The eye, ophthalmology, eye diseases, and blindness in Greek mythology

1. ὀφθαλμός (ophthalmós)
By
Ahmed Alsherbeny
MD, CABOphth, MRCSEd Ophth, FRCS Ophth (Glasg), FICO

2. Dr.Ahmed Khaled Tawfik
Thank you for being there one day. Without you, this work
would never come to light
Thank you for everything !
You are really missed :(

3. HOMER

4. Homer
Is the semi-legendary blind author of the Iliad and the
Odyssey, two epic poems that are the central works of ancient
Greek literature.

5. ATROPOS

6. Atropos
In Greek mythology, Atropos was the oldest of the three Fates who controlled
human destiny from the time they were born to the time they died. The three
fates were sisters and were daughters of Zeus and Themis. Each Fate had a
task: Clotho (Spinner), Lachesis (Allotter), and Atropos (Inflexible). Clotho
spun the “thread” of human fate, Lachesis dispensed it, and Atropos cut the
thread (thus determining the individual’s moment of death). Therefore, Atropos
was regarded as the most deadly of the three Fates. Atropos has been
featured in several stories such as Atalanta and Achilles.

7. Atropos lends her name to the genus Atropa, of which the
poisonous plant Atropa belladonna (deadly nightshade) is a member,
and to the alkaloid atropine, an anticholinergic drug which is
derived from it.
The latin name for Deadly Nightshade contains the word belladonna
which is Italian for “beautiful lady” because the plant was used
by women as eyedrops to dilate their pupils to make them look
seductive.

8. Atropine Indications
1. Diagnostic
• Mydriasis for intraocular surgery: • Prolonged duration, onset
30–40 min, duration 10–14D
• Cycloplegic refraction: • Indicated for poor response to
cyclopentolate or in cases of excessive accommodation
2. Therapeutic
• Uveitis
• Glaucoma:
• Inflammatory glaucoma • Neovascular glaucoma • Malignant
glaucoma
• Cataract (posterior subcapsular type): • In situations when
surgery is contraindicated or patient refused surgery
• Amblyopia: • Penalization technique (give atropine to the good
eye)
• Prevention of myopia progression
3. Systemic use
• Inhibit oculocardiac reflex during orbital/squint surgery
• Standby for tensilon test in myasthenia gravis

9. Atropine complications
1. Local
• Transient stinging effect
• Conjunctival irritation, hyperemia, follicular conjunctivitis
• Acute ACG
• Visual blurring from mydriasis and cycloplegia
• Amblyopia in children
2. Systemic
• Flushing (red as a beetroot)
• Dryness (dry as a bone)
• Fever (hot as a hare)
• Headache, dysarthria, ataxia, hallucination, amnesia (mad as a
hatter)
• Bladder distension, decreased gastrointestinal mobility (bloated as
a barrow)
• Tachycardia, dysrhythmia
• Hypotension, respiratory depression, coma and death

10. CYCLOPS

11. Cyclopes
In Greek mythology, the Cyclopes "Circle-eyes" or "Round-eyes“ are giant one-
eyed creatures. Three groups of Cyclopes can be distinguished. In Hesiod's
Theogony, they are the brothers: Brontes, Steropes, and Arges, who provided
Zeus with his weapon the thunderbolt. In Homer's Odyssey, they are an
uncivilized group of shepherds, the brethren of Polyphemus encountered by
Odysseus. Cyclopes were also famous as the builders of the Cyclopean walls of
Mycenae and Tiryns.

12. Cyclopia
A rare birth defect can result in foetuses (both human and animal) which have
a single eye located in the middle of their foreheads. Students of teratology
have raised the possibility of a link between this deformity and the myth of
the one-eyed Cyclopes. However, in the case of humans with a single eye,
they have a nose above the single eye, rather than below, as in ancient Greek
depictions of the Cyclops Polyphemus

13. Homer makes particular mention of Odysseus’ blinding of the Cyclops Polyphemus. A
detailed anatomical description of the infliction of the damage is given: the burning
pike first passes through the cornea, then pierces the hard sclera at the posterior
pole of the eye, and then reaches as far as the orbital fat and burns the optic nerve.

14. Arimaspi

15. Arimaspi
In Greek mythology, The Arimaspi were a legendary tribe of one-eyed people
of northern Scythia who lived in the foothills of the Riphean Mountains,
variously identified with the Ural Mountains or the Carpathians, had their origin
in a lost work by Aristeas, reported in Herodotus.

16. GLAUCUS

17. Glaucus
In Greek mythology, Glaucus was a fisherman who was transformed into a
sea-. god/fish. Glaucus was transformed after consuming a "marvellous herb",
also referred to as a "weed". According to Greek myth, when Glaucus was
transformed into a fish-like creature, he became extremely thirsty. Having
been a land-dwelling human, he became a marine sea god-fish, and his thirst
was quenched by living in the sea.

