Eye Signs References


Signs in Conjunctiva Images



Zhonghua Yi Xue Za Zhi (Taipei). 1999 Aug;62(8):496-502.  Related Articles, Links 


Relationship between pterygium/pinguecula and sunlight exposure among postmen in central Taiwan.


Tang FC, Chen SC, Lee HS, Lin WF, Chou MC, Lee MC.


Department of Family Medicine, Chung Shan Medical and Dental College, Taiwan, ROC.


BACKGROUND: The purpose of this study was to investigate outdoor hazards and their relationship to conjunctival disorders experienced by postmen. METHODS: Three hundred and ninety-four employees (248 postmen and 146 officers) working in 11 post offices in central Taiwan were recruited and participated in the 1994 annual labor health examination. Pinguecula and pterygium were diagnosed by an ophthalmologist. Meanwhile, detailed personal and occupational information was obtained using a structured questionnaire. The cumulative occupational sunlight exposure was calculated for each postman by considering the duration of their employment as postmen, the average working hours per day and their spectacle use (sunglasses and eyeglasses). A logistic regression was used to analyze the relationship between cumulative occupational sunlight exposure and pinguecula. RESULTS: Among the postmen, the prevalences of pinguecula and pterygium were 62.9% and 7.3%, respectively. The outdoor nature of postal work was significantly associated with the occurrence of pinguecula as well as pterygium (p < 0.05). When the cumulative occupational sunlight exposure increased by one unit (one year x hour/day), the risks of developing pinguecula and pterygium were raised by 2.1% and 0.8%, respectively. CONCLUSIONS: The results indicate that conjunctival disorders were associated with the cumulative occupational sunlight exposure of postmen working outdoors. This study reinforces the importance of ocular protection from sunlight.


PMID: 10462825 [PubMed - indexed for MEDLINE]






Ophthalmic Res. 1985;17(6):325-30.  Related Articles, Links 


The association between pinguecula, sunlight and cataract.


Perkins ES.


The pathology and epidemiology of pinguecula suggest that it is due to exposure to sunlight. There is some epidemiological and laboratory evidence that sunlight is an etiological factor in cataract so that it would be expected that the two conditions--pinguecula and cataract--would occur together more frequently than by chance. In a series of patients requiring cataract extraction pinguecula did not occur more frequently than in sex- and and aged-matched controls. Although there was a correlation between an outdoor working environment and the incidence of pinguecula there was no such correlation with cataract. It is concluded that direct exposure of the eye to sunlight did not seem to be a factor in the development of age-related cataract in this population.


PMID: 3877897 [PubMed - indexed for MEDLINE]






Aust N Z J Ophthalmol. 1998 May;26 Suppl 1:S2-5.  Related Articles, Links 


Prevalence of pterygium and pinguecula: the Blue Mountains Eye Study.


Panchapakesan J, Hourihan F, Mitchell P.


University of Sydney Department of Ophthalmology, New South Wales, Australia.


PURPOSE: The present study aimed to describe the prevalence of pterygium and pinguecula in an older population and to examine associations with skin, hair and eye colour, skin sun sensitivity, sun-related skin damage and skin cancer METHODS: The Blue Mountains Eye Study examined 3564 people aged 49 years or older Slit-lamp examination recorded pterygium and pinguecula and a questionnaire was used to collect information on physical variables. RESULTS: Two hundred and sixty-six subjects (7.3%) had pterygium (or had a history of pterygium surgery) and 2521 (69.5%) had pinguecula present in either eye. Significantly more men (11%) than women (4.5%) had pterygium (odds ratio (OR) 2.63; 95% confidence interval (CI) 2.03-3.42). This sex difference was aso found for pinguecula, present in 73.6 and 66.3% of men and women, respectively (OR 1.5; 95% CI 1.3-1.7). A s ight age-related increase in prevalence was found for both pterygium and pinguecula. CONCLUSIONS: The study found significant associations between pterygium and increased pigmentation (skin and hair colour), decreased skin sun sensitivity and sun-related skin damage. The age- and sex-specific pterygium prevalence rates in the present study are simi ar to rates found in non-Aboriginals examined in the 1980 Australian Trachoma Programme.


