- Eye signs of thyrotoxicosis.

Eye signs of thyrotoxicosis.

"DR Joffroy may validate symptoms"

• Dalrymple sign:- rim of sclera is seen all around the cornea, on looking straight forward.
• Rosenbach's sign:- fine tremor of the upper eyelids on slight closure of the eye.
• Joffroy's sign:-lack of wrinkling of the forehead when a patient looks upward.
• Moebius sign:- lack of convergence on looking to near object.
• Von Graefe's sign (lid lag sign):-lagging of the upper eyelid on looking downward without movinh the head.
• Stellwag's sign:-staring look with infrequent blinking.

Dr Ibrahim,,

- Classification of Graves' eye disease.

Classification of Graves' eye disease. 

"NO SPECS"

• Class 0: No signs or symptoms.
• Class 1: Only signs (limited to upper lid retraction and stare, with or without lid lag).
• Class 2: Soft tissue involvement (oedema of conjunctivae and lids, conjunctival injection, etc.).
• Class 3: Proptosis.
• Class 4: Extraocular muscle involvement.
• Class 5: Corneal involvement.
• Class 6: Sight loss (due to optic nerve involvement).

Enjoy,,

Dr Ibrahim

- Source:-

• Werner SC. Modification of the classification of the eye changes of Graves' disease: recommendations of the Ad Hoc Committee of the American Thyroid Association. J Clin Endocrinol Metab 1977;44: 203-4.

- Local causes of complicated cataract.

Local causes of complicated cataract.

"Rigid"

• long standing Retinal detachment
• Inflammatory conditions:- chronic iridocyclitis,chorioretinitis
• Glaucoma.
• Intraocular tumors
• Degenerative conditions:- retnitis pigmentosa, degenerative myopia. 
local Drugs:- corticosteroids, pilocarpine, adrenaline eye drops.

Mechanism:-

• Interference with lens metabolism.
• The posterior cortex is affected early,as the posterior capsule is thin and devoid of sub capsular epithelium.

Enjoy,,,

Dr Ibrahim

- Structures of angle of Anterior chamber.

Structures of angle of Anterior chamber.

"I Can See Till Schwalbe's Line"

• Iris root.
• Cilliary Body.
• Scleral spur.
• Trabecular Meshwork.
• Schwalbe's Line.

These Structures are seen by gonioscopy.

Enjoy,,,

Dr Ibrahim

-Sjögren's syndrome.

Sjögren's syndrome

(Sicca syndrome.)

*Def:-

It is chronic inflammatory autoimmune disorder in which immune cells attack and destroy the exocrine glands(1)that produce tears and saliva.

*synonymes:-

• Mikulicz disease.
• Sicca syndrome.

*It is named after Swedish ophthalmologist Henrik Sjögren(2)(1899–1986) who first described it.

*Pathology:-

It is characterized by unusual infiltration of these glands that are responsible for fluid production by lymphocytes, thus causing decreased saliva (dry mouth), decreased tear production (dry eyes), and drying of other mucous membranes.

- Horner's syndrome.

Horner's syndrome

*Def:-

It is a clinical syndrome caused by damage to the sympathetic nerve supply to head and neck.

*synonymes:-

• Bernard-Horner syndrome
• oculosympathetic palsy.

*Causes:-

Due to lesion or compression of one side of the cervical or thoracic sympathetic chain which generates symptoms on the ipsilateral (same side as lesion) side of the body:-

-Local causes of Miosis.

Local causes of Miosis (Constriction of the pupil)
"Path"

Puncture of anterior chamber.
Acute iritis.
Traumatic Miosis.
Hypermetropia.

Dr Ibrahim

-Causes of sudden complete loss of vision.

Causes of sudden complete loss of vision

"March"

Malingeres.
Amaurosis fugax.
Rupture globe(painful)
Central retinal artery occulsion(painless).
Hysteria.

Dr Ibrahim

-Effect of blunt trauma on optic nerve.

Effect of blunt trauma on optic nerve
"Heat"

Hemorrhage of the optic nerve sheaths.
Edema of the optic nerve with hypotony.
Avulsion of the optic nerve with twisting injuries.
Traumatic optic atrophy usually of primary type due to ischemia due to rupture of the capillaries.

Dr Ibrahim

-Differential diagnosis of of leukocoria in infants.

Differential diagnosis of of (white pupil)leukocoria in infants
"predict"

• Presistent hyperplastic primary vitreous:congenital anomaly with fibrosis of anterior vitreous so there is opacity behind the lens.
• Retinoblastoma(the most important cause).
• Retinopathy of prematurity:- due to exposure of premature infants to high oxygen concentration in incubators with subsequent fibrosis and tractional retinal detatchment.
• Endopthalmitis.
• Dysplasia of retina.
• Inflammatory cyclitic membrane:- a membrane of exudate lie behind the lens.
• Congenital Cataract (the most common cause).
• Coat's disease:-unilateral extensive leakage from the retinal vessels resulting in large massses of subretinal lipids.
• Toxocariasis.

Dr Ibrahim

-Cuases of chronic catarrhal conjuctivitis.

Cuases of chronic catarrhal conjuctivitis
"Legs"

Local irritation with rubbing lashes.
Error of refraction.
General irritation with dust,smoke,wind or heat.
Sequelae of acute conjuctivitis.

Dr Ibrahim

-Treatment of dry eye.

