Dots and spots in Opthalmology

Dots & Spots in Ophth

• Leopard spots: in FFA, resulting from patchy subretinal infiltrates in a patient with reticulum cell sarcoma.

• Histo spot: Punched-out chorioretinal scars in Presumed ocular histoplasmosis syndrome (POHS)

• Cotton-Wool Spots: Diabetic retinopathy is the most common cause of cotton-wool spots. Cotton-wool spots have been associated with numerous other abnormalities, such as systemic arterial hypertension, collagen vascular diseases, cardiac valvular disease, carotid artery obstructive disease, coagulopathies, metastatic carcinoma, trauma, and human immunodeficiency virus infection.

• Bitot’s spot=White, foamy area of keratinising squamous metaplasia of bulbar conjunctiva,seen in vitamin A deficiency.

• Brushfield spot=Whitish grey spot in peripheral iris,seen in Down’s syndrome.

• Elschnig spot=Yellow patches overlying area of choroidal infarction in hypertension.

• Fischer-Khunt spot= Senile scleral paque,area of hyalinised sclera anterior horizontal rectus muscle insertion. Seen in old age.

• Foster Fuch’s spot=Pigmented (RPE hyperplasia) macular leisons in pathological myopia.

• Gunn’s dot=light reflectios from internal limiting membrane around disc and macula

• Horner-Trantras Dot= Collections of eosinophils at limbus in vernal conjunctivitis.

• Kayes’ dot (Krachmer’s spot)= subepithelial infiltrates seen in corneal graft rejection

• Mittendorf’s dot= whitish spot at posterior lens surface,remnant of hyaloid artery.

• Roth spots= haemorrhageswith white centres,seen in SABE, severe anaemia,collagen vascular disorders.

• Cherry red spot: Central retinal artery occlusion, Commotio retinae (Berlin’s oedema),Tay-Sachs’ disease, Niemann-Pick’s disease, Gaucher’s disease

• Cream-colored spots: The classic diagnostic feature of bird-shot vitiliginous chorioretinitis is cream-colored spots, often as large as 0.5 to 1 disc diameter, that are scattered throughout the fundus.

• Koplik’s spots: on conjunctiva in measles
Lines & Rings in Ophth

• Arlt’s Line = conjunctival scar in sulcus subtarsalis in Trachoma.

• Ehrlich-Turck Line = linear deposition of KPs in uveitis

• Ferry’s Line = corneal epithelial iron line at the edge of filtering blebs.

• Hudson-Stahil Line= Horizonatl corneal epithelial iron line at the inferior one third of cornea due to aging.

• Khodadoust Line = corneal graft endothelial rejection line composed of inflammatory cells.

• Paton’s Line = Circumferential retinal folds due to optic nerve edema.

• Sampaoelesi line = Increased pigmentation anterior to Schwalbe’s line in pseudoexfoliation syndrome.

• Zentmeyer line (Scheie’s Line): on the equatorial surface of the lens pigment dispersion syndrome

• Schwalbe’s Line = Angle structure representing peripheral edge of Descemets membrane.

• Stockers Line = Corneal epithelial iron line at the edge of pterygium

• White lines of Vogt = Sheathed or sclerosed vessels seen in Lattice degeneration

• Fingerprint lines: The map-dot fingerprint dystrophy

• LASIK Iron Line: After LASIK for myopia, the central corneal curvature is flatter than before surgery. The tear film distribution is therefore altered, allowing some pooling centrally. This pooling can cause iron deposition in the central epithelium. A similar effect can be seen after steeping of the cornea from treatment of hyperopia. In the case of hyperopia, a pseudo-Fleischer’s ring iron deposition can be seen. These iron lines do not affect vision.

• Vogt’s striae occur centrally in a patient with keratoconus. By applying digital pressure on the eye while looking through the slit lamp, these striae in the deep cornea, mostly Descemet’s membrane, disappear, which is charac teristic of keratoconus.

• The Descemet’s breaks or Haab’s striae from birth trauma tend to be vertical, while the Descemet’s tears associated with congenital glaucoma tend to be horizontal or curvilinear.

• Ring Keratitis: The hallmark of Acanthamoeba keratitis

• Kayser-Fleischer’s ring: Wilson’s disease

• Corneal rust ring: A small, reddish brown, circular opacity remained in the cornea after the removal of an iron foreign body.