PMID: 9685008 [PubMed - indexed for MEDLINE]






Acta Ophthalmol (Copenh). 1979 Feb;57(1):96-105.  Related Articles, Links 



Prevalence of pinguecula in Greenland and in Copenhagen, and its relation to pterygium and spheroid degeneration.


Norn MS.


The prevalence of pinguecula has been studied by slit lamp examination of 659 Eskimos in South Greenland and 810 Caucasians in Copenhagen. The overall prevalence was found to be 56 per cent in Greenland against 41 per cent in Copenhagen (P less than 0.001) and to rise with increasing age, though with a fall after the age of 60 among Greenland women. Pingueculae (measured by their vertical height) are largest among Greenlanders, and larger in males than in females. They increase in size with increasing age. They are generally located nasally in Greenlanders and temporally in Copenhageners. The prevalence of pinguecula in almost 1 1/2 times higher among Greenlanders than among Copenhageners, while that of spheroid degeneration and that of pterygium are 3 times and slightly over 10 times higher respectively. The incidence of pinguecula and spheroid degeneration are correlated per site and per subject in the two geographically different series. Pterygium is not correlated with regard to site, this being always located nasally. Pterygium practically never harbours spheroid degeneration, neither in its body nor in its head (81 pterygia). Pinguecula and pterygium are therefore to be regarded as two different disorders, while spheroid degeneration is related to pinguecula.


PMID: 419982 [PubMed - indexed for MEDLINE]






Eye. 1989;3 ( Pt 2):218-26.   


Pathogenesis of pterygium.

Hill JC, Maske R.

Department of Ophthalmology,Groote Schuur Hospital, Cape Town, South Africa.

This paper reviews the histological and epidemiological characteristics of pterygium which suggest that chronic exposure to ultraviolet radiation plays an important role in the pathogenesis of this disorder. However, there is conflicting evidence indicating that chronic inflammation from other causes can induce the disease. The results of two epidemiological surveys undertaken in Southern Africa show that pterygium is not closely linked to other chronic actinic disorders such as pinguecula and climatic droplet keratopathy. Pterygia differ from these disorders by their vascularity which is probably induced by chronic inflammation. On histological examination, we found that excised pterygia contained a lymphocytic infiltration consisting predominantly of T cells. In the pathogenesis of pterygium we believe that chronic irritation (from whatever cause) produces a chronic inflammatory cell infiltration with resultant inflammatory oedema, attempt at repair and cell induced angiogenesis. These processes, together with actinic damage, are responsible for the fibrovascular reaction so characteristic of a growing pterygium.

Publication Types:
Review, Tutorial

PMID: 2695353 [PubMed - indexed for MEDLINE]



Cornea. 1994 May;13(3):219-24.  Related Articles, Links 

A model for pterygium formation.

Kwok LS, Coroneo MT.

Corneal Physiology and Biophysics Laboratory, College of Optometry, University of Houston, TX 77204-6052.

The formation of a pterygium is modelled using a population balance model of corneal and limbal epithelial production. Scattered light incident at the temporal limbus is focused at the nasal limbus with a peak intensity > or = 20 times. We hypothesize that this causes a focal alteration of corneal epithelial stem cells (which play a role in maintaining a barrier between corneal and conjunctival epithelia). Normative rabbit corneal data were used. Light-induced conjunctival epithelial proliferation was implemented by amplifying normal epithelial cell production along a nasal sector of the limbal circumference. A ten-fold normal peak in stimulation was assumed at the nasal zero azimuth (3 o'clock position in the right eye) with a quadratic attenuation to zero stimulation (normal) at the circumferential limits. Adjacent points on the outer limbus were assumed to be independent generators of epithelial cells that migrated in centripetal streams into the cornea. Normalization of the attrition rate for a net surface accumulation of the proliferating cells was embedded into the computational algorithm. The localized conjunctival mass was allowed to travel the predicted distance along the surface before the final shape was computed. The result shows a wing-shaped mass with a curved leading edge (corneal side). It is proposed that the initial biologic event in pterygium pathogenesis is an alteration of limbal stem cells due to chronic ultraviolet light exposure. The concomitant breakdown of the limbal barrier and subsequent conjunctivalization of the cornea explain the shape and formation of a primary pterygium.