Treatment of dry eye
"Spot"

Systemic steroids(in autoimmune cases).
Protective glasses and conycy lenses.
Occulsion of puncti to reduce tear drainage.
Tear substitutes (eye drops,eye gel)
Treatment of any associated diseases.

Dr Ibrahim

-Signs of Acute Dacryocystitis.

Signs of Acute Dacryocystitis
"Rate"

Marked Redness of skin over the sac.
Regurgitation test: -ve due to congestion of canaliculi.
Abscess formation with flactuation.
Tender swelling of lacrimal sac.
Marked Edema of skin over the sac.

Dr Ibrahim

- Clinical Picture of Symblepharon.

Clinical Picture of Symblepharon

"Blade"

Bad cosmetic appearance.
Limitation of ocular motility and diplopia.
Ankyloblepharon.
Diminution of vision in cases of corneal affection.
Exposure Keratopathy and chronic conjuctivitis.

Dr Ibrahim

- Cuases of lacrimation.

Cuases of lacrimation

Lacrimation is increased production of tears.

Cuases:-          "Life"
latent squint.

Inflammation of(Lid margins,Conjunctiva,Cornea,iris,ciliay body).
IOP elevation (Glaucoma).

Foreign body(Conjunctival or corneal).

Error of refraction,Emotional conditions.

Dr Ibrahim

-Grades of binocular single vision.

Grades of binocular single vision

Grade I(Simultaneous preception):
It is the ability to see two objects at one time.

Grade II(Fusion):
It is the ability to fuse similar objects with control.

Grade III (stereopsis)(perception of depth):
It is the ability to perceive depth when eye is presented with slightly dissimilar image of the same object.

Return to list of medical grades (click here) 

Dr Ibrahim

-Grading of hypertensive retinopathy.

Grading of hypertensive retinopathy

Grade 1: mild generalized arteriolar attenuation especially branches.

Grade 2: more severe,generalized,and focal
arteriolar constriction with deflection of veins at arterio-venous crossings(salus sign).

Grade 3: Copper wiring of the arterioles,banking veins,distal crossing changes,tapering of veins on either side of the crossing and right angled deflection of veins.These findings are associated with flame shapped hemorrhage,cotton wool spots and hard exudates.

Grade 4: all of the above changes as well as silver wiring of the arterioles and disc swelling.

Return to list of medical grades (click here) 

Dr Ibrahim

- Medical syndromes.

Medical syndrome is defined as :-
A group of symptoms and signs that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.
There are a lot of medical syndromes and we try to list some of them:-
1-Down syndrome (click here).
2-Plummer-Vinson syndrome (click here).
3-Ramsay Hunt syndrome (click here).
4-Wolf-Hirschhorn Syndrome (click here).
5-Cri-du-chat syndrome (click here).
6-YY syndrome (click here).
7-Klinefelter's syndrome (click here).
8-Turner's syndrome (click here).
9- Fanconi syndrome (click here).
10-Abderhalden-Kaufmann-Lignac syndrome (click here) .
11-Light Wood-Albright syndrome(Lightwood syndrome)(click here).
12-Oculo-cerebro-renal Syndrome (click here).
13-Metabolic syndrome (click here).
14-Pickwickian syndrome (click here).
15- Kallmann syndrome (click here).
16-Sertoli-cell-only syndrome (click here).
17-Lambert-Eaton syndrome (click here).
18-Guillain Barré syndrome (click here).
19-Horner's syndrome (click here).
20-Brown-Séquard syndrome. (click here).
21-Carpal tunnel syndrome. (click here).
22-Sjögren's syndrome (click here).
23-Felty's syndrome (click here).
24-Caplan's syndrome (click here).
25-Congenital Rubella Syndrome  (click here).
26-Caroli's syndrome.  (click here).
27-Malabsorption syndrome.  (click here).
28-Duhin-Johnson syndrome.  (click here).
29-Exploding head syndrome. (click here). 

If you have other syndromes plz tell us...
Dr Ibrahim,,

- Differential Diagnosis of acute red eye.

This is an illustrative picture for

differential Diagnosis of acute red eye

Due to non proptotic causes.

I think it is really simple & good for

systematic diagnosis of acute red eye..

wait for loading.. the picture...

Enjoy...

see you...

Dr Ibrahim.....

- cornea.

cornea

* Definition :

It is a colorless (transparent) structure

covering the anterior 1/6 of the eye ball.


*Development of the cornea:

• Surface ectoderm forms the epithelium of the cornea.
• Mesoderm gives rise to the corneal stroma.
• Neural crest cells gives rise to the corneal Endothelium.

**Characters of the cornea :-

- colorless (transparent) structure and has a smooth surface.

- A vascular structure.

- Highly innervated by non-myelinated trigeminal nerve fibers.

-The most powerful refractive media of the eye

( 42+ diopters ).

- Diameter :-

• Horizontal = 12mm 
• vertical = 11mm Why…?

Due to scleral overlapping on upper

& lower sides of the cornea.

- It is not uniformly curved How…?

>>the central or optical zone having a smaller radius of

curvature than the peripheral parts,and the

posterior surface is more strongly curved than the anterior.

>> Ant radius of curvature = 7.7 mm 

>> Post radius of curvature = 6.6 mm

>>Thus the cornea is thinner (0.6 mm) at its

center than near its margin (1 mm).

see you,

Dr Ibrahim