Eponyms and more

This section has the named tests associated with Ophthalmology.

Dots & Spots

Bitot’s Spot: White, foamy-appearing area of keratinizing squamous metaplasia of bulbar conjunctiva in vitamin A deficiency

Brushfield Spots: White-gray spots on peripheral iris in Down syndrome

Elschnig Spot: Yellow patches (early) of retinal pigment epithelium overlying area of choroidal infarction in hypertension, eventually becomes hyperpigmented scar with halo

Fuchs Spots: Pigmented macular lesions (retinal pigment epithelial hyperplasia) in pathologic myopia

Fischer–Khunt Spot: (Senile scleral plaque) blue-gray area of hyalinized sclera anterior to horizontal rectus muscle insertions in elderly individuals

Gunn’s Dots: Light reflections from internal limiting membrane around the disc and macula

Horner–Trantas Dots: Collections of eosinophils at limbus in vernal conjunctivitis

Kayes’ Dots: Subepithelial infiltrates in corneal allograft rejection

Koplik Spots: Small gray-white spots on buccal mucosa opposite lower molars that appear during prodromal phase of measles

Kunkmann–Wolffian Bodies: Small white peripheral iris spots that resemble Brushfield spots but occur in normal individuals

Mittendorf’s Dot: White spot (remnant of hyaloid artery) at the posterior lens surface

Roth Spots: Intraretinal hemorrhages with white center in subacute bacterial endocarditis, leukemia, severe anemia, collagen vascular diseases, diabetes mellitus, and multiple myeloma

Singerman’s Spots: Superficial glistening white dots in macular telangiectasia

Siegrist Streak: Linear chain of hyperpigmented spots over sclerosed choroidal vessel in chronic hypertension or choroiditis

Cherry red Spot: Red colour of fovea contrast to the milky retinal odema seen in CRAO

Eponyms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

Adie’s Pupil: Tonic pupil that demonstrates cholinergic supersensitivity

Adie’s Syndrome: A condition in which one or both pupils is dilated and responds slowly or not at all to light and a near stimulus, accompanied by slow constriction and relaxation in the change from near to distant vision, and impaired accommodation

Alexander’s Law: Jerk nystagmus; usually increases in amplitude with gaze in direction of the fast phase

Amsler Grid: Chart used to detect or document macular diseases

Amslers Veerey Sign: Haemorrhage caused by applanation tonometry and cataract surgery in Fuch’s heterochromic iridocyclitis (FHI). It was once thought to be pathognomonic for FHI, was previously used as a diagnostic and confirmatory test in patients with suspected FHI

Anderson-Kestenbaum Procedure: This is done for asymmetrical gaze nystagmus. In eccentric nystagmus the position of balance between the opposing muscles can be gained only by conjugate deviation. Hence, if the muscles which bring the eyes into that position of balance are weakened surgically and the counteracting muscles are strengthened, the impulse for conjugate deviation will rotate the eyes to or near the mid-position. Thus surgery has to shift the eyes into the direction opposite to the rest position, i.e. towards the side of the greater oscillation, which usually coincides with the direction of head turn and of the quick component of the nystagmus

Arden Plates: The Arden grating test is a subjective clinical test of visual function introduced in a portable book form by Arden and Jacobsen in 1976. The principle of the test is the measurement of contrast sensitivity by sine-wave gratings

Arden Ratio: The clinical EOG provides an indirect measure of the minimum amplitude of the standing potential in the dark (at the DT) and then again at its maximum amplitude in the light (at the LP). This is expressed as the EOG light peak-to-dark trough ratio (LP:DT ratio) or ARDEN’S RATIO

Argyll Robertson Pupil: Small, irregular pupils that do not react to light but do respond to accommodation; occurs in syphilis

Argyll Robertson’s Syndrome: A frequent symptom of neurosyphilis, especially tabes dorsalis, and other diseases of the central nervous system, in which the pupil is small and responds slowly or not at all to light, but reaction to accommodation and convergence is retained

Arlt Line: A thick band of scar tissue in the conjunctiva, near the lid margin,associated with eye infections like trachoma

Arlt’s Operation: Transplantation of eyelashes back from the edge of the eyelid for treatment of distichiasis

Arlt’s Syndrome: A contagious eye infection caused by Chlamydia trachomatis

Arlt’s Triangle: Keratic precipitates distributed in a wedge-shaped area on the inferior corneal endothelium

Axenfeld Syndrome: A syndrome characterised by posterior corneal embryotoxon, prominent Schwalbe’s line and iris adhesion to the Schwalbe’s line

Axenfeld Loop: The term is used to describe intrascleral nerve loops of the long, posterior, ciliary nerves as they pierce the sclera. The loop commonly appears as a grey, white nodule under the bulbar conjunctiva. It may be surrounded by pigment, especially in those with a darker iris. They are typically found a constant distance from the corneoscleral junction, usually within 3-4 mm of the limbus

B

Bell’s Palsy: Bell’s palsy is a type of facial paralysis that results in a temporary inability to control the facial muscles on the affected side of the face. It is an unexplained episode of facial muscle weakness that begins suddenly and worsens over 48 hours

Bells Phenomenon: It is a medical sign that allows observers to notice an upward and outward movement of the eye, when an attempt is made to close the eyes.(also called the palpebral oculogyric reflex)

Berlin’s Edema: (Commotio retinae) whitening of retina in the posterior pole from disruption of photoreceptors after blunt trauma

Behr’s Optic Atrophy: A recessive form of optic atrophy which may occur in isolation or may be associated with deafness, diabetes, and neurologic complications

Behçet’s Syndrome: Recurrent systemic disease characterized by uveitis with hypopyon, recurrent ulceration of the mucous membranes of the mouth and pharynx, and ulceration of the genitalia

Bjerrum screen: The Bjerrum Tangent Screen is a flat, usually black surface, used to measure the central 30 degrees of the visual field. The Bjerrum screen is made of black matte material and stitched with radial lines at 15 degree intervals and circles at 5 degree intervals

Bjerrum Scotoma: A visual field defect characteristic of glaucoma. It is a nerve fiber bundle defect extending from the blind spot, sweeping around the macular region and ending in a straight line on the nasal side corresponding to the temporal raphe in the retina

Bielschowsky Phenomenon: Downdrift of occluded eye as increasing neutral-density filters are placed over fixating eye in dissociated vertical deviation

Bielschowsky’s Head Tilt Test: A test for palsy of the superior oblique muscle caused by damage to the IVth cranial nerve

Bogorad Syndrome (Crocodile Tears): It is the gustolacrimal reflex results from an anomalous lacrimal gland innervation that causes profuse and inappropriate tearing in response to stimulation of the taste buds

Bowman’s Membrane: The Bowman’s membrane (Bowman’s layer, anterior limiting lamina, anterior elastic lamina) is a smooth, acellular, non regenerating layer, located between the superficial epithelium and the stroma in the cornea of the eye

Bowman’s Dystrophy: Typically present with normal corneas at birth but develop painful recurrent erosions, opacification, and progressive vision loss within the first decade of life . Irregular, grey-white, geographic-like opacities are located in the Bowman layer and anterior stroma. In more advanced stages of the disease, the opacities can extend to the limbus and deeper stroma. It is now known as Reis-Bücklers dystrophy, and is formerly also known as Granular corneal dystrophy type III

Bowman’s Glands: These are Olfactory glands, or branched tubulo-alveolar glands which are located in the lamina propria of the olfactory membrane. Mucus produced from these glands keeps the olfactory surface moist

Bowman Muscle: It is a synonym for ciliary muscle

Brown Syndrome: Brown syndrome is a vertical strabismus syndrome characterized by limited elevation of the eye in an adducted position, most often secondary to mechanical restriction of the superior oblique tendon/trochlea complex

Brown’s Classification of Duane Syndrome

Brown has classified Duane’s syndrome according to the characteristics of the limitation of movement:

Type A: with limited abduction and less-marked limitation of adduction
Type B: showing limited abduction but normal adduction
Type C: the limitation of adduction exceeds the limitation of abduction. There is an exotropic deviation and a head turn to compensate the loss of adduction

Bruch’s Membrane: Bruch’s membrane is the innermost layer of the choroid which has 5 layers. It is also called the vitreous lamina, because of its glassy microscopic appearance. It is 2-4 μm thick

Bruch’s Glands: Lymph nodes located in the palpebral conjunctiva. They are sometimes referred to as trachoma glands

C

Coat’s White Ring: It is a superficial ring of iron deposition that occurs after a metallic foreign body is removed

Coats’ Disease: It is a developmental retinal vascular anomaly consisting of leaking telangiectatic and aneurysmal retinal vessels with associated lipid exudation, which frequently occurs in one eye of otherwise healthy boys in the first decade of life

Cloquet’s Canal: Also known as the hyaloid canal or Stilling’s canal, is a transparent canal that runs from the optic nerve disc to the lens traversing the vitreous body. It serves as a perivascular sheath surrounding the hyaloid artery in the embryonic eye

Cogan’s Sign: Cogan’s lid twitch, in patients with myasthenia. When the patient’s eyes are directed downward for 10 to 20 seconds and the patient is then instructed to make a vertical saccade back to primary position, the upper eyelid elevates and either slowly begins to droop or else twitches several times before settling into a stable position

Cogan’s Dystrophy: Also known as the Epithelial Basement Membrane Dystrophy (also known as map-dot-fingerprint, or anterior basement membrane dystrophy). The characteristic slit lamp findings for Cogan’s dystrophy are best described by the name “map-dot-fingerprint.” The “map” changes are the most common ones seen in many EBMD patients. They appear as amorphous or geographic, sharply demarcated clear zones within light grayish areas. The “dots” appear as small, irregular putty-like grayish white opacities, and the “fingerprints” consist of small clusters of curved, parallel lines.