PMID: 8033571 [PubMed - indexed for MEDLINE]



Pterygia Pathogenesis
Corneal Invasion by Matrix Metalloproteinase Expressing Altered Limbal Epithelial Basal Cells

Nicholas Dushku, MD; Molykutty K. John, PhD; Gregory S. Schultz, PhD; Ted W. Reid, PhD

Arch Ophthalmol. 2001;119:695-706.

Objective  To assess the potential role of matrix metalloproteinases (MMPs) in the pathogenesis of pterygia by comparing the immunolocalization patterns of MMPs in altered limbal basal stem cells, activated fibroblasts, and areas of elastotic degeneration adjacent to the pterygia.

Methods  Nine primary and 1 recurrent pterygia along with normal superior limbal-conjunctival tissue and cornea were immunostained with mouse monoclonal antibodies specific for MMP-1, MMP-2, MMP-3, MMP-9, membrane type 1 (MT1)–MMP (MMP-14), and membrane type 2–MMP (MMP-15).

Results  Normal conjunctival, limbal, and corneal cells lacked significant immunostaining except for cell surface MT1-MMP. In contrast, altered limbal basal epithelial cells of the 9 primary and 1 recurrent pterygia immunostained for all 6 MMPs. Activated and altered fibroblasts associated with the pterygia immunostained primarily for MMP-1. In contrast, stromal areas of elastotic degeneration (pingueculae) showed variable immunostaining of MMPs.

Conclusions  Altered limbal basal epithelial cells (pterygium cells) immunostained for multiple types of MMPs in contrast to normal conjunctival, limbal, and corneal cells. The pterygium cells invading over Bowman's layer produce elevated MMP-1, MMP-2, and MMP-9 expression, which probably are the main MMPs responsible for the dissolution of Bowman's layer. Pterygium cells may also cause activation of fibroblasts at the head of the pterygium, leading to the initial cleavage of fibrillar collagen in Bowman's layer by the production of MMP-1. Altered fibroblasts in areas of elastotic degeneration (pingueculae) trailing behind the pterygium constitute a second type of tumor, which is noninvasive.

Clinical Relevance  These data of altered MMP expression support the concept that altered basal limbal epithelial cells play a key role in the formation and migration of a pterygium.

From the Department of Ophthalmology, Kaiser Permanente Medical Center, Sacramento, Calif (Dr Dushku); Department of Obstetrics and Gynecology, Institute for Wound Healing, University of Florida, Gainesville (Drs John and Schultz); and Departments of Ophthalmology and Visual Sciences, Texas Tech University, Lubbock (Dr Reid).





Int Ophthalmol. 1998;22(5):293-8.  Related Articles, Links 


Outdoor work and the risk of pterygia: a case-control study.


Khoo J, Saw SM, Banerjee K, Chia SE, Tan D.


National University of Singapore, Singapore.


AIM: To investigate the relationship between outdoor work and pterygium formation in a hospital-based case-control study in Singapore. METHOD: Sixty-one patients with pterygium (49 males, mean age 54.2 years) and 125 controls (41 males, mean age 50.2 years), excluding patients with cataract and age-related macular degeneration presenting at outpatient clinics of the Singapore National Eye Centre were interviewed face-to-face with a standard questionnaire. Demographic data and information on outdoor work and eye protection, were collected. RESULTS: Thirty-eight subjects (20.4%) were outdoor workers and 148 (79.6%) were indoor workers. Outdoor workers were more likely to be male smokers and alcohol drinkers with lower family income and higher sunlight exposure than indoor workers. The crude odds ratio for pterygium in outdoor workers was 7.0 (95% confidence interval 3.2, 15.3). The adjusted odds ratio was 4.2 (95% confidence interval 1.7, 10.1). CONCLUSION: There is a statistically significant association between outdoor work and pterygium formation, which may be related to the higher exposure to sunlight and dust in outdoor workers. Efforts may be made to educate outdoor workers to wear proper equipment to protect their eyes against excessive sunlight.