• Coats’ ring: remnants of a foreign body. The remnants are fine iron deposits in the cornea.

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

• Pseudo-Fleischer’s ring: iron deposition can be seen in Hyperopia

• Soemmering’s ring: early  of lens capsule in cataract

• Vossius’ ring: on lens in concussion injury to eye

• Weiss ring: epipapillary glial tissue torn from the optic disc in Posterior vitreous detachment (PVD)

• Double ring sign: with the peripheral margin of the encircling ring corresponding to the border of a normal-sized optic disc. Seen in Hypoplasia of the Optic Disc.
Signs in Ophth

• Munson’s sign, i.e. localised bulging of lower lid in Keratoconus

• Grade III HTN Retinopathy: banking of veins distal to arteriovenous crossings (Bonnet sign), tapering of veins on either side of the crossings (Gunn sign) and right-angle deflection of veins (Salu’s sign).

• TED: Lid signs: These are: Retraction of the upper lids producing the characteristic staring and frightened appearance (Dalrymple’s sign); Lid lag (von Graefe’s sign) i.e., when globe is moved downward, the upper lid lags behind; Fullness of eyelids due to puffy oedematous swelling (Enroth’s sign); Difficulty in eversion of upper lid (Gifford’s sign); Infrequent blinking (Stellwag’s sign). Convergence weakness (Mobius’s sign)

• The Bruckner test is a way to estimate near-sightedness versus hyperopia.
Ratio in Ophth

• Kesten-Baum index refers to ratio of large blood vessels versus small blood vessels on the disc. Normal ratio is 4:16. This ratio is decreased in patients with optic atrophy.

• Cup-disc ratio. Normal cup disc ratio is 0.3. (i) Large cup may be physiological or glaucomatous. (ii) Cup becomes full in papilloedema and papillitis.

• Results of EOG are interpreted by finding out the Arden ratio as follows:

Arden ratio = (Maximum height of light peak/ Minimum height of dark trough) × 100 Normal curve values are 185 or above. Subnormal curve values are less than 150. Flat curve values are less than 125.

• Normal arterioles are bright red in colour and veins are purplish with a caliber ratio of 2: 3. Following abnormalities may be detected: Narrowing of arterioles is seen in hypertensive retinopathy, arteriosclerosis, and central retinal artery occlusion. Tortuosity of veins occurs in diabetes mellitus, central retinal vein occlusion and blood dyscrasias. Sheathing of vessels may be seen in periphlebitis retinae, and hypertensive retinopathy.
Operations in Ophth

• Fucala’s operation: Removal of clear crystalline lens for unilateral very high myopia

• McReynold’s operation: Transplantation of pterygium in the lower fornix, not performed now.

• Cicatricial entropion. 1. Resection of skin and muscle 2. Resection of skin, muscle and tarsus 3. Modified Burow’s operation 4. Jaesche-Arlt’s operation 5. Modified Ketssey’s operation

• Senile entropion. Commonly used surgical techniques are as follows: i. Modified Wheeler’s operation: ii. Bick’s procedure with Reeh’s modification: iii. Weiss operation. iv. Tucking of inferior lid retractors (Jones, Reeh and Wobig operation):

• Mechanical ectropion. It is corrected by treating the underlying cause. i. V-Y operation. ii. Z-plasty (Elschnig’s operation) iii. Excision of scar tissue and full thickness skin grafting.

• Congenital ptosis. It almost always needs surgical correction. In severe ptosis, surgery should be performed at the earliest to prevent stimulus deprivation amblyopia. However, in mild and moderate ptosis, surgery should be delayed until the age of 34 years, when accurate measurements are possible. Congenital ptosis can be treated by any of the following operations: 1. Fasanella-Servat operation. ( ans: Horner’s Syndrome) 2. Levator resection. (A)Conjunctival approach (Blaskowics’ operation): (B)Skin approach (Everbusch’s operation):

• The classical technique of lateral orbitotomy using S-shaped brow skin incision is called Kronlein’s operation, done for AXIAL PROPTOSIS.

• Seton operation: In this operation, a valvular synthetic tube is implanted which drains the aqueous humour from the anterior chamber into the subconjunctival space. It is performed for neovascular glaucoma and intractable cases of primary and other secondary glaucomas where medical treatment and conventional filtration surgery fail.

• TRIPPLE SNIP operation for Punctum block