Cogan Reese Disease: A syndrome characterized by a matted or smudged appearance to the surface of the iris, unilateral glaucoma in the eyes with multiple peripheral anterior synechiae, multiple nodules of the iris, and ectopic Descemet’s membrane

Cogan’s Syndrome: Syndrome of interstitial keratitis characterized by abrupt onset of vertigo, tinnitus, and usually rapid development of bilateral deafness

Cogan’s Rule: This rule states that, in a patient complaining of homonymous hemianopia, if there is an asymmetric optokinetic response (lack or diminished response in the direction of the corrective saccade when the optokinetic nystagmus (OKN) stimulus moves towards the affected lobe), the lesion is more likely to involve the deep portions of the parietal lobe that are outside the territory of the posterior cerebral artery and therefore the lesion is unlikely of vascular origin. In contrast, the asymmetric optokinetic response is usually associated with tumors, as tumors are more common in the parietal than the occipital lobe

Collier’s Sign: Bilateral eyelid retraction associated with midbrain lesions

D

Dalrymple’s Sign: Widened palpebral fissure secondary to upper eyelid retraction in thyroid disease

Dalen Fuch’s Nodules: Small, deep, yellow retinal lesions composed of inflammatory cells seen histologically between retinal pigment epithelium and Bruch’s membrane in sympathetic ophthalmia (also in sarcoidosis, Vogt–Koyanagi–Harada syndrome)

Drance Hemorrhage: Nerve fiber layer (“splinter”) hemorrhage at disc margin in glaucoma

Doyne Honeycomb Choroiditis: The occurrence of colloid bodies (drusen) observed to lie on Bruch’s membrane in certain families who lived in Oxford, England. These drusen tended to merge together and eventually become confluent, resembling a honeycomb; hence, the name Doyne’s honeycomb choroiditis

Dua’s Layer: It is a layer found between the corneal stroma and the descemet’s membrane. It is about 15 micrometres thick, the fourth caudal layer, and located between the corneal stroma and Descemet’s membrane. Despite its thinness, the layer is very strong and impervious to air.It is strong enough to withstand up to 2 bars (200 kPa) of pressure

Dua’s Classification of Ocular Burns: The Dua’s classification is based on an estimate of limbal involvement (in clock hours) and the percentage of conjunctival involvement

Duane’s Syndrome: The characteristic lid narrowing and retraction of the globe on adduction, caused by simultaneous contraction of the medial and lateral rectus muscles, help identify the condition. Duane’s retraction syndrome is frequently mistaken for a sixth-nerve palsy in infancy because of deficient abduction of the involved eye. In fact, as a cause of limited abduction Duane’s syndrome is quite common in children, so it must be kept in mind

E

Eales’ Disease: Idiopathic inflammatory disorder of the retinal vessels (mainly veins) with recurrent vitreous and retinal haemorrhages giving sudden visual impairment. It is thought to be related to tuberculosis

Edinger-Westphal’s Nucleus: The parasympathetic nucleus of the oculomotor nerve involves in light reflex. It is the site of damage in Argyll-Robertson’s pupils

Elschnig’s Pearl: Translucent mass following cataract surgery caused by aberrant attempt of lens epithelium to form lens fibres

Elschnig Spots (acute): Localized yellow areas visible in retinal pigment epithelium on ophthalmoscopic exam, which represent hypertensive choroidopathy; caused by fibrinoid necrosis within choriocapillaris

Elschnig Spots (chronic): Darkened pigment areas developing over several weeks in areas of acute yellow Elschnig spots

Enroth’s Sign: Eyelid edema in thyroid disease

Ellingson Syndrome (or UGH Syndrome): It is a triad of uveitis, glaucoma, and hyphema

F

Fischer Kuhnt Spots: These are senile scleral plaques, with area of hyalinised sclera, anterior to horizontal rectus muscle insertion

Fuchs’ Corneal Dystrophy: Familial degenerative condition of the eye seen more commonly in women, with clouding of the cornea and often complicated by glaucoma

Fuchs’ Heterochromic Cyclitis: An idiopathic disorder of the eye, with heterochromia, uveitis of the lighter coloured eye, iridocyclitis, keratitic precipitates and often catarct

Fuchs’ Spot: A small black spot on the fundus in high myopia, occurring after macular haemorrhage

Fuch’s Dimples: Shallow, saucerlike depression on the surface of the cornea

Fuchs Phenomenon: Paradoxical lid retraction associated with eye movements during 3rd nerve regeneration. While the eye may be adducted and lid elevated, no movement up or down occurs when the vertical recti contract together. It occurs classically in exophthalmic goiter, but also due to trauma or tumor at the base of the skull, anterior poliomyelitis or vascular lesions of the brain stem, with regenerating fibres growing to wrong muscles

Fuch’s Coloboma: In this condition, the superior pole of the optic disc may appear elevated with posterior displacement of the inferior nasal disc, or the disc can be horizontally tilted, resulting in an oval-appearing optic disc with an obliquely oriented long axis. It is also known as the tilted disc syndrome

Fuch’s Keratitis: A rare form of keratitis seen in the middle-aged and elderly, characterized by bilateral bands of superficial infiltrates around the corneal margins, while the central portions remain clear

Fuch’s Atrophy: Peripheral atrophy of the optic nerve. Consists of headache, fever, cyanosis, swelling of the face, ulceration of mucocutaneous membranes, and severe conjunctivitis. Eponym indicates a nonfebrile Stevens-Johnson variant

Fleischer Ring: Fleischer rings are yellowish to dark-brown pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin. They may be complete or broken and are indicative of keratoconus

Kayser-Fleischer Ring: They are dark rings that appear to encircle the iris of the eye and are due to copper deposition in the Descemet’s membrane. These rings first appear as a crescent at the top of the cornea. Eventually, a second crescent forms below, at 6 o’clock, and ultimately completely encircles the cornea. It is found in Wilson’s disease

G

Gass Classifcation of Macular Holes

Gass first described his clinical observations on the evolution of a macular hole:

Stage 1 MH, or Impending MH, demonstrates a loss of the foveal depression. A stage 1A is a foveolar detachment characterized a loss of the foveal contour and a lipofuscin-colored spot. A stage 1B is a foveal detachment characterized by a lipofuscin-colored ring
Stage 2 MH is defined by a full thickness break < 400µm in size. It might be eccentric with an inner layer “roof.” This can occur weeks to months following Stage 1 MHs. A further decline in visual acuity is also noted. In most cases, the posterior hyaloid has been confirmed to be still attached to the fovea on OCT analysis
Stage 3 MH is further progression to a hole ≥400 µm in size. Nearly 100% of stage 2 MHs progress to Stage 3 and the vision further declines. A grayish macular rim often denotes a cuff of subretinal fluid. The posterior hyaloid is noted to be detached over the macula with or without an overlying operculum
Stage 4 MH is characterized by a stage 3 MH with a complete posterior vitreous detachment and Weiss ring

Gass Classification of Parafoveal Telangiectasia

Macular telengiectasia is usually divided into 3 main groups:

Type 1: congenital and unilateral. Thought to be similar to and/or possibly a variant of Coats disease. Uncommon
Type 2: acquired and bilateral. The most common form of the three types. Usually found in middle-aged or older patients. According to the Beaver Dam Eye Study which graded only color fundus images, Mac Tel has a prevalence of 0.1% with an average age of 63 years. Although not initially described by Gass, Yannuzzi found a slight female preponderance of 58%. Of note, on common usage, the term ‘Mac Tel’ is often used to refer to Mac Tel type 2. This entry will largely focus on type 2 as it has the most clinical relevance
Type 3: an poorly understood primarily occlusive phenomena which is quite rare

Goldmann Perimeter: The Goldmann perimeter is a hollow white spherical bowl positioned a set distance in front of the patient. An examiner presents a test light of variable size and intensity. The light may move towards the center from the perimeter (kinetic perimetry), or it may remain in one location (static perimetry)

Goldmann Applanation Tonometer: This test measures fluid pressure in your eye. The test involves using a slit lamp equipped with forehead and chin supports and a tiny, flat-tipped cone that gently comes into contact with your cornea. The test measures the amount of force needed to temporarily flatten a part of your cornea

Goldmann Goniolens: This truncated-cone like device utilises mirrors to reflect the light from the iridocorneal angle into the direction of the observer (as shown by the schematic diagram). In practice the image comes out roughly orthogonal to the back surface (nearer the practitioner), making observation and magnification with a slit lamp easy and reliable. The small, curved front surface does not rest on the cornea, but instead vaults over it, with lubricating fluid filling the gap. The border of the front surface rests on the sclera

