My Talk In National Eye Center , Cairo Egypt On 9th September , 2019

1. !!!!
By
Ahmed Alsherbeny
M.D. , CABOphth, FICO , MRCSEd Ophth , FRCS Ophth (Glasg)

2. a statement or proposition which, despite sound (or
apparently sound) reasoning from acceptable premises,
leads to a conclusion that seems logically unacceptable
or self-contradictory.

3. The Marcus Gunn pupil
The Marcus Gunn pupil is also known as the relative afferent pupillary defect
(RAPD)
“It is elicited with the swinging torchlight test.” “There is paradoxical dilation of
the pupil when the torchlight is swung from the contralateral eye to the affected
eye” !!!

4. Acute congestive angle closure
some patients particularly blacks in whom the condition is uncommon, have
remarkably little pain and no congestion despite very high IOPs, the only
symptom being impairement of vision !!

5. Nuclear sclerotic cataract
Nuclear cataract is an exaggeration of normal ageing change. It is often
associated with myopia due to an increase in the refractive index of the nucleus,
resulting in some elderly patients being able to read without spectacles again
‘second sight of the aged’ !!!

6. Leber hereditary optic neuropathy (LHON)
Surprisingly, the pupillary light reactions may remain fairly brisk. !!!

7. Uveitis of JIA
The uveitis of JIA is particularly dangerous because it is invariably
asymptomatic and must generally be detected by screening with slit lamp
examination. Even during acute exacerbations with +4 aqueous cells, it is rare
for patients to complain, although a few report an increase in vitreous floaters.
Often uveitis may not be suspected until the parents recognize complications
such as strabismus, or an abnormal appearance of the eyeball due to band
keratopathy or cataract. ○ Injection is usually absent even in the presence of
severe uveitis. !!!

8. Superior limbic keratoconjunctivitis
Soft contact lenses, which intervene between the lid and the superior
conjunctiva, are effective in some cases. Interestingly, a unilateral lens
may provide bilateral relief !!!

9. Posner–Schlossman syndrome (PSS)
typically shows a few anterior chamber cells and one to several fine white
central keratic precipitates. Injection is likely to be absent or minimal. Mild
corneal epithelial oedema is frequent.
IOP is typically 40 – 80 mmHg
Presentation is with mild discomfort !!!

10. Tumour necrosis factor inhibitors
Although these drugs (e.g. etanercept, infliximab, adalimumab) have been
adopted for the treatment of ocular inflammation, paradoxically uveitis has also
been documented as an adverse effect !!!
The induction of sarcoidosis has also been reported !!!

11. ‘paradoxical watering’
Dry eye secondary to deficiency of mucous or meibomian secretions can have
paradoxical watering as the instability of the tear film leads to compensatory
excessive aqueous secretion !!!

12. Behçet disease
AAU often bilateral, is typical. It is not granulomatous. A transient mobile
hypopyon in a relatively white eye is characteristic !!!

13. Riddoch’s phenomenon
Riddoch’s phenomenon (can see moving targets but not stationary targets) !!!
a form of visual impairment often caused by lesions in the occipital lobe which
limit the sufferer's ability to distinguish objects. Only moving objects in a blind
field are visible, static ones being invisible to the patient. The moving objects are
not perceived to have color or detail. The subject may only have awareness of
the movement without visual perception of it or the general shape of a moving
object may be perceivable as a shadow like outline

14. Anton–Babinski syndrome
Anton’s syndrome (cortical blindness plus denial of blinding)
Those who have it are cortically blind, but affirm, often quite adamantly and in
the face of clear evidence of their blindness, that they are capable of seeing.
Failing to accept being blind, people with Anton syndrome dismiss evidence of
their condition and employ confabulation to fill in the missing sensory input !!!

15. Congenital rubella
Reported ocular features of congenital rubella include cataract,
anterior uveitis, ‘salt and pepper’ pigmentary retinopathy,
glaucoma and microphthalmos.
10% of infants with congenital rubella syndrome also have
congenital glaucoma due to angle anomaly similar to that in
PCG. This maybe missed because the eye may not appear
significantly enlarged, due to pre-existing microphthalmos !!!

16. Oguchi disease
The fundus has an unusual golden yellow colour in the light-adapted state
which becomes normal after prolonged dark adaptation (Mizuo or Mizuo–
Nakamura phenomenon) !!!

17. Antiphospholipid antibodies
In vitro, antiphospholipid antibodies cause anticoagulation (i.e. bleeding)
• In vivo, they are associated paradoxically with coagulation (i.e.
thrombosis) !!!

18. Amblyopia
VA paradoxically improves with neutral density filter !!!
Decreased illumination of visual targets has less of an effect on amblyopic
eyes because they are not using central acuity • It was found that neutral
filters profoundly reduce vision in eyes with organic amblyopia whereas
vision of eyes with functional amblyopia was not reduced and
occasionally even slightly improved. • Hence it can be used to differentiate
the two.

19. Congenital Nystagmus
Paradoxical OKN response (two-thirds of patients) !!!

20. Uhthoff phenomenon
sudden worsening of vision or other symptoms on exercise or increase in body
temperature (Hot Bath) !!!

21. Thank You