PMID: 10826547 [PubMed - indexed for MEDLINE]



Bitot spots


Dry Eye (Xerophthalmia)


Abnormal microvascular topography



Bibl Anat. 1979;(18):310-2. 

An evaluation of biomicroscopy of the conjunctival vessels.

Davis E.

Human clinical biomicroscopy is an aid to the assessment of the microcirculation in health and disease. It has only limited diagnostic value but in some important conditions gives helpful clues and in a few conditions pathognomonic information. Features which can be evaluated include intravascular red cell aggregation, small blood vessel patterns, diameter of vessels, stasis pools, microaneurysms, petechiae and vasomotion. Red cell aggregation correlates well with sedimentation rate. Some of these factors, or combinations of them, correlate well with arteriosclerosis, diabetes, and hypertension. The apparatus required is relatively simple, and the method is noninvasive.

PMID: 496855 [PubMed - indexed for MEDLINE]



Microvasc Res. 1978 Nov;16(3):369-72.  Related Articles, Links 

Arteriolar rarefaction in the conjunctiva of human essential hypertensives.

Harper RN, Moore MA, Marr MC, Watts LE, Hutchins PM.

PMID: 748720 [PubMed - indexed for MEDLINE]



Biomedicine. 1976 Jan;24(1):UNKNOWN.  Related Articles, Links 

Biochemical and ultrastructural study of human diabetic conjunctiva.

Kern P, Regnault F, Robert L.

Combined biochemical and ultrastructural study of conjunctival biopsies of 27 normal subjects and 45 diabetics (40 to 60 years old) was made. The "in vitro" incorporation of 14C-glucosamine and 3H-proline in freshly excised conjunctival biopsies was studied. The alterations of the capillary basement membrane of the conjunctiva were studied by electron microscopy. The following results were obtained: 1) A decrease of the specific activity of 14C-glucosmaine incorporation was found in fractions of diabetic conjunctiva. 2) In diabetic conjunctiva the percentages of 3H-proline incorporation in polymeric collagen containing fraction and structural glycoproteins containing fraction were significantly increased with a parallel decrease of 3H-proline incorporation in "crude soluble collagen" fraction expressed as a percentage of total incorporation. 3) Significant thickening of capillary basement membrane was observed with the appearance of collagen-like fibrils within the basement membrane in diabetic conjunctiva. Such fibrils were not seen in normal basement membranes. A relation between the extent of basement membrane thickening and the appearance of collagen-like fibrils is suggested. 4) The higher percentage of incorporation of 3H-proline in polymeric collagen may be related to the appearance of collagen fibrils in thickened basement membranes of the diabetic conjunctival capillaries. 5) These results suggest an abnormal regulation of the relative rate of biosynthesis and/or excretion of intercellular matrix macromolecules (collagen, structural glycoproteins) as part of the metabolic disorders characterising diabetes.

PMID: 1268306 [PubMed - indexed for MEDLINE]



Am J Physiol. 1996 Sep;271(3 Pt 2):H1229-39.  Related Articles, Links 

Modeling and simulation of illumination effects for evaluation of microvessels of the conjunctiva.

Wick CE, Loew MH, Kurantsin-Mills J.

Department of Weapons and Systems Engineering, US Naval Academy Annapolis, Maryland 21402, USA.