Goldman Weekers Dark Adaptometer: Dark adaptation is most often tested on an instrument such as the Goldmann-Weekers adaptometer. The patient is first light-adapted to a bright background light. This light is then extinguished, and the patient, now in the dark, is presented with a series of dim light targets approximately 11° below fixation. The intensity of the test lights is controlled by neutral-density filters, and the threshold at which the test light is perceived is plotted against time. Under these conditions, the dark adaptation curve shows 2 plateaus: the first represents the cone threshold, which is usually reached in 5–10 minutes, and the second represents the rod threshold, which is reached after about 30 minutes. If the clinical interest is limited to rod sensitivity in the dark, the test can be shortened by eliminating the first step of adaptation to bright light and recording only an endpoint rod threshold, which is normally reached within about 10 minutes of dark adaptation

Goldmann Favre Disease: A syndrome that consists of congenital retinoschisis indistinguishable ophthalmoscopically from the X-linked recessive type with pigmentation in the fundus, complete night blindness, or loss of the scotopic b-wave of the ERG.The disease is transmitted by autosomal recessive inheritance

Globe’s Sign: Lid lag on upgaze in thyroid disease

Graefe’s Sign: Von Graefe’s sign is the lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter (Graves’ Disease).It is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis

Graefe’s Knife: The von Graefe knife was a tool used to make corneal incisions in cataract surgery

Gunn’s Sign: Arteriovenous nicking in hypertensive retinopathy

H

Haab’s Striae: Breaks in Descemet’s membrane (horizontal or concentric with limbus) in congenital glaucoma (versus vertical tears associated with birth trauma)

Haab’s Reflex: Attention reflex with contraction of pupils without alteration of the eye’s position (accommodation or convergence) when attention is on a bright object in the periphery of vision. May indicate a cortical lesion

Haab’s Magnet: A powerful magnet used for removing metallic particles from the eye. In directing the one pole toward the patient’s eye, iron/metallic particles may be demonstrated and removed

Haab’s Scale: It is a device used to measure pupillary diameter

Hassle Henle Bodies: Small hyaline excrescences in the periphery of the Descemet membrane. They occur because of focal alteration in endothelial cell homeostasis, resulting in modified production or deposition of membrane material in a nonplanar fashion

Henle’s Layer: Obliquely oriented cone fibers in fovea

Henle’s Fibers: The inner fibers of photoreceptors

Crypts Of Henle: Crypts of Henle are microscopic pockets found in scattered sections of the conjunctiva around the eyeball. They are responsible for secreting mucin, a proteinaceous substance that makes up the inner layer of tears. It coats the cornea to provide a hydrophilic layer that allows for even distribution of the tear film

Herbert’s Pits: Cavities in the cornea filled by a clear epithelial tissue. They are a characteristic defect left after the healing of a limbal follicle in trachoma

Herbert’s Operation: Displacement of a wedge-shaped flap of sclera for the formation of a filtering cicatrix in glaucoma

Hering’s Law: Equal and simultaneous innervation to yoke muscles during conjugate eye movements

Hollenhorst Plaque: It is a cholesterol embolus that is seen in a blood vessel of the retina

Horner Tranta Spots/Dots: Small, white-yellow chalky concretions of the conjunctiva around the limbus. These are associated with vernal conjunctivitis

Horner Syndrome: A syndrome mainly characterised by a triad of miosis, ptosis, and enophthalmos. It is also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion of the sympathetic trunk

Horner’s Muscle: Circular fibres that are the innermost portion of the ciliary muscle. Often called Horner’s muscle because it is affected in Horner’s syndrome

Horner’s Pupil: Miosed pupil in Horner’s syndrome

Horner’s Hollow Chisel: An instrument for removing foreign bodies from the cornea

Hutchinson’s Sign: Involvement of tip of nose in herpes zoster ophthalmicus (nasociliary nerve involvement)

Hutchinson’s Triad: Three signs of congenital syphilis: interstitial keratitis, notched teeth, and deafness

Hutchinson’s Pupil: Fixed, dilated pupil in comatose patient caused by uncal herniation and compression of CN III

Hutchinson’s Freckle: It is normally found in the elderly (peak incidence in the 9th decade), on skin areas with high levels of sun exposure like the face and forearms. This is also known as Lentigo maligna, where melanocyte cells have become malignant and grow continuously along the stratum basale of the skin,but have not invaded below the epidermis

Hutchinson Tay Choroiditis: This was a name given probably to dominantly inherited drusen when 10 patients in 1875, were found to have whitish spots in the macula and peripapillary region, small and round in shape, sometimes coalescing to give larger plaques. This is also known as Holthouse-Batten chorioretinitis, Doyne’s honeycomb familial choroiditis and Malattia levantinese

Hutchinson’s Patch: Hutchinson’s patch (or Salmon patch of Hutchinson) is a dull orangish-pink area (generally without clear boundaries) on the cornea, most often found at the periphery of the cornea. The sign is an indication of interstitial (or parenchymatous) keratitis, causing corneal neovascularisation

Hughes Classification of Chemical Injury: This classification divided the chemical injuries into mild, moderate and severe. This depended on the visibility of anterior chamber details and the blanching of the surrounding conjunctiva

Hughes Tarso-Conjunctival Flap: The Hughes tarso-conjunctival flap is a technique to repair full-thickness lower eyelid defects involving > 50% of the lower eyelid margin

Hudson Stahli Line: Horizontal corneal epithelial iron line at the inferior third of the cornea at level of tear film caused by normal aging

I

Irvine Gass Syndrome: The occurrence of a cystoid macular edema (CME) that specifically arises after cataract surgery

J

Javal Schiotz Keratometer: The Javal-Schiotz Keratometer is a two position instrument which uses a fixed image and doubling size and adjustable object size to determine the radius of curvature of the reflective surface

Lester Jones Tubes: Jones tubes are small tubes that create a new channel for draining the tears. They create a bypass route of tear drainage when the normal tear ducts fail and alternative techniques to provide drainage are not possible

Jones Test I & II

The Jones I Test or Primary Dye Test investigates lacrimal outflow under normal physiologic conditions. The examiner instills fluorescein into the conjunctival fornices and recovers it in the inferior nasal meatus by passing a cotton-tipped wire applicator into the region of the ostium of the NLD at 2 and 5 minutes. As this test occasionally yields abnormal results in normal patients, it is not uniformly performed
The nonphysiologic Jones II Test determines the presence or absence of fluorescein in the irrigating saline fluid retrieved from the nose. This test is performed as follows. The residual fluorescein is flushed from the conjunctival sac following an unsuccessful Jones I test. This is done so that the examiner can determine whether any reflux upon irrigation contains fluorescein. Irrigation of the lacrimal drainage system is performed with clear saline, which is retrieved from the inner aspect of the nose

Jones Procedure: The direct plication of lower lid retractors from the skin side to correct entropion

K

Kestenbaum Pupil Number: Kestenbaum’s Number (K) is the difference in the pupil size attained in each eye under direct illumination while the other eye is occluded

Kestenbaum Test: The above test of noting the size of the pupil of the unoccluded eye under direct illumination while the other eye is occluded is known as the Kestenbaum test

Kestenbaum Sign: A decrease in the number of arterioles crossing optic disk margins as a sign of optic neurtis

Krachmer Spots: These are in stromal graft rejection and sub eoithelial infiltrates

Krause’s Glands: Accessory lacrimal glands

Khodadoust Line: A Khodadoust line separates immunologically damaged endothelium from unaffected endothelium. In the area of damage, the endothelium is decompensated resulting in stromal and epithelial edema

Klein’s Tags: Yellow spots at base of macular hole

Kocher’s Sign: Globe lags behind upper lid on upgaze in thyroid disease

Kollner’s Rule: Acquired color vision loss from the inner retina, optic nerve, visual pathway, and visual cortex diseases causes red-green defects; that from outer retinal diseases and media changes causes blue-yellow defects (main exception is glaucoma [optic nerve disease but initially causes blue-yellow defect])

Krukenberg Spindle: Bilateral, central, vertical corneal endothelial pigment deposits in pigment dispersion syndrome

L

Leber’s Congenital Amaurosis: Syndrome characterised by severe visual deficiency, with total or nearly total blindness, present at birth or shortly thereafter

Leber’s Miliary Aneurysm: A form of unilateral exudative retinopathy occurring in children before puberty, it is now considered as a milder form of Coat’s disease

Leber’s Optic Atrophy: A rare hereditary form of optic atrophy that usually affects young males

Lhermitte’s Sign: Also known as Lhermitte’s Phenomenon, also referred to as the Barber Chair Phenomenon, is the name which describes an electric shock-like sensation that occurs on flexion of the neck. This sensation radiates down the spine, often into the legs, arms, and sometimes to the trunk

Lisch Nodules / Sakurai Lisch Nodules: Iris melanocytic hamartomas in neurofibromatosis

Lisch Syndrome: Syndrome of perlucide iris with hereditary nystagmus and with/without fundus flavimaculatus. Disease picture seen in a larger Tyrolean kindred with translucent iris, hereditary nystagmus, and partly fundus flavimaculatus. Inheritance is autosomal dominant

Lisch Dystrophy: Lisch Epithelial Corneal Dystrophy (LECD), also known as band-shaped and whorled microcystic dystrophy of the corneal epithelium, is a rare form of corneal dystrophy first described in 1992 by Lisch, et al.