18. Glaucoma
The word glaucoma is derived originally
from glaukos/glaucos ‘bluish-green, bluish-
grey’
The term Glaucus can also refer to the
bluish colour of the sea. The colour of the
transformed god/fish was blue. It would
seem possible that the dual meanings of
Glaucus are associated with semantic drift.
It may not be coincidental that one of the
effects of Cannabis is to induce
thirstiness. This serves as a basis for
suggesting that the "weed" or "marvellous
herb" in the Glaucus myth refers to
Cannabis. (The term "weed" in
Shakespearean literature has also been
linked to the use of Cannabis).
It may be entirely coincidental that
Cannabis is one means of alleviating the
symptoms of glaucoma.

19. Don’t Forget
It is important to exclude congenital glaucoma in an
infant with watering eye
Overestimation of IOP may be due to tight collar which
obstructs venous return and causes IOP to rise
Incidence of glaucoma:
1- primary open angle 1:100
2- primary closed angle 1:1000
3- congenital glaucoma 1:10000
Progressive enlargement of the corneal diameter is as
important sign of uncontrolled congenital glaucoma as
progressive visual field loss is in adult glaucoma
White Eyes with Increased IOP and mild uveitis :
1- Prodroma of PCAG
2- Disciform Keratitis
3- Posner Schlossman syndrome
Beta blockers are contraindicated with digitalis or
calcium channel blockers
Alphagan is contraindicated with MAO inhibitors and
children

20. Don’t Forget
Steroid Responders :
1- Primary open angle glaucoma patients
2- offspring of glaucoma patients
3- Myopia
4- Diabetics
5- Pigment dispersion syndrome
In Glaucoma , Primary types is diagnosed after exclusion of
secondary causes
Glaucoma with deep A.C:
1- Plateau iris syndrome
2- pigment dispersion syndrome
3- Buphthalmos
Central corneal thickness is increased in eyes with aniridia
which may result in incorrect measurement of IOP
Neurological lesions causing optic nerve or chiasmal
compression can produce visual field defects that may be
misinterpreted as glaucomatous, and neuroimaging should be
performed if there is any suspicion; some practitioners
routinely perform a cranial MRI in all cases of NTG.

21. IRIS

22. Iris
In Greek mythology, iris is the Greek goddess of the rainbow. Iris was the
messenger of the Olympian Gods because she was able to stretch a bow between
the sky and the Earth, the rainbow. Additionally, she was believed to replenish
the rain-clouds with water with her pitcher from the sea. Iris was depicted as a
beautiful young maiden with gold wings. Her dress was shiny with seven colors of
the rainbow

23. Heterochromia Iridis
Hypochromic
Idiopathic congenital
Horner syndrome, particularly if congenital
Waardenburg syndrome
Hyperchromic
Unilateral use of a topical prostaglandin
analogue for glaucoma
Oculodermal melanocytosis (naevus of Ota)
Ocular siderosis
Diffuse iris naevus or melanoma
Sturge–Weber syndrome
Hypo- or hyperchromic
Fuchs uveitis syndrome
Other chronic anterior uveitides

24. OEDIPUS

25. Oedipus
In Greek mythology, Oedipus was the king
of Thebes. The prophecy informed his
father that his son would kill his father
that is why the baby was left in mountains
to die. Oedipus was found by shepherds and
raised by another royal family as their own
son. Oedipus did not known his true
parents. Once he met an old man and
quarreled with him. In range, he killed the
stranger, without knowing that he killed his
own father. Later still unaware of this
fact, he married his mother. Years later,
he realized that he killed Laius, his father.
His mother realized that she married her
son and murder of her husband, and she
committed suicide. In despair, Oedipus
blinded himself by two golden pins from his
dead mother’s dress.

26. Ocular trauma is one of the most frequently
mentioned eye conditions described by Homer,
perhaps because such injuries involve relatively
easily understood pathologies.
We have descriptions of globe rupture, such as
when Menelaus struck Peisandros with his sword.
The blow was on the forehead, above the bridge
of the nose; the bones were broken and both eyes
fell down into the dust at Peisandros’ feet.
A similar wound was inflicted by Patroclus on
Hector’s charioteer, Cebriones, whom he struck
with a stone on the forehead, across both
eyebrows. The frontal bone broke and both
Cebriones’s eyes fell into the dust.
Other cases of enucleation are also described,
such as Peneleus striking Ilioneus

