Various Dots spots lines_and_rings_in_ophthalmology are compiled from books and internet media.Helpful for diagnosis of an eye disease. No conflict of interest.
4. BRUSHFIELD SPOT
Brushfield spots are small, white or grayish/brown spots on
the periphery of the iris in the human eye due to aggregation of
connective tissue, a normal iris element.
The spots are named after the physician Thomas Brushfield,
who first described them in his 1924 M.D. thesis.
These spots are normal in children (Kunkmann-Wolffian
bodies), but are also a feature of the chromosomal disorder
Down syndrome.
They occur in 35–78% of newborn infants with Down
syndrome. They are much more likely to occur in children with
Down syndrome of European descent than children of Asian
heritage with Down's Syndrome.
They are focal areas of stromal hyperplasia, surrounded by
relative hypoplasia, and are more common in patients with
lightly pigmented irises.
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6. ELSCHNIG SPOT
Elschnig's spots are black spots surrounded by bright
yellow or red halos seen on the retina during fundoscopy
in patients with advanced hypertensive retinopathy. They
are named after Anton Elschnig.
Elschnig spots are commonly caused by acute
hypertensive events of the choroidal vascular system,
mostly in the young, because their system of vessels is
not ready to handle the changes in blood pressure.
These changes in blood pressure cause an infarct of the
vessels leading to death of the RPE and photoreceptors
they support creating this window defect.[1]
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9. FUCH'S SPOT
The Fuchs spot or sometimes Forster-Fuchs' retinal
spot is a degeneration of the macula in case of high
myopia.
It is named after the two persons who first described it:
Ernst Fuchs, who described a pigmented lesion in 1901,
and Forster, who described subretinal neovascularisation
in 1862.
The size of the spots are proportionate to the severity of
the pathological myopia.
First signs of a Fuchs spot are distorted sight of straight
lines near the fovea, which some days later turn to the
typical well-circumscribed patches after absorption of
haemorrhage, and a pigmented scar remains.
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11. ROTH SPOTS
Roth's spots are retinal hemorrhages with white or pale centers.
The original retinal spots identified in 1872 were attributed to
nerve-fibres that had burst or exploded.
Present-day analysis shows that they can be composed of
coagulated fibrin including platelets, focal ischemia, inflammatory
infiltrate, infectious organisms, or neoplastic cells.
They are typically observed via fundoscopy (using an
ophthalmoscope to view inside the eye) or slit lamp exam.
They are usually caused by immune complex mediated vasculitis
often resulting from bacterial endocarditis.
Roth's spots may be observed in leukemia, diabetes, subacute
bacterial endocarditis, pernicious anemia, ischemic events,
hypertensive retinopathy and rarely in HIV retinopathy.
Roth's spots are named after Moritz Roth.
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15. HISTO SPOTS
A small circular punched-out spot in the retina at a site
where spores of the fungus histoplasma (histo) seeded in
the eye.
Histo spots may be multiple, found in both eyes, and
scattered throughout the retina. Can be seen in presumed
ocular histoplasmosis syndrome (POHS).
Histo spots in the macula are significant since they may
stimulate the growth of abnormal new blood vessels
located under the retina.
These new blood vessels may suddenly bleed, causing
permanent macular scarring and impairing central vision.
If the process is detected at an early stage, it may be
successfully treated with focal retinal laser.
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17. COTTON WOOL SPOTS
Cotton wool spots are an abnormal finding on funduscopic exam of
the retina of the eye.
They appear as fluffy white patches on the retina. They are caused
by damage to nerve fibers and are a result of accumulations of
axoplasmic material within the nerve fiber layer.
There is reduced axonal transport (and hence backlog and
accumulation of intracellular products) within the nerves because of
the ischemia. This then causes the nerve fibers to be damaged by
swelling in the surface layer of the retina.
A 1981 analysis concluded that "in most instances, cotton-wool spots
do not represent the whole area of ischaemic inner retina but merely
reflect the obstruction of axoplasmic flow in axons crossing into much
larger ischaemic areas".