Lincoff Rules

These rules are required to finding the break in Primary RRD:

Rule 1: In superior-temporal or superior-nasal detachment: The primary break IS within 1.5 clock hours of the highest border (in 98% of cases)
Rule 2: In total detachments superior that cross the 12 o’clock meridian (vertically above the disc): The primary break is at 12 o’clock or the break is a triangle with the apex at the ora serrata and the base at the equa tor, extending from 11 to 1 o’clock (in 93% of cases)
Rule 3: In inferior detachments: The higher side of the detachment indicates the side of the disc where the primary break lies, and the break is found below the horizontal meridian (in 95% of cases). However, in inferior detachment where right/left borders are equally high, the break is in the inferior retina at 6 o’clock
Rule 4: In inferior bullous detachments: The primary break is located above horizontal meridian

Lincoff’s Rules (Modified)

Inferior RD with equal SRF levels on both sides of the Optic Disc : A primary RB will be at inferior, at 6 o’clock position
A shallow inferior RD in which the SRF is slightly higher on the temporal side: A primary RB will be located inferiorly on that side. In the other words, in “Lateral” RRD that means inferior swallow RRD with SRF higher on one side of the optic disc (OD) (superotemporal or superonasal RRD), primary RB is within 1.5 clock hours of the higher border of RRD
A bullous inferior RRD: A primary RB will usually exist above the horizontal meridian
A diffuse RRD with a superior attached wedge retina from Optic Disc to ora serrata: Because of the primary RB located in the upper nasal quadrant, the SRF will revolve around the OD and then rise on the temporal side until it is level with the primary RB
A subtotal RRD with a superior wedge of the attached retina A primary RB will locate in the periphery nearest its highest border
A diffuse RRD with an inferior attached wedge retina from OD to ora serrata: When the SRF crosses the vertical midline above; the primary break is near to 12o’clock, the lower edge of the RRD corresponding to the side of the break

Lincoff Balloon (temporary) Scleral Buckle: A temporary balloon buckle for the treatment of small retinal detachments

M

Marcus Gunn Jaw Winking Phenomenon: Unilateral eyelid movement with movement of the jaw

Marcus Gunn Pupil: Relative afferent pupillary defect caused by optic nerve lesion or extensive retinal disease

Maddox Cross: The Maddox Cross is a tangent scale for squint angle measurement and retinal correspondence testing

Maddox Rod: It can be used to subjectively detect and measure a latent, manifest, horizontal or vertical strabismus for near and distance. The test is based on the principle of diplopic projection

Maddox Wing: It is a quantitative and subjective method of measuring the size of a strabismic deviation by dissociation of the eyes brought about by two septa which are placed in such a way as to present fields to either eye separated by a diaphragm at the centre

Mikulicz’s Syndrome: Chronic dacryoadenitis with bilateral painless swelling of lacrimal and salivary glands and decreased or absent lacrimation. Seen in sarcoidosis, lymphoma and other infiltrative diseases

Mizuo–Nakamura Phenomenon: Loss of abnormal macular sheen with dark adaptation in Oguchi’s disease

Mobius Syndrome: A congenital syndrome characterized by congenital palsy of the external rectus and facial muscles, usually bilateral, associated with paralysis of the sixth and seventh nerves

Moebius’ Sign: Poor convergence in thyroid disease

Morax-Axenfeld Bacillus: Morax-Axenfeld bacillus: a rod-shaped bacterium of the genus Moraxella (M. lacunata) that causes Morax-Axenfeld conjunctivitis

Muller’s Muscle: Müller’s muscle is sometimes used as a synonym for superior tarsus muscle. However, the same term is also used for the circular fibers of the ciliary muscle,and also for the orbitalis muscle that covers the inferior orbital fissure

Muller’s Cell: Müller glia, or Müller cells, are a type of retinal glial cells, first recognized and described by Heinrich Müller. They are found in the vertebrate retina, which serve as support cells for the neurons, as all glial cells do

Morgagnian Cataract: Hypermature cortical cataract in which liquified cortex allows the nucleus to sink inferiorly

Munson’s Sign: Protrusion of the lower lid with downgaze in keratoconus

N

Naffziger’s Sign: Standing behind, patient’s neck is extended and examiner looks from behind along the superior orbital margin of the patient. Eyeball is seen beyond the superior orbital margin in exophthalmos

O

Ohngren’s Line: Ohngren’s Line is a line that connects the medial canthus of the eye to the angle of the mandible. The line defines a plane orthogonal to a sagittal plane that divides the maxillary sinus into (1) an anterior-inferior part, and (2) a superior-posterior part

P

Parinaud’s Oculoglandular Conjunctivitis: Unilateral granulomatous follicular conjunctivitis associated with ipsilateral regional lymphadenopathy

Parinaud’s Syndrome: A dorsal midbrain lesion such as pinealoma which results in vertical gaze palsy, convergence-retraction nystagmus and light-near dissociation

Panum’s Area: Zone of single binocular vision around the horopter Parry’s sign: Exophthalmos in thyroid disease

Paton’s Line: Circumferential peripapillary retinal folds caused by optic nerve edema

Posner Gonioprism: The Ocular Posner Diagnostic and Surgical Gonioprism is a four mirror gonio lens designed for static and dynamic gonioscopy which requires no gonioscopic solution for optical interface. The lens consists of a highly polished truncated pyramid with a plano anterior viewing surface over four mirrors inclined at 64°. The mirrored surfaces are silvered and double coated with a proprietary coating to prevent peeling and damage under normal daily use. The posterior surface of the Posner Gonio Prism has a base curve of 41.5D and a diameter of 9mm. The lens is easily positioned and maneuvered by an aluminum handle set at 17°

Posner Schlossman Syndrome: Posner-Schlossman Syndrome (PSS), also known as glaucomatocyclitic crisis, is a disease typified by acute, unilateral, recurrent attacks of elevated intraocular pressure (IOP) accompanied by mild anterior chamber inflammation

Pourfour du Petit Syndrome: It is the term used for the combination of signs caused by sympathetic stimulation (i.e., lid retraction, mydriasis, and conjunctival blanching).This syndrome is the clinical opposite of Horner syndrome. It represents oculosympathetic overactivity instead of underactivity and usually is caused by lesions along the cervical sympathetic chain

Pseudo–von Graefe Sign: Lid elevation on adduction or downgaze caused by aberrant regeneration of CN III

Pulfrich Phenomenon: Perception of stereopsis (elliptical motion of a pendulum) caused by a difference in nerve conduction times between eyes and cortex, seen in multiple sclerosis

Purkinje Sanson Images: Reflected images from front and back surfaces of cornea and lens

Purkinje Shift: Shift in peak spectral sensitivity from photopic (555 nm, cones) to scotopic (507 nm, rods) conditions

Purkinje Fibers: Purkinje Fibers are networks of fibers that receive conductive signals originating at the atrioventricular node (AVN), and simultaneously activate the left and right ventricles by directly stimulating the ventricular myocardium

Purkinje Cells: Purkinje cells, also called Purkinje neurons, are neurons in vertebrate animals located in the cerebellar cortex of the brain. Purkinje cell bodies are shaped like a flask and have many threadlike extensions called dendrites, which receive impulses from other neurons called granule cells

Purkinje Vascular Entoptic Test: The Purkinje vascular entoptic test is a test of macular function which employs a light directed through the sclera illuminating the fundus. This light casts shadows of retinal blood vessels on to posterior pole photoreceptors. When the light source is moved, a patient with a good macular function should be able to see a negative image of his or her retinal blood vessels

Purkinje Effect: The Purkinje effect (sometimes called the Purkinje Shift) is the tendency for the peak luminance sensitivity of the eye to shift toward the blue end of the color spectrum at low illumination levels as part of dark adaptation

Purtscher’s Retinopathy: Patches of retinal whitening, retinal hemorrhages, and disc oedema after compression injury to the head. Patients may experience loss of vision in one or both eyes. Similar retinal abnormalities has been observed after severe compression injury to the chest

Pseudo Graefe’s Sign (pseudo lid lag): Shows a similar lag, but is due to aberrant regeneration of fibres of the oculomotor nerve (III) into the elevator of the upper lid. It occurs in paramyotonia congenita. A pseudo Graefe’s sign is most commonly manifested in just one eye but can occasionally be observed in both. The reason only one eye is affected is not yet clear

Q

R

Reiter Syndrome: The classic triad consists of conjunctivitis, urethritis, and arthritis; other characteristic features include heel pain, skin and mucous membrane lesions, and bone changes. This condition typically affects young men who are HLA B 27 positive

Riddoch Phenomenon: Visual field anomaly in which a moving object can be seen whereas a static one cannot

Rizutti’s Sign: Triangle of light on iris from oblique penlight beam focused by cone in keratoconus

Riley-Day Syndrome

Also called familial dysautonomia, is a rare disorder found almost exclusively in persons of Ashkenazi Jewish descent. The responsible gene is IKBKAP gene on chromosome 9 and is inherited in autosomal-recessive fashion. Diagnosis is based on five clinical signs:

