Rubeosis iridis (Neovascularization of iris)

• Diabetes mellitus
• Central retinal vein occlusion
• Chronic iridocyclitis
• Sickle-cell retinopathy
• Retinoblastoma.
Iridodonesis
• Dislocation of lens
• Aphakia
• Hypermature shrunken cataract
• Buphthalmos.
PUPIL
Normal pupil
• Diameter 3 to 4 mm
• In infancy pupil is smaller than at birth
• Myopes have larger pupil than hypermetropes.
Miosis
• Effect of miotic drugs (Parasympathomimetic
drugs, e.g. pilocarpine)
• Effect of systemic morphine
• Iridocyclitis (narrow, irregular non-reacting pupil)
• Horner’s syndrome
• Head injury (pontine haemorrhage)
• Senile rigid miotic pupil
• During sleep
• Argyll-Robertson pupil
• Poisonings
– Alcohol
– Barbiturates
– Organophosphorus compounds
– Morphine
– Carbolic acid
• Hyperpyrexia.
Mydriasis
• Topical sympathomimetic drugs such as adrenaline
and phenylephrine
• Topical parasympatholytic drugs such as atropine,
homatropine, cyclopentolate, tropicamide
• Acute congestive glaucoma (vertically oval, large,
immobile pupil)
• Absolute glaucoma
• Optic atrophy
• Retinal detachment
• Internal ophthalmoplegia
• Third nerve paralysis
• Belladona poisoning
• Coma
• Sympathetic stimulation
– Aortic aneurysm
– Cervical rib
– Irritative lesions in neck
– Mediastinal sarcoma, lymphosarcoma,
Hodgkin’s disease and pulmonary carcinoma
– Emotional excitement
• Severe anaemia
• Adie’s tonic pupil is larger than its fellow.
Leukocoria (white reflex in pupillary area)
• Congenital cataract
• Retinoblastoma
• Persistent hyperplastic primary vitreous
• Retrolental fibroplasia
• Toxocara endophthalmitis
• Coat’s disease.
Marcus Gunn Pupil
(In swinging flash light test, the pupil on the diseased
side dilates on transferring light to it)
• Optic neuritis
• Optic atrophy
• Retinal detachment
• Central retinal artery occlusion
• Ischemic central retinal vein occlusion.
Clinical Methods in Ophthalmology 15
LENS
Subluxation of lens
• Trauma
• Marfan’s syndrome (superotemporal)
• Homocystinuria (inferonasal)
• Weil-Marchesani syndrome.
RETINA
Cherry red spot
• Central retinal artery occlusion
• Commotio retinae (Berlin’s oedema)
• Taysach’s disease
• Niemann-Pick’s disease
• Gaucher’s disease
• Sialidosis
• Gangliosidosis
• Metachromatic leukodystrophy
• Multiple sulphates deficiency
• Rarely in krabbe’s disease
Macular oedema
• Trauma
• Intraocular operations
• Uveitis
• Diabetic maculopathy.
Superficial retinal haemorrhages
• Hypertensive retinopathy
• Diabetic retinopathy
• Central retinal vein occlusion
• Anaemic retinopathy
• Leukaemic retinopathy
• Retinopathy of AIDS.
Soft exudates (Cotton wool spots) on the retina
They are due to disturbance in axoplasmic flow
• Hypertensive retinopathy
• Retinopathy of toxaemia of pregnancy
• Diabetic retinopathy
• Anaemic retinopathy
• DLE, PAN and Scleroderma, SLE
• Leukaemic retinopathy
• Retinopathy of AIDS
• Eale’s disease
• Rarely CMV retinitis in AIDS.
Hard exudates on the retina
They are lipid deposits in retina
• Diabetic retinopathy
• Hypertensive retinopathy
• Coat’s disease
• Circinate retinopathy.
• Eale’s disease
• Old CRVO
Sub-retinal neovascular membrane
• Wet ARMD
• Presumed ocular histoplasmosis syndrome
(POHS)
• Angiod streaks
• Choroidal naevus
• Choroidal rupture
• High myopia
• Inappropriate photocoagulation
• Optic disc drusen.
Bull’s eye maculopathy
• Chloroquine toxicity
• Cone dystrophy
• Benign concentric annular macular dystrophy
• Batten’s disease
• Bardet-Biedl syndrome
• Occasionally Leber’s Amaurosis.