neuropathy, irrespective of
age
The PLR is maintained overall in LHON patients despite the severity of
optic atrophy

21. Cluster headache typically affects young to middle-aged men. It is of
particular interest to ophthalmologists because it is associated with ocular
features and may initially be misdiagnosed as a local ocular problem. ○ The
headache is unilateral, oculotemporal, excruciating, sharp and deep. ○ The
patient cannot keep still and is agitated, in contrast to a patient with
migraine who would rather lie quietly in a dark room. ○ Associated
autonomic phenomena may include lacrimation, conjunctival injection and
rhinorrhoea. ○ There may be a transient or permanent postganglionic
Horner syndrome.

22. Ocular penetrating injuries are three times more
common in males than females, and typically occur
in a younger age group (50% aged 15–34). The
most frequent causes are assault, domestic and
occupational accidents, and sport

23. Systemic diseases common in men
Wegner granulomatosis
Polyarteritis nodosa
Ankylosing spondylitis
Behcet syndrome
Whipple disease
Steven Johnson syndrome

24. Thank You