(a) lack of flare following intradermal histamine injection;
(b) absence of fungiform papillae on the tongue;
(c) pupillary miosis to dilute muscarinic agents such as pilocarpine (cholinergic denervation supersensitivity);
(d) severe hypolacrimation; and
(e) absent muscle-stretch reflexes

Recklinghausen’s Disease (Neurofibromatosis): Inheritable disease characterized by café au lait spots combined with multiple peripheral nerve tumours and a variety of others dysplastic abnormalities of the skin, nervous system, bones, and endocrine organs

Ross Syndrome: It is the eponym given to the triad of tonic pupils, absent muscle-stretch reflexes, and progressive segmental impairment of sweating. The tonic pupils observed in the Ross syndrome can be unilateral or bilateral and show the same clinical characteristics as an idiopathic tonic pupil

S

Schwalbe’s Line: An anatomical line located on the posterior surface of the eye’s cornea

Schwalbe’s Ring: It is a circular ridge consisting of collagenous fibers surrounding the outer margin of Descemet’s membrane

Radial Contraction Folds of Schwalbe: The radial contraction folds of Schwalbe are a series of very fine radial folds in the pupillary portion of the iris extending from the pupillary margin to the collarette. They are associated with the scalloped appearance of the pupillary ruff

Schwalbe’s Nucleus: Vestibular nucleus

Schwalbe’s Spaces: The subarachnoid or subdural spaces between the internal and external sheaths of the optic nerve are now referred to as “Schwalbe’s spaces”; also called the intervaginal spaces of optic nerve (spatia intervaginalia nervi optici)

Schwartz Matsuo syndrome: It is characterized by a triad of rhegmatogenous retinal detachment, cells in anterior chamber, and elevated intraocular pressure, often in the evening

Shaffer’s Angle Grading: Shaffer’s grading system is based on the angle between the iris and the trabecular meshwork

Shaffer’s Sign: Refers to the presence of a collection of brown pigmented cells in the anterior vitreous following a PVD. The presence of Shafer’s sign suggests that pigment from the retina or RPE has dislodged, which significantly increases the probability that the patient has a retinal tear or detachment

Shy-Drager Syndrome: A progressive disorder of the central and sympathetic nervous systems, also called multiple system atrophy with postural hypotension (an excessive drop in blood pressure when the patient stands up, causing dizziness or momentary blackouts).Common ocular signs in patients with Shy-Drager syndrome include anisocoria, iris atrophy, convergence insufficiency, and nystagmus

Schirmer’s Test: This involves folding sterile filter paper strips and inserting them between the lower lid and the globe at the lateral one-third of the lid margin. The result is expressed as millimetres of wetting at 5 minutes. If local anaesthetic is instilled in the eye before performing this test, it is known as the basic Schirmer test

Scheie Syndrome / Mucopolysaccharidoses 1: Scheie Syndrome is a disease caused by a deficiency in the enzyme iduronidase, leading to the buildup of glycosaminoglycans (GAGs) in the body. It is the most mild subtype of mucopolysaccharidosis type I; the most severe subtype of this disease is called Hurler Syndrome

Scheie’s Grading (Gonioscopy): The Scheie system is based upon visibility of the anatomical structures of the angle. They are graded Wide through IV, with Wide being the most open

SCHEIE (Systematic Classification of Humphrey visual fields-Easy Interpretation and Evaluation): Grading System for glaucomatous visual fields was created to convey qualitative and quantitative information regarding visual field defects in an objective, reproducible, and easily applicable manner for research purposes

Scheie’s Stripe: Pigment deposition along the insertion of the zonular fibers to the lens in pigment dispersion syndrome

Scheie’s Classfication of Hypertensive Retinopathy

The signs of chronic arteriosclerotic hypertension are as follows:

Stage 1: Widening of the arteriole reflex
Stage 2: Arteriovenous crossing sign (Figure 3)
Stage 3: Copper-wire arteries (copper colored arteriole light reflex)
Stage 4: Silver-wire arteries (silver colored arteriole light reflex)

Scheie Method of Cataract Extraction: Used to perform cataract surgeries in pediatric population. Posterior capsule was left intact and the lens matter was aspirated out

Schiotz Tonometer: An instrument for measuring intraocular pressure

Seidel’s Test: Method of detecting wound leak by observing aqueous dilute concentrated fluorescein placed over the suspected leakage site

Seidel’s Scotoma: Seidel’s Sign (also called Seidel’s Scotoma) is a sickle-shaped scotoma that is a superior or inferior extension of the blind spot. It occurs in some patients with glaucoma

Sjorgren’s Syndrome: A chronic autoimmune disease characterised chiefly by keratoconjunctivitis sicca and dry mouth

Snellen’s Charts: Tests visual acuity

Snellen’s Operation: This surgery is done for Trichiasis with slight entropion or only involving part of the eyelid or Entropion with a very thickened tarsal plate. A wedge is excised from the front of the tarsal plate so that the margin of the tarsal plate can rotate outwards. An ellipse of skin and muscle from the front of the eyelid is usually excised also, and a grey-line split performed as well. This helps the eyelashes to evert further

Salus’ Sign: Retinal vein angulation (90°) at the arteriovenous crossing in hypertension and arteriosclerosis

Shafer’s Sign: Anterior vitreous pigment cells (tobacco-dust) associated with retinal tear

Sherrington’s Law: Contraction of muscle causes relaxation of antagonist (reciprocal innervation)

Spiral of Tillaux: Imaginary line connecting insertions of rectus muscles

Stargardt’s Disease: The most frequently encountered juvenile onset macular degeneration characterised by multiple pisciform subretinal yellowish lesions

Stellwag’s Sign: Incomplete or infrequent blinking in thyroid disease

Sturge-Weber Syndrome: A congenital disorder characterised by port-wine stain of the face with mental retardation and epilepsy. There is a high incidence of glaucoma due to raised episcleral pressure

T

Tenon’s Capsule: Fascial covering of eye

Tay Sach’s Disease: An autosomal recessive disorder involving the lysozymal enzymes. The result is neuronal degeneration and cherry red spot of the eyes. Death occurs before 3 years of age

Terrien’s Marginal Degeneration: An uncommon but distinct variety of marginal thinning of the cornea. It is usually bilateral, although often asymmetric, and is seen mainly in younger men

Terson’s Syndrome: Terson described vitreous hemorrhages occurring in patients with subarachnoid hemorrhage and attributed it to a sudden increase in venous pressure that ruptures epipapillary and peripapillary capillaries. About 20% of patients suffering of subarachnoid, or subdural hemorrhages develop intraocular hemorrhages that in most cases are confined at the posterior pole. Intraretinal and subretinal bleeding may also be present, usually from the optic disc and retinal blood vessels. Subhyaloid hemorrhages are usually present. In most cases these hemorrhages clear spontaneously and vision function is unaffected

Trachoma Glands: Lymph nodes located in the palpebral conjunctiva. Also known as Bruch’s glands

Treacher Collins Syndrome: Coloboma of the lower lid at the junction of the middle and lateral third of the lid with systemic anomalies such as mandibulofacial dysostosis and malformed ear. It is an autosomal dominant condition

Tournay’s Phenomenon: Anisocoria that develops on extreme lateral gaze

U

Uhthoff ’s Symptom: Decreased vision or diplopia secondary to increased body temperature (e.g., exercise or hot shower); occurs after recovery in optic neuritis

V

Vogt’s Striae: Vertical stress lines seen deep in the affected stroma of keratoconus

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

von Graefe’s Knife: Knife designed for cataract extraction. Now of historical interest

White Lines of Vogt: Sheathed or sclerosed vessels seen in lattice degeneration

Palisades of Vogt: The limbus contains radially-oriented fibrovascular ridges known as the palisades of vogt that harbours stem cells

Limbal Girdle of Vogt: Corneal opacity that occurs in an arc concentric pattern and is adjacent to the limbus within the palpebral fissure at 3 and 9 o’clock; it is more common nasally than temporally, but it is frequently both.It is found in 60% of patients older than 40 years and occurs more frequently in women than in men

Vogt’s Anterior Mosaic Crocodile Shagreen: Anterior mosaic crocodile shagreen appears as bilateral, polygonal, grayish-white opacities in the deep layers of the epithelium and in Bowman’s layer

Vogt-Koyanagi-Harada (VKH) Syndrome: It is a systemic inflammatory condition involving the eye, as well as other organs commoner in certain races

Vogt’s Triad

Tuberous sclerosis

Facial nevus (adenoma sebaceum)
Seizures
Mental insufficiency

Congenital glaucoma/buphthalmos (BPL)

Lacrimation
Photophobia
Blepharospasm

Congenital toxoplasmosis (3C)

Congenital cataract
Chorioretinitis
Cerebral Calcification (diffuse)

Post congestive glaucoma (GAP)

Glaucomafleckens (Ant cortical opacity)
Iris Atrophy (stromal)
Pigment on the corneal endothelium

von Hippel-Lindau: A type of phakomatoses characterised by retinal angioma, cerebellar haemangioblastoma, renal tumour. The condition is autosomal dominant and the gene is now localized to chromosome 3.

