Talk No. 34

Talk No. 34
By
Ahmed Alsherbeny
M.D. , CABOphth, FICO , MRCSEd Ophth , FRCS Ophth (Glasg)

1
Ophthalmology Signs
Around Us !

Diffuse Lamellar Keratitis
(Post-LASIK Complication)

Stromal dystrophies
Marilyn Monroe Always Gets Her Man in LA
City
Macular dystrophy
Mucopolysaccharide
Alcian blue
Granular Dystrophy
Hyaline material
Masson's Trichrome
Lattice Dystrophy
Amyloid
Congo Red

Alfred Vogt
Swiss ophthalmologist, born 31st October, 1879, Menziken, Aargau; died 1943.

Vogt's anterior mosaic crocodile
shagreen
bilateral, polygonal, grayish-white opacities in the deep layers of the
epithelium and in Bowman's layer

4
Rings , Dots , Lines & Spots !

Fleischer’s ring
visible all around the base of cone in Keratoconus .

Holding a book too close or
sitting too close to the
television set is harmful to the
eyes

Myth !
kids can actually focus up close without
eyestrain better than adults, so they often
develop the habit of sitting right in front of the
television or holding reading material close to
their eyes. However, sitting close to a TV may
be a sign of nearsightedness.

6
Ophthalmology Signs
Around Us II !

Chronic Blepharitis
(expressed toothpaste-like material)

7
Simply, …..
No Title ! 

There is much speculation concerning the strong distinctive yellow color
and halos in Van Gogh’s paintings. They may have been due to
xanthopsia, a form of dyschromatopsia that causes the sufferer to have
the impression of seeing things through a yellow filter. This condition
may be caused by early cataract but, in van Gogh’s case, may have been
through intoxication by the digitalis that he was prescribed for mania and
depression.

The artist could also have been suffering from glaucoma, and the
halos clearly painted around the stars-Starry night painting—may
have been created under the effect of high interocular pressure
(IOP) spikes

Sir Jonathan Hutchinson
English ophthalmologist, born 1828 and died 1913.

Hutchinson's sign
Involvement of the tip of the nose from herpes zoster, a sign taken
to indicate that the eye may be seriously involved by VZV because
of the involvement of the nasal branch of the nasociliary nerve.

Ask about gastric bypass procedures in
patients who have recent severe dry
eye with no discernible cause.
Vitamin A deficiency may be the
reason.

B Blockers
Beta-blockers reduce IOP by decreasing aqueous production, mediated
by an effect on the ciliary epithelium. In approximately 10% of cases the
response decreases with time (tachyphylaxis), sometimes within only a
few days. There may be limited supplementary effect if a topical beta
blocker is added when a patient already takes a systemic beta-blocker

B Scan
is a diagnostic test used in ophthalmology to produce a two-
dimensional, cross-sectional view of the eye and the orbit

Unilateral arcus senilis is rare
entity that may be associated
with carotid disease or ocular
hypotony

13
Mnemonics of Ophthalmology
II

Assessment of severity of TED
" NOSPECS "
0 N No signs or symptoms
1 O Only Signs, no symptoms
2 S Soft tissue involvement
3 P Proptosis
4 E Extraocular muscle involvement
5 C Corneal Involvement
6 S Sight Loss

14
Ophthalmology Eponyms III !

Johann Friedrich Horner
(27 March 1831 – 20 December 1886) was an ophthalmologist based at
the University of Zurich, Switzerland.
Horner became a full professor of ophthalmology in 1873. After his death
in 1886, his position at the University of Zurich was filled by Otto Haab
(1850–1931).

Horner muscle
lacrimal portion of the orbicularis occuli muscle

Corneal ulcer stained with fluorescein

Preparation of fortified antibiotics:

Contrary to his earlier paintings, his later work has
fewer details, the shapes are “blurring”. The cataract related
changes in his lenses reduced their sensitivity to
contrast and light permeability

Many of these later paintings verge on the abstract, with colors
bleeding into each other and a lack of rational shape and
perspective

The first one was painted when he used his left eye, which had not
been operated on and was affected with cataract: warm colors
red- orange-yellow, are dominating. The second one, painted
when he used his right eye operated for cataract surgery, shows
only cool colors, blue and violet.

Hannibal
Hannibal lost one eye due to conjunctivitis seven
months after he had crossed the alps, while wading through
a fetid Etruscan (= Tuscan) Swamp.

Forest Whitaker
is well known for his lazy left eye, though in his case, it’s a vision problem as
well. Whitaker says that when he looks up, he can’t see well out of his left eye,
and that the problem might be fixed if his lazy eye is corrected.

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

Primary Acquired Melanosis
The term primary acquired “melanosis” is inaccurate because the lesion is
characterized by proliferation of conjunctival epithelial melanocytes and not
deposition of pigment – a more appropriate term is “Conjunctival Melanocystic
intraepithelial neoplasia”

21
Can You Trust Your Eyes ?!!

Occipital Lobe Disorders Related
Phenomena
Riddoch phenomenon
Riddoch and Holmes observed that individuals recovering
from occipital lobe injuries first perceive moving objects
but not stationary ones. The Riddoch phenomenon can
be observed during confrontation field testing by
comparing the patient’s responses to moving and still
targets. More recently it has been shown that rare
patients with uni- or bilateral occipital lesions lose object
recognition but in some instances may have
“blindsight,” an unconscious ability to locate light
sources and detect moving targets in affected fields

In Congenital Glauoma, Evaluation
under general anaesthesia is generally
required; intravenous ketamine lowers
IOP less than other agents.

23
Ophthalmology Signs
Around Us III !

Laser iridotomy, Many practitioners
target a site under the upper eyelid
between 11 and 1 o’clock

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).

Uveitis of JIA
The uveitis of JIA is particularly dangerous because it is invariably
asymptomatic and must generally be detected by screening with slit lamp
examination. Even during acute exacerbations with +4 aqueous cells, it is rare
for patients to complain, although a few report an increase in vitreous floaters.
Often uveitis may not be suspected until the parents recognize complications
such as strabismus, or an abnormal appearance of the eyeball due to band
keratopathy or cataract. ○ Injection is usually absent even in the presence of
severe uveitis. !!!

27
Mnemonics of Ophthalmology
III

Cryotherapy
" ABCD "
Adhesion (retinal breaks)
Blood vessels (PDR new vessels,
telangiectasia of Coat’s disease)
Ciliary body (cyclodestructive
procedures for glaucoma)
Cataract extraction (ICCE)
Destruction (lid and intraocular
tumors, trichiasis)

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

The clinical picture of APMPPE can be
mimicked by other entities such as
sarcoidosis and tuberculosis.
APMPPE Sarcoidosis choroiditis

Gonorrhea is a venreal
genitourinary tract
infection caused by
Neisseria gonorrhoea,
which capable of invading
the intact corneal
epithelium
N.B. The patient must
be hospitalized if there
is corneal ulceration
N.B. Patients must be
referred to a
genitourinary department
to be screened for
associated chlamydial
infection and contact
tracing.

Treatment of Acanthamoeba keratitis
A B C D E
• Aminoglycosides (neomycin)
• Biguanides (polyhexamethylene biguanide)
• Chlorhexidine
• Diamidines (Brolene)
• Econazole (Imidazoles)

Harold Glendon Scheie
U.S. ophthalmologist, 1909-1990.

In pigment dispersion, Pigment
granules may be deposited on the
anterior surface of the lens
(Scheie’s stripe)

Talk No. 34

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Talk No. 34