27. Don’t Forget
Always check the pressure in the contralateral
eye in a patient with ocular trauma.
Asymmetrically low intraocular pressure may be
an important clue to a potential ruptured globe.
Patients with traumatic ocular injuries must be
evaluated for systemic injuries as well.
Patients recovering from a traumatic hyphema
are at increased risk for glaucoma and retinal
detachments in the future. They need ongoing
ophthalmic evaluation for the rest of
their lives.
MRI should never be performed if a metallic
foreign body is suspected
After ocular trauma , especially rupture globe ,
In follow up visits after primary repair , careful
examination of the other eye is very important
to detect sympathetic ophthalmitis

28. PANOPTES Argus

29. Argos Panoptes
Argos Panoptes was a hundred-eyed giant and servant to Hera, the
Queen of the heaven and God. The word “Panoptes” means all seeing
due to his many eyes. As a result of having so many eyes, Argus
Panoptes was said to be always awake for only two eyes went to
sleep at any one time, ensuring that 98 eyes were always
functioning. Hera used him as an invaluable guard.

30. One day, Hera caught her husband Zeus having and affair with Io, the virgin
priestess of Hera. Zeus then turned Io into a heifer in order to hide her
from Hera. However, not to be fooled, Hera asked for the heifer as a gift
which Zeus could not refuse. Hera then appointed Argus Panoptes as a
herdman for the heifer, preventing Zeus from visiting Io or transforming her
back to her original form. Zeus sent Hermes to rescue his lover. Hermes
disguised himself as a fellow heardsman and played soothing music which so
hypnotized Argus Panoptes that all his eyes were closed. Hermes then struck
and cut off the giant head and rescused Io.
After the death of her favorite servant, Hera took the eyes of the deceased
Argus Pantoptes and used them to decorate the feathers of her pet bird, the
peacock

31. Panoptic: it is made up of two words “pan-“ means all and “-
optic” means vision, the whole word means showing or seeing the
whole at one view.
Panoptix Trifocal IOL Panoptic ophthalmoscope

32. Graeae

33. Graeae
In Greek mythology, the Graeae were three old women who shared a
single tooth and a single eye and passed it around so that each in turn
could see. Perseus stole the eye while they were passing it, forcing
the now-blind women to disclose to him the secrets he would need to
slay the Medusa. Perseus returned their eye, and they resumed
bickering about who got to see next.

34. According to the previous myth , Sharing of visual
experience is nothing new, of course. Thankfully,
unlike the Graeae, we are not forced to share visual
images sequentially; but the era of different types
of keratoplasty opened a light window for many blind
people to be able to see again.
behind every corneal graft, there's someone who had
passed away and deserves our respect for giving
sight to another one he didn’t even see or know.

35. Lamellar Keratoplasty
1. Indications
• Partial thickness corneal diseases:
• Superficial corneal dystrophies
• Superficial corneal scars
• Recurrent pterygium
• Corneal thinning (Terrien’s marginal degeneration)
• Impending corneal perforation
• Congenital lesions (limbal dermoid)
• Superficial tumors
• Endothelial dystrophies/endothelial failure
2. Advantages
• Anterior lamellar keratoplasty:
• Minimal donor tissue requirements • No intraocular
entry • Faster wound healing and rehabilitation • Lower
risk of rejection and less use of topical steroids
• Endothelial keratoplasty:
• Reduced astigmatism • Smaller wound — lower risk
of wound rupture • Replaceable and repeatable •
Reduced risk of rejection • Faster recovery • Less
epithelium related problems

36. Lamellar Keratoplasty
Disadvantages
• Interface scarring • Technically more difficult • Not
suitable when residual lamella (Descemet’s/endothelium
in anterior lamellar keratoplasty, OR anterior stroma in
endothelial keratoplasty) is not clear/intact.
Complications
• Anterior lamellar keratoplasty:
• Intraoperative perforation
• Astigmatism
• Double anterior chamber (DM detachment)
• Interface haze/scarring •
Endothelial Keratoplasty
• Early
• Graft detachment • Glaucoma — pupil block, steroids
• Delayed epithelial healing
• Late
• Glaucoma — PAS formation, steroids • Endothelial
rejection • Endothelial failure

37. Acephali

38. Acephali
In Greek mythology, the Acephali were human beings whose
their eyes and mouth are placed in their chest. And they had
no heads at all. According to the accounts of Herodotus and
Josephus, the Acephali lived in Libya. They are similar to the
Blemyahs.

39. Acephaly
Congenital absence of the head

40. Athena

41. Athena
Athena, sister of Apollo, had honours bestowed upon her thanks to her ability
to cure eye diseases. For this reason she was given the epithets “Ophthalmitis”
“Optilitin” (a Doric term for the eyes) and “oxyderkis” (she who is sharp-
sighted, oxy + derko = to see perceptively)

42. Odysseus

43. Odysseus
In accounts of external eye diseases, the descriptions given of “knyzosis” are
particularly interesting. With the term “knyzosis,” Homer refers to an eye
condition that Athena inflicted on Odysseus. This gave his eyes an unpleasant
appearance, although without decreasing their vision, and was accompanied by
an itchy feeling (knyo = to scratch). The goddess inflicted this illness on
Odysseus to change his appearance temporarily so he would not be recognized
once he returned to Ithaca.