von Hippel-Lindau Disease: A syndrome characterised by angiomatosis of the retina, haemangioblastoma of the cerebellum and walls of the fourth ventricle, commonly associated with polycystic lesions of the kidney and pancreas

von Hippel-Lindau Tumour: A disturbance characterised by angiomata of the retina and cysts and angiomata of the brain and certain visceral organs

Vossius Ring: A Vossius Ring is a result of compression of the pigmented posterior iris epithelial cells and/or pupillary ruff against the anterior lens capsule with abrupt blunt force to the eye

W

Waardenburg Syndrome: A hereditary congenital defect involving pigmentation, lateral displacement of the medial canthi and lacrimal points, and deafness

Waring Line: It is found in Cornea and comprises of stellate corneal epithelial iron deposition seen after radial keratotomy (RK). It is present in up to 80% of RK eyes

Wieger’s Ligament: Attachment of hyaloid face to back of lens

Willebrandt’s Knee: Inferonasal optic nerve fibers that decussate in chiasm and loop into contralateral optic nerve before traveling back to optic tract

Sturge-Weber Syndrome: A congenital disorder involving the brain, skin and eyes

Rendu-Osler-Weber Disease: A familial syndrome characterised by multiple telangiectasia of the skin, and of the oral, nasal, conjunctival and gastrointestinal mucous membranes

Wessley Ring: Corneal stromal infiltrate of antigen–antibody complexes

Weiss Ring / Vogt Ring: Ring of adherent peripapillary glial tissue on posterior vitreous surface after posterior vitreous detachment

Weiss Procedure: The principle is to split the lower lid transversely to create a fibrous tissue scar barrier which prevents the upward movement of the pre-septal muscle. This is combined with everting sutures which shorten the lower lid retractors and transfer their pull to the upper border of the tarsus

Wernicke’s Hemianopic Pupil: This phenomenon is caused by division of the optic tract that results in a contralateral homonymous hemianopia. The pupils fail to react when a narrow pencil of light is shone onto the non-seeing part of the retina, but they do react if it falls onto the seeing retinal areas

Wernicke’s Encephalopathy: Wernicke’s encephalopathy is a triad of nystagmus and ophthalmoplegia, unsteadiness of stance and gait(ataxia), and mental status change

Edinger-Westphal Nucleus: The parasympathetic (accessory) nucleus of the 3rd oculomotor nerve

X

Y

Z

Zentmayer’s Line: Pigment deposition on equatorial surface of lens, seen in pigment dispersion syndrome

Z-Plasty: It is a plastic surgery technique used to improve the functional and cosmetic appearance of scars. It involves the creation of two triangular flaps of equal dimension that are then transposed

Common Tendinous Ring of Zinn: The annulus of Zinn, also known as the annular tendon or common tendinous ring, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit. It is the common origin of the four rectus muscles (extraocular muscles)

Zinn’s Zonules: The zonule of Zinn (Zinn’s membrane, ciliary zonule) is a ring of fibrous strands connecting the ciliary body with the crystalline lens of the eye. The zonule is split into two layers: a thin layer which lines the hyaloid fossa and a thicker layer which is a collection of zonular fibers

Zinn’s Central Artery: The central retinal artery (Zinn’s artery) is a branch of the ophthalmic artery

Circle of Zinn: The arteries surrounding the optic nerve are sometimes called the “circle of Zinn-Haller”. This vascular structure is also sometimes called “circle of Zinn”

Zinn’s Membrane: It is a ring of fibrous strands forming a zonule (little band) that connects the ciliary body with the crystalline lens of the eye

Household Item Names for Signs

Bread crumb appearance: Complicated posterior subcapsular cataract

Cotton wool exudates: Fluffy white patches caused by damage to nerve ibre in infarction of retina (Diabetes, HT, AIDS) due to accumulation of axoplasmic material within the NFL.

Cotton cheese appearance: Regression of retinoblastoma, CMV retinitis

Cellophane maculopathy: Epiretinal membrane

Copper wire: Arteriosclerosis of retinal arterioles seen in Grade III hypertensive retinopathy

Candle wax drippings: Exudation along retinal vessels in sarcoidosis

Fish Flesh: Regression of retinoblastoma in large size

Snowball opacities: Retinal granuloma in sarcoidosis and pars planitis

Silver wire: Retinal arteries in arteriosclerosis seen in Grade IV hypertensive retinopathy

Salt and pepper retinopathy: In congenital syphilis, rubella

Lines

Arlt’s line: Horizontal palpebral conjunctival scar in trachoma

Arlt’s triangle: (Ehrlich–Türck line): Base-down triangle of central keratic precipitates in uveitis

Ferry’s line: Corneal epithelial iron line at edge of filtering bleb

Fingerprint lines: Seen in map dot fingerprint dystrophy

Hudson–Stahli line: Horizontal corneal epithelial iron line at the inferior third of the cornea at level of tear film caused by normal aging

Khodadoust line: Corneal graft endothelial rejection line composed of inflammatory cells

Paton’s lines: Circumferential peripapillary retinal folds caused by optic nerve edema

Sampaoelesi’s line: Increased pigmentation anterior to Schwalbe’s line in pseudoexfoliation syndrome

Scheie’s line: Pigment on lens equator and posterior capsule in pigment dispersion syndrome

Schwalbe’s line: Angle structure representing peripheral edge of Descemet’s membrane

Stocker’s line: Corneal epithelial iron line at edge of pterygium

White lines of Vogt: Sheathed or sclerosed vessels seen in lattice degeneration

Zentmayer’s line/Scheie’s line: Pigment deposition on equatorial surface of lens, seen in pigment dispersion syndrome

Rucker’s line: Sclerosed vessels due to periphlebitis retinae seen in Multiple sclerosis

Schlagel’s lines: Multiple yellow lines at posterior pole and periphery, arranged in clumps or linear streaks in multifocal choroiditis

Nodules, Plaques and Pearls

Bergmeister’s papilla: Remnant of fetal glial tissue at optic disc

Berlin nodules: Clumps of inflammatory cells in anterior chamber angle in granulomatous uveitis

Busacca nodules: Clumps of inflammatory cells on front surface of iris in granulomatous uveitis

Dalen–Fuchs nodules: Small, deep, yellow retinal lesions composed of inflammatory cells seen histologically between retinal pigment epithelium and Bruch’s membrane in sympathetic ophthalmia (also in sarcoidosis, Vogt–Koyanagi–Harada syndrome)

Elschnig pearls: Cystic proliferation of residual lens epithelial cells on capsule after cataract extraction

Hassall–Henle bodies: Peripheral hyaline excrescences on Descemet’s membrane caused by normal aging

Herbert’s pits: Scarred limbal follicles in trachoma

Hollenhorst plaque: Cholesterol embolus usually seen at vessel bifurcations associated with amaurosis fugax and retinal artery occlusions

Koeppe nodules: Clumps of inflammatory cells at pupillary border in granulomatous uveitis

Kyreileis’ plaques: White–yellow vascular plaques in toxoplasmosis

Lisch nodules: Iris melanocytic hamartomas in neurofibromatosis

Sattler’s veil: Superficial corneal edema (bedewing) caused by hypoxia (contact lens)

Rings

Coats’ ring: White granular corneal stromal opacity containing iron from previous metallic foreign body

Corneal rust ring: Small,reddish brown,circular opacity remained in the cornea after removal of iron foreign body

Double ring sign: Seen in hypoplasia of optic disc,with the peripheral margin of the encircling ring corresponding to the border of normal sized optic disc.

Fleischer ring: Corneal basal epithelial iron ring at base of cone in keratoconus

Kayser–Fleischer ring: Limbal copper deposition in Descemet’s membrane that occurs in Wilson’s disease

Pseudo fleischer’s ring: Iron deposition seen in hyperopes

Schwalbe’s ring: Posterior embryotoxon (anteriorly displaced Schwalbe’s line)

Soemmering’s ring cataract: Residual peripheral cataractous lens material after capsular rupture and central lens resorption from trauma or surgery

Vossius ring: Ring of iris pigment from pupillary ruff deposited onto the anterior lens capsule after blunt trauma

Weiss ring: Ring of adherent peripapillary glial tissue on posterior vitreous surface after posterior vitreous detachment

Wessley ring: Corneal stromal infiltrate of antigen–antibody complexes

Rings used for Management of Certain Conditions

Limbal ring method: An old method used in radiological localisation of intraocular foreign body.