Associated findings include microvascular infarcts and hemorrhages.
The appearance of cotton wool spots may decrease over time.
Abundant cotton wool spots are seen in Malignant hypertension.
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19. CHERRY RED SPOT
A cherry-red spot is a finding in the macula of the eye in a variety
of lipid storage disorders and in central retinal artery occlusion.
It describes the appearance of a small circular choroid shape as
seen through the fovea centralis.
Its appearance is due to a relative transparency of the macula;
storage disorders cause the accumulation of storage material
within the cell layers of the retina, however, the macula, which is
relatively devoid of cellular layers, does not build up this material,
and thus allows the eye to see through the macula to the red
choroid below.
The sign was first described by Warren Tay, founding member of
the British Ophthalmological Society, in 1881, with reference to a
patient with Tay–Sachs disease.
The cherry red spot is seen in central retinal artery occlusion,
appearing several hours after the blockage of the retinal artery
occurs.
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20. CHERRY RED SPOT
The cherry red spot is seen because the macula receives
its blood supply from the choroid, supplied by the
posterior ciliary arteries, while the surrounding retina is
pale due to retinal artery infarction.
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21. CREAM COLOURED SPOT
The classic diagnostic feature of birdshot vitiligenous
chorioretinitis is cream colored spots, often as large as
0.5 to 1 disc diameter, that are scattered throughout the
fundus.
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22. KOPLIK’S SPOT
Koplik spots (also Koplik's sign) are a prodromic viral
enanthem of measles manifesting two to three days before
the measles rash itself.
They are characterized as clustered, white lesions on the
buccal mucosa (opposite the lower 1st & 2nd molars),
conjunctiva and are pathognomonic for measles.
The textbook description of Koplik spots is ulcerated
mucosal lesions marked by necrosis, neutrophilic exudate,
and neovascularization.
They are described as appearing like "grains of salt on a wet
background“, and often fade as the maculopapular rash
develops.
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25. GUNN'S DOT
Gunn's dots, originally described by Marcus Gunn, are
tiny white dots sometimes visible overlying the large
vessels near the optic nerve or the nerve fiber layers.
Their presence depends on lighting conditions, and they
have no pathologic significance.
They are visible reflections of the internal limiting
membrane, created by the footplate of the Muller cells.
The tiny white specks in these photos are best visualized
at the 12:00 and 6:00 positions approximately 1 disc
diameter from the optic nerve head.
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28. KAYES' DOT
Kaye dots are white punctate epithelial opacities located in the
epithelium anterior to the suture line of a corneal graft.
The dots represent epithelial cells in various stages of
degeneration on histopathology and it has been hypothesized that
they may result from an epithelial response to the area of tissue
angulation.
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29. MITTENDORF'S DOT
A Mittendorf dot is a small, circular opacity on the posterior lens
capsule, classically nasal in location, which represents the anterior
attachment of the hyaloid artery.
The hyaloid artery is present during gestation and typically regresses
completely.
Failure to do so can lead to benign findings, such as a Mittendorf dot
or a Bergmeister's papilla, or pathologic changes as seen in persistent
fetal vasculature syndrome.
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31. ARLT'S LINE
Arlt's line is a thick band of scar tissue in the conjunctiva
of the eye, near the lid margin, that is associated with
eye infections.
Arlt's line is a characteristic finding of trachoma, an
infection of the eye caused by Chlamydia trachomatis.
The line runs horizontally, parallel to eyelid, and is found
at the junction of the anterior one third and posterior two
thirds of the conjunctiva.
The line is named after the Austrian ophthalmologist
Carl Ferdinand von Arlt.
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34. FERRY'S LINE
Seen in front of filtering bleb in glaucoma.
Filtering bleb is a blister of conjunctiva resulting from
glaucoma surgery by which a flap of sclera is created in
the eye wall, allowing aqueous humor to percolate out of
the eye and underneath the conjunctiva, thus lowering
intraocular pressure.
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35. HUDSON-STAHLI LINE
The Hudson–Stahli line is a line of iron deposition lying
roughly on the border between the middle and lower thirds of
the cornea.
