- 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

-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

- 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.....