Kera rings: An intrastromal ring segment, designed for treating corneal ectasias and refractive errors

Signs

Thyroid

Lid Signs

Dalrymple’s Sign: Lid Retraction

Von Graefe’s Sign: Lid lag of the upper eyelid on downward gaze

Vigoroux Sign: Eyelid fullness/swelling

Grove Sign: Resistance to pulling down the retracted upper lid

Rosenbach’s Sign: Fine tremors of the eyelids when closed

Gifford’s Sign: Difficulty in everting upper lid

Enroth Sign: Edema of lower lid

Boston’s Sign: Jerky irregular movement of upper lid on downward gaze

Kocher’s Sign: Increased lid retraction with visual fixation (staring look)

Abadie Sign: Spasm of the levator palpebrae superioris muscle with retraction of the upper lid

Riesman’s Sign: Bruit heard over the closed eye with a stethoscope

Facial Signs

Stellwag Sign: Incomplete and infrequent blinking (staring look)

Joffroy Sign: Absent creases in the forehead on superior gaze

Jellinek’s Sign: Hyperpigmentation of the superior eye folds

Hertoge’s Sign: Loss of the lateral third of eyebrows

Sainton’s Sign: Delayed forehead wrinkling on up gaze

Extra-Ocular Muscle Signs

Möbius Sign: Inability to converge

Ballet Sign: Restriction of one or more extraocular muscles

Jendrassik’s Sign: Limitation of abduction and rotation of eyeballs

Suker’s Sign: Poor fixation on abduction

Pupillary Signs

Cowen’s Sign: Jerky pupillary constriction to light

Lowy’s Sign: Mydriasis with instillation of lower concentration of adrenaline

Knies’s Sign: Unequal dilatation of pupil in dim light

Conjunctiva Signs

Goldzeiher’s Sign: Deep injection of the bulbar conjunctiva

Globe Sign

Payne Trouseau Sign: Globe luxation

IOP Sign

Sattler Sign: Increased intra-ocular pressure in upgaze

Becker’s Sign: Retinal arteries show visible pulsations

Multiple Sclerosis

Rucker’s Sign: Sheathing of the retinal veins in multiple sclerosis has been referred to as Rucker’s sign

Hepatic Cirrhosis

Summerskill’s Sign: Some patients with hepatic cirrhosis have eyelid retraction

Hypertensive Retinopathy

Gunns Sign: Tapering of veins on the either side of arteriovenous crossings

Bonnet Sign: Banking of veins distal to the atreriovenous crossings

Shalus Sign: Deflection of veins as it crosses the arterioles

Copper Wiring: Arterioscerosis causes the light reflex from the vessel wall takes on a reddish brown hue which is called copper wiring

Silver Wiring: In the presence of severe arteriolosclerosis, blood is not seen inside the vessel wall. This is called silver wiring

Guiat’s Sign: Tortuosity of retinal veins in arteriosclerosis

Herpes Zoster

Hutchinson’s Sign: Lesion on tip of the nose which can present before ocular herpes zoster

Hyperthyroidism and Basedow’s Disease

Kocher’s Sign: In fixation, on a fast upwards movement, a convulsive retraction of the eyelid is seen

Sigmoid Sinus Thrombosis

Empty Delta Sign: It is a triangular area of enhancement with a relatively low-attenuating center, seen on multiple contiguous CT in the area of sagittal sinus, which is the thrombosed sinus

Keratoconus

Munson’s Sign: V-shaped conformation of the lower lid produced by the ectatic cornea in down gaze

Rizutti’s Sign: Conical reflection on the nasal cornea when a penlight is shown from the temporal side

Charleaux Sign: On dilated dilated fundus examination, an annular dark shadow separating the bright reflex of the peripheral areas and the central areas is seen. It occurs due to complete internal reflection of the light

Fuch’s Heterochromic Iridocyclitis

Amsler’s Verrey Sign: Fine stream of blood seen usually coming from the opposite side of the point of entry while operating on a case of FHI. This is present due to fragile blood vessels and decompression of the anterior chamber

Plateau Iris

Double Hump Sign: The peripheral hump on the iris is caused by the ciliary body propping up the iris root, whereas central hump is the central third of the iris resting over the surface of the lens

Papilledema with Optic Atrophy

Kestenbaum’s Sign: Decrease in the number of vessels on the optic disc

Optic Atrophy

Laminar Dot Sign: Visibility of lamina pores

Optic Nerve Hypoplasia

Double Ring Sign: In this condition, the optic nerve head is small, grey in colour, surrounded by a yellowish mottled peripapillary halo, bordered by a ring of increased or may be decreased pigmentation where,

Outer Ring: normal junction between the sclera and lamina cribrosa

Inner Ring: abnormal extension of retina and RPE over the outer portion of lamina cribrosa

Third Nerve

Pseudo Graefe’s Sign (pseudo lid lag): Shows a similar lag like the Graefe’s sign, but is due to aberrant regeneration of fibres of the oculomotor nerve (III) into the elevator of the upper lid. It occurs in paramyotonia congenita. A pseudo Graefe’s sign is most commonly manifested in just one eye but can occasionally be observed in both. The reason only one eye is affected is not yet clear

Ocular Myasthenia

Peek Sign: After initial apposition of the lid margins, the lids quickly (within 30 seconds) start to separate and the sclera starts to show

Aberrant regeration of the 3rd CN

Czarnecki’s Sign: Segmental pupillary constriction with eye movements due to aberrant regeneration of CN III

Cotton Wool Spot

Depression Sign of Goldberg: Focal loss of nerve fiber layer after resolution of cottonwool spot

Measles

Hirschberg’s Sign: Pale, round spots (Koplik spots) on conjunctiva and caruncle in measles

Sarcoidosis

Lander’s Sign: Inferior preretinal nodules in sarcoidosis

Sickle Cell Disease

Paton’s Sign: Conjunctival microaneurysms in sickle cell disease

VKH

Sugiura’s Sign: Perilimbal vitiligo associated with Vogt–Koyanagi–Harada syndrome

Normal Fundus

Van Trigt’s Sign: Venous pulsations on the optic disc (normal finding)

Angle Closure Glaucoma

Vogt’s Sign: White anterior lens opacities (glaukomflecken) caused by ischemia of lens epithelial cells from previous attacks of angle closure

Macular Hole

Watzke–Allen Sign: Patient with macular hole perceives break in light when a slit beam is focused on the fovea

Triads

Near Triad: Accommodation (increased curvature of anterior surface of lens), convergence, and miosis

Optic Nerve Triad: Consists of relative afferent pupillary defect (RAPD), color vision, and brightness sense

AGR Triad: Aniridia, ambiguous genitalia, and mental retardation

Alport’s Syndrome: An oculorenal syndrome characterized by ocular anomalies, progressive sensori-neural hearing loss, and hemorrhagic nephropathy

Congenital Rubella Syndrome: Characterized by the triad of cataracts, deafness, and cardiac defects

Hutchinson’s Triad: Seen in congenital syphilis - Hutchinson’s teeth, sensory neural hearing loss, and interstitial keratitis

The ICE (Iridocorneal Endothelial) Syndrome: A spectrum of diseases including progressive (essential) iris atrophy, Chandler’s syndrome, and Cogan-Reese syndrome (iris-nevus syndrome)

Intraoperative Floppy Iris Syndrome (IFIS): A triad of floppy iris that billows in response to normal irrigation in the anterior chamber, propensity for the iris to prolapse out of the main and side port incisions, and progressive pupillary constriction during surgery

Oculocerebrorenal Syndrome of Lowe (OCRL): has a triad that includes congenital cataracts, mental retardation, and renal tubular dysfunction

Oculoglandular Syndrome of Parinaud: Characterized by a triad of follicular (granulomatous) conjunctivitis, regional lymphadenopathy, and fever

Postnatally Acquired Measles: Patients exhibit a triad of cough, coryza, and follicular conjunctivitis

Tyrosinemia Type-II (Richner-Hanhart syndrome, oculocutaneous Tyrosinemia, or Oregon type tyrosi-nemia): Characterized by a triad of bilateral dendriform keratitis, hyperkeratotic lesions of the palms and soles, and mental retardation

UGH Syndrome or Ellingson Syndrome: A triad of uveitis, glaucoma, and hyphema

Acute Retinal Necrosis (also called Kirisawa’s Uveitis): A triad of an arteritis and phlebitis of the retinal and choroidal vasculature (mainly arteritis); a confluent, necrotizing retinitis, especially in peripheral retina; and a moderate to severe vitritis

Behcet Syndrome (Adamantiades Behcet Disease): Consists of a triple symptom complex of recurrent aphthous oral ulcers, genital ulcers, and uveitis

Congenital Toxoplasmosis: Patients have a triad of chorioretinitis (seen in 80% of patients), hydrocepha-lus, and intracranial calcification

Fuch’s Heterochromatic Iridocyclitis: Classically characterized by a triad of iris heterochromia, cataract, and keratic precipitates (low-grade iritis)

Reactive Arthritis (Reiter’s) Syndrome: Defined as classical triad of urethritis, polyarthritis, and con-junctival inflammation

Early onset sarcoid: In children younger than four years of age has a distinct clinical picture characterized by the triad of rash, polyarthritis, and uveitis

Susac Syndrome (SICRET Syndrome: Small Infarctions of Cochlear, Retinal, and Encephalic Tissue): Characterized by encephalopathy, hearing loss, and branch retinal arterial occlusion

Open Angle Glaucoma: Characterized by triad of glaucomatous optic disc changes, visual field changes, and raised intraocular pressure (IOP)

Vogt’s Triad of Glaucoma: It is characterized by glaucomaflecken (anterior subcapsular lenticular opacity), patches of iris atrophy, and slightly dilated non-reacting pupil (due to sphincter atrophy)

Aicardi Syndrome: A triad consisting of widespread round or oval chorio-retinal lacunae clustered around the disc, infantile spasms, and agenesis of corpus callosum

Coats’ Disease: In advanced cases may simulate advanced exophytic retinoblastoma by the triad of retinal detachment, dilated retinal vessels, and appearance of subretinal mass