It lies in the corneal epithelium. Usually it has about 0.5 mm
in thickness and is 1–2 mm long.
It is generally horizontal, with possible mild downward trend
in the middle.
It is present normally in people over the age of 50, but seems
to dissipate to some degree by the age of 70.
The Hudson-Stahli line is not associated with any pathology
calling for clinical intervention. Formation of the line may
depend upon the rate of tear secretion.
However, the Hudson-Stahli line can be enhanced in
hydroxychloroquine toxicity.
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37. KHODADOUST LINE
A Khodadoust Line or chronic focal transplant reaction is a
medical sign that indicates a complication of corneal graft surgery
on the eye.
This method is called Khodadoust Line because of many years
research about this by Professor Ali Asghar Khodadoust.
This medical condition is similar to organ rejection after an
organ transplant, except that it involves immunological rejection of
a transplanted cornea rather than an internal organ.
A Khodadoust line is made up of mononuclear cells (
white blood cells). These cells appear at the vascularized edge of
the recently transplanted cornea.
If untreated, the line of white blood cells will move across and
damage the endothelial cells of the cornea over the space of
several days.
Prompt treatment by immunosuppression can prevent further
damage
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39. PATON'S LINE
Circumferential retinal folds in peripapillary region due to
papilledema.
Papilledema is defined as optic nerve head edema
secondary to increased intracranial pressure. The main
cause of optic nerve head swelling is blockage of the
axoplasma transport and the blockage occurs at the
lamina cribrosa.
The optic nerve head can swell to the extent where it is
extended forward into the vitreous as well as laterally.
This lateral swelling causes the retina to buckle inward at
the temporal aspect of the optic nerve head. The buckling
is known as Paton's lines or folds.
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41. SAMPAOLESI LINE
Sampaolesi line is a sign which may be observed during
a clinical eye examination.
During gonioscopy (where the structures of the eye's
anterior segment are examined), if an abundance of
brown pigment is seen at or anterior to Schwalbe's line, a
Sampaolesi line is said to be present
The presence of a Sampaolesi line can signify
pigment dispersion syndrome or pseudoexfoliation
syndrome, trauma and iris melanoma.
Gonioscopy is performed during eye examinations, which
involves placing a mirrored lens on the patient's cornea in
order to visualise the angle of the
Anterior chamber of eyeball.
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43. SCHEIE'S LINE OR ZENTMAYER'S LINE
Pigment on lens equator and posterior capsule in pigment
dispersion syndrome.
Peripheral pigmentation of the posterior lens capsule
anterior to the junction between the anterior hyaloid face
and the posterior lens capsule (ligamentum hyaloideo-
capsulare of Wieger)
"Scheie's line" is considered to be pathognomonic for
pigment dispersion syndrome.
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45. SCHWALBE'S LINE
Schwalbe's line is the anatomical line found on the
interior surface of the eye's cornea, and delineates the
outer limit of the corneal endothelium layer.
Specifically, it represents the termination of Descemet's
membrane.In many cases it can be seen via gonioscopy.
Some evidence suggests that the corneal endothelium
actually possesses stem cells that can produce endothelial
cells, especially after injury, albeit on a limited scale.
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46. STOCKERS LINE
A vertical line at the head of pterygium has been termed
Stocker's line.
The lesion consisted of corneal linear iron deposition.
Stocker's line is a punctate, brownish, subepithelial line
passing vertically in front of the invasive apex of the
pterygium.
The mechanism of iron deposition in the development of
pterygium is still unknown, but iron level was reported
significantly higher in the pterygium tissue than in the
normal conjunctiva
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48. WHITE LINES OF VOGT
Sheathed or sclerosed vessels seen in Lattice degeneration.
Lattice degeneration of the retina is a fairly common
degenerative disease of the peripheral retina characterized by
the presence of lattice lines created by fibrosed blood vessels.
Crisscrossing fine white lines that account for the name lattice
degeneration are present in roughly only 10% of lesions and
most likely represent hyalinized blood vessels.