We present the development of a comprehensive model that was undertaken to determine the relationships between the components of an image and the light intensity values present in the image of the microvessels of translucent tissues such as the bulbar conjunctiva. Experiments were conducted during the modeling process by use of a cylindrical microvessel embedded in a diffuse medium (phantom) on a reflecting background to affirm model components and simulations. The three-dimensional model was reduced to a single illumination plane with four regions of interest and modeled as Lambertian radiators and surfaces. The modeling showed that the top of the cylinder and its immediate vicinity are diffuse reflectors of light from the source plus light reflected from the background. The limbus of the cylinder is a diffuse reflector of the source and background illumination and a specular reflector of background reflections that achieve a high grazing angle with the cylinder. The immediate vicinity of the cylinder receives direct illumination from the source, but the light is partially obscured by the cylinder. The region beyond the shadow of the cylinder is a diffuse reflector of the overhead light. The diffuse medium additionally reflects the source and also attenuates the illumination reaching the other compo- rents of the scene. The direct and reflected illumination at each region of the model was calculated by use of specific geometric relationships. To verify those calculations, we analyzed a video simulation for the effects of different illumination conditions and their contributing elements. Intensity values were calculated from the relative reflectivity data determined from the video signals. The illumination values at the points along the line at the meridian of the cylinder were due to its reflectivity and also that of the medium. Similarly, the values of points distant from the shadow of the cylinder were due to the reflectivity of the background and the medium. The excellent agreement between the model and the phantom provides a foundation for the detection and precise measurement of microvessel dimensions within a diffuse medium. The additional ability to compute relative depth, from a single view, also permits discrimination between neighboring microvessels in complex images.

PMID: 8853363 [PubMed - indexed for MEDLINE]



Cerebrovasc Dis. 2002;13 Suppl 2:48-52.  Related Articles, Links 


Small vessel disease and Alzheimer's dementia: pathological considerations.

Kalaria RN.

Institute for Ageing and Health, Newcastle General Hospital, and Department of Psychiatry, University of Newcastle, Newcastle upon Tyne, UK. r.n.kalaria@ncl.ac.uk

Current evidence suggests that the neuropathology of Alzheimer type of dementia comprises more than amyloid plaques and neurofibrillary tangles. At least a third of Alzheimer disease (AD) cases may exhibit significant cerebrovascular pathology, which constitutes distinct small vessel disease (SVD). Cerebral amyloid angiopathy, microvascular degeneration affecting the cerebral endothelium and smooth muscle cells, basal lamina alterations, hyalinosis and fibrosis are often evident in AD. These changes may be accompanied by perivascular denervation that is causal in the cognitive decline of AD. Amyloid beta protein may cause degeneration of both the larger perforating arterial vessels as well as cerebral capillaries, which represent the blood-brain barrier. In addition, macro- and microinfarctions, haemorrhages, lacunes and ischaemic white matter changes are also present in AD. The development of SVD in late-onset AD may engage an interaction of perivascular mediators as well as circulation-derived factors that perturb the brain vasculature. Peripheral vascular disease such as long-standing hypertension, atrial fibrillation, coronary or carotid artery disease and diabetes could further modify the cerebral circulation such that a sustained hypoperfusion or oligaemia is impacted upon the ageing brain. Copyright 2002 S. Karger AG, Basel

Publication Types:


Review, Tutorial

PMID: 11901243 [PubMed - indexed for MEDLINE]



Probl Endokrinol (Mosk). 1986 Sep-Oct;32(5):18-22.  Related Articles, Links 

[Microcirculatory disorder in the bulbar conjunctiva of patients with diabetic retinopathy]

[Article in Russian]

Danilova AI.

Biomicroscopy was employed to study the state of microcirculation of the bulbar conjunctiva in 166 patients with diabetes mellitus at different stages of the ophthalmoscopic assessment of the fundus of the eye. Disorder in conjunctival microhemodynamics was found in 89.7% of the patients, in the presence of retinopathy in all the cases and in a normal picture of the fundus of the eye in 69.3%. Qualitative and quantitative changes in microcirculation of the conjunctiva were shown to depend on the stage and form of diabetic retinopathies. Values of changes of the total conjunctival index and its constituents were on an increase with aggravation of a pathological process in the fundus of the eye. Vascular changes prevailed in the diabetic-sclerotic and diabetic-hypertensive forms of retinopathies, intravascular changes and perivascular edema prevailed in the diabetic-renal form.