44. Explanation
In the Canadian journal of
ophthalmology in 2007 , in the
article “Greek mythology: The
eye, ophthalmology, eye
disease, and blindness”
The myth about Odysseus’ eye
condition described as
“knyzosis” infers an eye
disease, the symptoms of which
were well known. The
differential diagnosis involves
many conditions but
consequently, madarosis is
considered to have been the
most likely diagnosis for
Odysseus’ eye condition.

45. Cause of Madarosis
1. Local
Chronic anterior lid margin disease
Infiltrating lid tumours
Burns
Radiotherapy or cryotherapy of lid tumours
2. Skin disorders
Generalized alopecia
Psoriasis
3. Systemic diseases
Myxoedema
Systemic lupus erythematosus
Acquired syphilis
Lepromatous leprosy
4. Following removal Procedures for trichiasis
Trichotillomania – psychiatric disorder of hair removal

46. Phoenix

47. Phoenix
Phoenix was falsely accused by his father Amyntor's concubine, and blinded by his
father, but Chiron restored his sight. Phoenix fled to Peleus, the king of Phthia, and
Achilles' father, where Peleus made Phoenix a king of the Dolopians, and gave him
the young Achilles to raise.

48. Explanation
In the Canadian journal of ophthalmology
in 2007 , in the article “Greek
mythology: The eye, ophthalmology, eye
disease, and blindness”
In the myth of Phoenix’s intentional
blinding by his own father. The story
contains only limited data, but these
suggest an acquired and treatable
condition for which there are several
possible explanations. Reduced vision
could occur from corneal edema after
thermal or mild chemical burns.
Another hypothesis is the use of
atropine locally on Phoenix’s eyes, which
could cause paralysis of accommodation
(cycloplegia) for a period of up to two
weeks.

49. Achilles

50. Achilles
There are many references to transient or permanent amaurosis in Homer. Achilles
experienced a transient loss of vision during his battle with Aeneas, which is
attributed to an intervention by Poseidon. Athena had lifted the mist from his eyes
so he could fight on

51. Explanation
In the Canadian journal of
ophthalmology in 2007 , in the
article “Greek mythology: The
eye, ophthalmology, eye disease,
and blindness”
Achilles’ case of transient
amaurosis could be attributed,
given the military context of the
epics, to nonorganic visual loss
(conversion reaction). Patients
with a conversion reaction,
previously called hysterical
blindness, react to environmental
stress. A conversion reaction of
hysterical blindness on the
battlefield is a reported
expression of battle fatigue.

52. Amaurosis fugax
Systemic
• Carotid artery atherosclerosis (most common
cause)
• Carotid emboli
• Cardiac emboli
• Vasculitis: • Giant cell arteritis • Migraine •
Systemic lupus, polyarteritis nodosa and others
• Coagulation disorders
Ocular
• Raised IOP
• Drusens
• Papilledema
• Anterior ischemic optic neuropathy

53. Diomedes

54. Diomedes
After Diomedes had been injured by a perforating wound to his right shoulder while
fighting at Troy, Diomedes experienced transient bilateral blurred vision, possibly
due to hemorrhage

55. Explanation
In the Canadian journal of ophthalmology
in 2007 , in the article “Greek mythology:
The eye, ophthalmology, eye disease, and
blindness”
blood loss from his battle wound could
have reduced vision by primary or
secondary vasospastic syndrome.
The eyes are frequently involved in the
vasospastic syndrome, and ocular
manifestations of vasospasm include
alteration of conjunctival vessels, corneal
edema, retinal arterial and venous
occlusions, choroidal ischemia, amaurosis
fugax, anterior ischemic optic neuropathy,
and glaucoma.

56. Melampus

57. Melampus
We encounter the first reference to the method of “licking” treatment in
the myth that refers to the life of the seer and physician Melampus. This
treatment was widely applied in the ancient Greek world, and Melampus is
believed to have inspired it. When Melampus was still a child he raised
two snakes, who would lick his ears with their tongues. This technique
was subsequently applied to eye diseases and the snakes would lick the
injuries on the front surface of the eye. This kind of treatment was
obviously used for such problems as keratitis and corneal ulcers.

58. Using traditional eye therapy
such as licking, burning, topical
herbs etc.. without consulting
your eye doctor may cost you
your eyes

59. Thank You