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49. FINGERPRINT LINE
Corneal map-dot-fingerprint dystrophy is by far the most common
corneal dystrophy and is named for the appearance of its
characteristic slit-lamp findings.
Map-dot-fingerprint dystrophy is also known as epithelial basement
membrane dystrophy, anterior basement membrane dystrophy, and
Cogan microcystic epithelial dystrophy.
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50. KRUKENBERG SPINDLE
Krukenberg's spindle is the name given to the pattern
formed on the inner surface of the cornea by pigmented iris
cells which are deposited as a result of the currents of the
aqueous humor.
The sign was described in 1899 by Friedrich Ernst Krukenberg
(1871-1946), who was a German pathologist specialising in
Ophthalmology
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51. VOGT STRIAE
Vogt's striae are vertical (rarely horizontal) fine, whitish
lines in the deep/posterior stroma and Descemet's
membrane commonly found in patients with keratoconus.
It may be asymmetric depending on the degree of
keratoconus in each eye. There is a positive correlation
between the orientation of the lines with the steepest axis
of the cornea and the mechanism is thought to be related
to mechanical stress forces on collagen lamellae
radiating from the cone apex.
The striae can temporarily disappear with external
pressure to the globe.
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53. HAAB’S TRIAE
Haab's striae, or Descemet's tears, are horizontal
breaks in the Descemet membrane associated with
congenital glaucoma.
It is named after Otto Haab.
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55. RING KERATITIS
Acanthamoeba keratitis, first recognized in 1973, is a rare, vision
threatening, parasitic infection seen most often in contact lens
wearers.
It is often characterized by pain out of proportion to findings and
the late clinical appearance of a stromal ring shaped infiltrate.
It is both difficult to diagnose and difficult to treat.
If clinical suspicion exists, the involved area of cornea can be
scraped with a sterile instrument (blade, spatula, needle, calcium
alginate swab, or cotton tip applicator) under topical anesthesia at
the slit lamp.
The culture specimen can then be inoculated into a dish of E. coli
plated over non-nutrient agar.
Acanthamoeba trophozoites and cysts can also be identified with
the help of Gram, Giemsa-Wright, hematoxylin and eosin, periodic
acid-Schiff, calcoflour white, or other stains.
Confocal microscopy has also been used to diagnose
Acanthamoeba cysts with some success.
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57. KAYSER–FLEISCHER RINGS
Kayser–Fleischer rings (KF rings) are dark rings that appear
to encircle the iris of the eye.
They are due to copper deposition in part of the cornea (
Descemet's membrane) as a result of particular liver diseases.
They are named after Dr. Bernhard Kayserand Dr.
Bruno Fleischer, the German doctors who first described them
in 1902 and 1903. Initially thought to be due to the
accumulation of silver, they were first demonstrated to contain
copper in 1934.
The rings, which consist of copper deposits where the cornea
meets the sclera, in Descemet's membrane, first appear as a
crescent at the top of the cornea. Eventually, a second
crescent forms below, at 6 o'clock, and ultimately completely
encircles the cornea
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59. CORNEAL RUST RING
Corneal rust rings occur commonly when metallic foreign
bodies become embedded in the cornea.
Removal of the rust ring is imperative to avoid permanent
staining of the cornea, persistent inflammation, or
disruption of corneal integrity (necrosis) with loss of
stromal substance.
Two techniques for the removal of rust rings are
discussed: hypodermic needle extraction and corneal burr
drill removal.
The use of topical deferoxamine as a chemical chelator
should only be used by an Ophthalmologist and is
mentioned only for the sake of completeness.
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61. COAT’S WHITE RING
GEORGE COATS was the first to describe two cases ‘showing
a small superficial opaque white ring in the cornea.’(Stromal
discrete). Size usually 0.1 to 0.2mm in diameter.
The rings were round, oval and pear-shaped; the majority
were situated in the periphery of the cornea, but a few were
present -near its centre.
It is a form of iron deposit at the level of Bowman’s layer
due to metallic foreign body.