PMID: 3786297 [PubMed - indexed for MEDLINE]



Am J Med. 1977 Aug;63(2):208-14.  Related Articles, Links 

Conjunctival microangiopathy. An early sign of degenerative vascular disease?

Elliott FA, Leonberg SC Jr.

Biomicroscopic examination of the bulbar conjunctival vessels regularly discloses degenerative microangiopathy in patients with overt arteriosclerotic cerebral vascular disease. Examination of a group of normotensive nondiabetic adults aged 21 to 39 years disclosed similar but less severe changes in 56 per cent of the men and 26 per cent of the women. The incidence was higher (88 per cent of the men and 45 per cent of the women) in those with a strong family history of early death from arteriosclerotic disease. There was no consistent correlation between the severity of the microangiopathy and the values for hematocrit, cholesterol, triglycerides or blood pressure. Conjunctival microangiopathy, like atherosclerosis of larger vessels, starts in the second and third decades and advances with age. We suggest that microangiopathic changes in the conjunctival vessels may provide the first readily detectable evidence of degenerative vascular disease.

PMID: 888844 [PubMed - indexed for MEDLINE]



J Mal Vasc. 1988;13(2):101-5.  Related Articles, Links 

[Conjunctival and peri-ungual angioscopy in noninsulin-dependent diabetes mellitus. Informational value of observed anomalies]

[Article in French]

Lagrue G, Hamon P, Maurel A, Balanger S.

Service de Nephrologie, Association Claude Bernard, INSERM U. 139, Hopital Henri-Mondor, Creteil.

Microangiopathy is one of the most frequent and serious complications of diabetes. Its diagnosis is based on fundus of eye and fluorescein angiography findings, but several teams have emphasized the value of conjunctival angioscopy (CA) and peri-ungual capillaroscopy (PUC), describing suggestive anomalies: microectatic venous dilatation (V/A greater than 4.5), sludge on CA, "fish shoal" capillaries on PUC. Up to the present, however, the diagnostic value of these anomalies has not been evaluated based on data that are sensitive, specific and indicate predictive positive and negative values of a sign (Se, Sp, PPV, NPV). Anomalies of CA and PUC as a function of presence or absence of "diabetes" were studied in 114 patients with moderate hypertension, including 46 "diabetics" (33 with glucose regulation disorders and 13 non-insulin dependent diabetics). "Diabetes" was observed more predominantly in males of more advanced age and with a significantly higher global CA score (4.25 +/- 1.44 as against 2.65 +/- 1.35), and this in an increased manner as the "diabetes" was severe. Some anomalies had themselves a major orientation value with an Sp greater than 80% and an Se close to 40% (global score greater than 4; V/A greater than 4.5, microectasia, rheologic changes). For the fish shoal appearance the Sp was 73.5% and the Se 43.5%. The Sp was greater than 95% when at least 4 of the following 6 signs were present: global score greater than 4, V/A greater than 4.5, microectasia, rheologic disorders, fish shoal, gerontoxons. The more signs associated the more the Sp increased; the Se decreased from 40% for one sign to less than 10% for 4 associated signs.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 3397669 [PubMed - indexed for MEDLINE]



Diabete Metab. 1990 May-Jun;16(3):192-8.  Related Articles, Links 

[Erythrocyte aggregation in vivo and diabetic microangiopathy. Physiopathologic determinants and clinical correlations]

[Article in French]

Benhamou PY, Carpentier P, Halimi S, Bertrand C, Mouillon M, Franco A.

Service d'Endocrinologie, Diabetologie, Maladies de la Nutrition, CHRU Grenoble.