Cone Degeneration: Includes the triad of progressive central acuity loss, color vision disturbances, and photophobia

Familial Amyloidotic Polyneuropathy (FAP): Characterized by peripheral neuropathy, cardiomyopathy, and vitreous opacity (amyloidosis)

Kearns Sayre Syndrome: A mitochondrial cytopathy characterized by a triad of chronic progressive external ophthalmoplegia, retinitis pigmentosa, and cardiac conduction defects (heart block)

Norrie’s Disease (Oculoacousticocerebral Degeneration): Characterized by a triad of retinal malformation or dysplasia, deafness, and mental retardation

Presumed Ocular Histoplasmosis Syndrome (POHS): A triad of multiple white atrophic scars (histo spots), peripapillary pigmentary changes, and maculopathy due to choroidal neovascularization in the absence of vitreous cells

Retinitis Pigmentosa: Consists of triad of pale optic discs, attenuated retinal arterioles, and bony spicule pigmentation

Schwartz Matsuo Syndrome: Characterized by a triad of rhegmatogenous retinal detachment, cells in anterior chamber, and elevated intraocular pressure,often in the evening

Stargardt disease: A triad of a bull’s-eye maculopathy, fundus flavimaculatus flecks, and a silent or dark choroid on fluorescein angiography

Balint’s Syndrome / Balint-Holmes Syndrome: A disorder of visuospatial relationships resulting from bilateral occipitoparietal lesions. It is characterized by the triad of simultanagnosia, optic ataxia, and acquired oculomotor apraxia

Charles Bonnet Syndrome: A triad of complex visual hallucinations, ocular pathology causing bilateral visual deterioration, and preserved cognitive status

The Foster Kennedy Syndrome (Gowers-Paton-Kennedy Syndrome, Kennedy’s Phenomenon, or Kennedy’s Syndrome): Consists of the triad of optic atrophy, contralateral papilledema, and anosmia (or hyposmia)

Horner’s Syndrome (Horner Syndrome, Bernard-Horner Syndrome, Claude Bernard-Horner Syndrome, or Oculosympathetic Palsy): A classical triad of mild (1–2 mm) ptosis, miosis, and anhidrosis

Ischemic Optic Neuropathy: Described classically as a triad of vision loss, afferent pupillary defect, and a swollen optic nerve

Leber’s Hereditary Optic Neuropathy: A triad of circumpapillary telangiectatic microangiopathy, swelling of the nerve fiber layer around the disc (pseudoedema), and absence of leakage from the disc or papillary region on fluorescein angiography

Neuroretinitis due to cat scratch disease: A triad of abrupt vision loss, unilateral optic disc swelling, andmacular edema (macular star)

Ocular Tilt Reaction (OTR): A triad of skew deviation with ocular torsion and a head tilt

Optic Neuritis: A triad of subacute unilateral loss of vision, periocular pain, and impaired color vision

Orbital Apex Syndrome (OAS): Characterized by a triad of ophthalmoplegia due to paresis of the third, fourth, and sixth cranial nerves; anesthesia in the region of supply of ophthalmic division of the fifthnerve; and amaurosis due to involvement of the optic nerve

Ross Syndrome: A rare focal dysautonomia. It is characterized by the triad of tonic pupil, absent muscle stretch reflexes, and progressive segmental impairment of sweating

Spasmus Nutans: A triad of nystagmus (unilateral or bilateral asymmetric, high frequency, horizontal), head nodding, and torticollis

Blepharophimosis Syndrome (BPES): A triad of horizontal shortening of the palpebral fissures (blepharophimosis), congenital ptosis, and epicanthus inversus (epicanthic fold more prominent in the lower lid)

Direct Carotid-Cavernous Fistula: Clinically characterized by Dandy’s triad (pulsatile proptosis, conjunctival chemosis, and ocular bruit)

Crouzon Syndrome: Consists of a triad of premature synostosis, midfacial hypoplasia, and exophthalmos

Meningioma (of the optic nerve sheath): Denoted by a triad of optic atrophy, optocilliary shunt vessels, and painless, slowly progressive monocular vision loss

Allergic Triad: Symptoms for atopy consists of eczema (atopic dermatitis), hay fever (seasonal aller-gic rhinitis), and asthma

Cerebellopontine Angle Mass (usually a Vestibular Schwannoma): A triad of unilateral deafness, corneal anesthesia, and a mild lower motor neuron facial nerve paresis

Churg Strauss Syndrome: A rare disorder characterized by the triad of severe asthma, eosinophilia, and systemic vasculitis

Cushing’s Triad: A feature of raised intracranialpressure leading to cerebral herniation, and fatal brainstem compression

Felty Syndrome: A triad of rheumatoid arthritis(RA), splenomegaly, and neutropenia

Gardner’s Syndrome: A triad of multiple polyps of the colon, multiple osteomas (ofthe skull, mandible, and long bones), and soft tissue tumors (epidermoid cysts, lipomas and fibromas)

Type 2 Gaucher Disease (Acute Infantile Neuropathic Gaucher’s Disease): A triad of trismus, strabismus, and retroflexion of the head is seen

Goldenhar Syndrome (Oculoauriculovertebral Dys-plasia or Branchial Arch Syndrome): The classical triad has ocular dermoid cyst, preauricular skin tags, and vertebral dysplasia (cervical hemivertebra)

Gradenigo’s Syndrome (Gradenigo-Lannois Syndrome): The classical triad consists of periorbital unilateral pain due to trigeminal nerve involvement, diplopia due to sixth nerve palsy, and persistent otorrhea

Graves Disease: Clinically defined by a triad of exophthalmos, pretibial myxedema, and hyperthyroidism

Merseburger Triad: The classical symptom triad of exophthalmos, goiter, and tachycardia in Graves disease. Name given by German physician Karl Adolph von Basedow (1799–1854) and Irish surgeon Robert James Graves (1796–1853), so the disease is also known as Basedow-Graves disease

Hemochromatosisis: Characterized by the classic triadof bronze complexion, hepatomegaly, and diabetes mellitus

Hand-Schuller-Christian Disease: Characterized by a triad of proptosis, diabetes insipidus (from involvement of posterior pituitary), and osteolytic defects in the skull

Henoch-Schonlein Purpura: Consists of purpuric rash occurring on the lower extremities,abdominal pain or renal involvement, and arthritis

Hyperviscosity Syndrome: Typically presents with a triad of bleeding diathesis (gingival, epistaxis, gastrointestinal, intraretinal, or postsurgical bleeding), visual disturbances (from retinal vein vascularabnormalities, retinal vein thrombosis, diplopia, or optic nerve edema), or focal neurologic findings (headache, vertigo, deafness, syncope, ataxia, diplo-pia, or even coma, cerebral hemorrhage, seizures, and chorea)

Klippel–Trenaunay Syndrome (KTS, Angiosteohyper-trophy): A sporadic disease characterized by a triadof cutaneous hemangiomata, especially of an extre-mity, hemihypertrophy of bone and soft tissue of theaffected limb, and varicosities (naevus variqueuxosteohypertrophique)

Lambert Eaton myasthenic syndrome (LEMS): A classic triad of proximal muscle weakness, areflexia, and dysautonomia

Wallenberg’s Lateral Medullary Syndrome: A triad of a central Horner syndrome, ipsilateral ataxia, and contralateral hypalgesia clinically identified as lateral medullary infarction or Wallenberg syndrome

Classic Miller Fisher Syndrome (MFS): A rare form of Guillain–Barre ́syndrome (GBS), characterized by descending paralysis. Eyes are involved early and a characteristic triad of bilateral ophthalmoplegia, ataxia, and areflexia develops

Progressive Multifocal Leukoencephalopathy (PML): Characterized pathologically by a triad of multifocal demyelination, hyper-chromatic enlarged oligodendroglial nuclei, and enlarged bizarre astrocytes with lobulated hyperchromatic nuclei

Sampter’s Triad: Characterized by asthma, nasal polyps, and allergy to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs)

Sjogren’s Syndrome (SS): Consists of a triad ofsymptoms including dry eyes (keratoconjunctivitissicca), dry mouth (xerostomia), and rheumatoidarthritis

Sturge–Weber Syndrome (Encephalotrigeminal Angioma-tosis): Characterized by the triad of skin [nevus flammeus (cutaneous hemifacial hemangioma)], central nervous system (leptomeningeal angiomatosis,cerebral gyriform calcifications), and ocular findings(choroidal hemangioma and glaucoma)

Suprasellar Germ Cell Tumors (Ectopic Pinealomas Oratypical Teratomas): A symptom triad of diabetes insipidus, visual disturbances, and pan-hypopituitarism

Tuberous Sclerosis (Bourneville disease or Epiloia): A triad of epilepsy, low intelligence quotient (mental retardation), and adenoma sebaceum or facial angio-fibroma. This is called Vogt’s triad of tuberous sclerosis

Wegner’s Granulomatosis: A histological triad ofnecrotizing vasculitis (granulomatous and dissemi-nated small vessels), granulomatous inflammation, and tissue necrosis

Wernicke’s Encephalopathy: A triad of nystagmus and ophthalmoplegia, unsteadiness of stance and gait(ataxia), and mental status change

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