It also may be associated with previous corneal foreign
body and mostly occurs after focal corneal injury
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63. FLEISCHER RING
Fleischer rings are pigmented rings in the peripheral cornea,
resulting from iron deposition in basal epithelial cells, in the form of
hemosiderin.
They are usually yellowish to dark-brown, and may be complete or
broken.
They are named for Bruno Fleischer.
Fleischer rings are indicative of keratoconus, a degenerative
corneal condition that causes the cornea to thin and change to a
conic shape.
Some confusion exists between Fleischer rings and Kayser
-Fleischer rings.
Kayser-Fleischer rings are caused by copper deposits, and are
indicative of Wilson's disease, whereas Fleischer rings are caused
by iron deposits.
One example of a medical condition that can present with
Fleischer rings is Keratoconus.
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65. SOEMMERING RING
SomEm RiNG's ring is a special form of after-cataract which is
formed in the following ways:
In extra-capsular extraction of cataract in which the central portion of
the anterior capsule is removed, or in injury of the lens, or in
discission operations in which the anterior capsule is torn and the
central portion of the lens substance is penetrated and becomes
absorbed, a greater part of the capsule sac remains intact.
According to Wessely (1910), when the central part of the anterior
capsule is opened up, it then loses its stretching capacity and
collapses, forming at first a flat ring.
The torn anterior capsule then becomes retracted and adheres to the
posterior capsule at the margin, so that the remains of the lens fibres
cannot be absorbed and therefore form a ring of folded capsule.
The epithelial cells can grow in this ring and, associated with the
deposition of hyaline capsular material in the remains of the lens
substance, a swollen ring or cushion is formed.
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66. SOEMMERING RING
In its typical form, Soemmering's ring can only be
diagnosed clinically after its dislocation has taken place,
when a coloboma of the irs has been made, or when the
pupil has been widely dilated.
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67. VOSSIUS RING
A Vossius ring is a well-circumscribed complete or incomplete
ring of pigment deposited on the anterior lens capsule surface,
usually as a result of significant blunt eye trauma.
The disease was first described by Vossius in 1903, at which
time he discussed both a pigmented variety of ring and a non-
pigmented variety that he thought was a result of degeneration
of anterior lens epithelial cells.
The non-pigmented form is no longer considered to be a
Vossius ring.
When the eye is injured, a circular ring of fainted or stippled
opacity is seen on the anterior surface of the lens due to brown
amorphous granules of pigment lying on the capsule.
It has the same diameter as the contracted pupil, and is due to
impression of the iris on the lens as a result of the force of a
concussion injury, which drives the cornea and iris backward.
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69. WEISS RING
A Weiss ring is a type of 'floater'.
These are pieces of debris that float around in the vitreous
humor of the eye, which is the gel-like substance that sits
inside the eyeball - between the lens and the retina. Floaters
are often caused by shrinkage of the vitreous humor, causing
tiny specks of collagen-like material to become visible as
floating spots or threads in your field of vision.
This is more common as you get older and is most noticeable
when moving your eyes across a light background.
A Weiss ring is a much larger, ring-shaped floater that is
created by a posterior vitreous detachment (PVD) from around
the optic nerve head. In other words, this is when the vitreous
tissue detaches from the retina.
One (most common) or multiple large floaters that are circular,
ovoid or shaped in a bent line
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70. WEISS RING
While a Weiss ring is usually harmless and will
disappear on its own eventually, in a small number of
cases a PVD can cause a retinal tear.
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71. DOUBLE RING SIGN
In optic nerve hypoplasia, optic disc is often pale or gray
and smaller than normal.
Optic discs often present with double ring sign – yellow to
white ring around the disc. A ring of hypopigmentation or
hyperpigmentation often, but not always surrounds the
disc defining the area of the putative scleral canal.
The outer ring represents the normal junction between
sclera and the lamina cribrosa; the inner ring represents
the abnormal extension of retina and pigment epithelium
over the outer portion of the lamina cribrosa.
Tortuous retinal arterioles, venules, or both may
accompany ONH, but retinal vessels can also present
with normal caliber.
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