Conjunctival angioscopy is a non invasive way for visualization and quantitative evaluation of the microcirculation. Grading red blood cell aggregation is possible in vivo using Ditzel's four grades score. The two-dimensional organization of conjunctival microvessels allows morphometric quantification of microvascular density. The aim of our study was to evaluate the determinant factors of erythrocyte aggregation and the place of conjunctival angioscopy in the early detection of diabetic microangiopathy. Conjunctival parameters were red blood cell aggregation (Ditzel's score) and morphometric evaluation of capillary, venular and arteriolar density. Criteria of diabetic microangiopathy were microalbuminuria and retinal fluorescein angiogram. Both conjunctival angioscopy and retinal angiogram were scored independently. Results obtained in 30 type 1 diabetic patients, with multifactorial statistical analysis, show that red blood cell aggregation in vivo is an essential discriminant factor for diabetic retinopathy and nephropathy. This rheological phenomenon depends more on duration of diabetes (analysis of variance p = .0005, r = .65) and metabolic control than on albuminemia or fibrinogenemia such as in non-diabetic patients. Manual morphometric data confirmed vascular rarefaction associated with excessive red blood cell aggregation (beta = .50). These results suggest that grading red blood cell aggregation in vivo is an interesting tool for physiopathological and clinical studies of diabetic microangiopathy.

PMID: 2210013 [PubMed - indexed for MEDLINE]



Transplantation. 1999 Oct 15;68(7):927-32.  Related Articles, Links 

Improvements in diabetic microangiopathy after successful simultaneous pancreas-kidney transplantation: a computer-assisted intravital microscopy study on the conjunctival microcirculation.

Cheung AT, Perez RV, Chen PC.

Department of Medical Pathology, UC Davis Medical Center, Sacramento, California 95817, USA.

A computer-assisted intravital microscopy technology has been developed to noninvasively and objectively study diabetic microangiopathy in the conjunctival microcirculation of type-1 diabetics. Quantitative characterization of the conjunctival microcirculation was performed on 12 patients pre- and 18 months postsimultaneous pancreas-kidney transplantation (SPK). Healthy nondiabetic volunteers (n=12), solitary kidney (K) transplanted type-1 diabetics (n=5), and nontransplanted type-1 diabetics (n=12) served as controls. Pre-SPK diabetics showed abnormal-sized venules (diameter=66+/-7 microm) and reduced presence of arterioles (arteriole length/area=18+/-6 microm(-1)) compared with nondiabetic controls (53+/-4 microm; 31+/-8 microm(-1); P<0.05). The computed vascular perfusion capacity of the conjunctival microvasculature was diminished in the same patients (pre-SPK diabetics=49+/-9%; nondiabetic healthy controls=71+/-6%; P<0.05). Significant improvement in microangiopathy was observed in all post-SPK diabetics (diameter=58+/-6 microm; arteriole length/area=26+/-9 microm(-1); vascular perfusion=63+/-8%; P<0.05) 18 months post-SPK. Blood flow velocities in the conjunctival microcirculation in the same post-SPK patients showed noticeable but not significant improvements (nondiabetic controls=2.94+/-0.57 mm/sec; pre-SPK=1.23+/-0.49 mm/sec; post-SPK=1.65+/-0.42 mm/sec). The solitary kidney transplant controls (post-K) showed no significant improvements in diabetic microangiopathy, confirming the unique role of the pancreas in SPK. In general, significant improvements (P<0.05) in diabetic microangiopathy were observed in all 12 diabetics 18 months post-SPK but not in the controls.

PMID: 10532529 [PubMed - indexed for MEDLINE]


Arteriolar narrowing

Generalized Retinal Arteriolar Narrowing Predicts Severe Hypertension
Charles Vega, MD, FAAFP
Medcape Medical News. August 11, 2004.

Aug. 11, 2004 — Generalized retinal arteriolar narrowing is associated with an increased risk of severe (grade 2 or 3) hypertension in five years, according to the results of a prospective study published in the Aug. 9 Online First issue of Hypertension.

Signs in Iris Images

Lisch Nodules


Wolfflin spots

Schmidt I. The Wolfflin spots on the iris. Am J Optom. 1971 July;48(7):573-585.


Brushfield spots

Grey Iris or Bilateral Heterochromia

Central Heterochromia

Sectoral Heterochromia

Iris Hypoplasia

Signs in Corneal and Limbus Images

Corneal Arcus

Nishimoto JH, Townsend JC, Selvin GJ, De Land PN. Corneal arcus as an indicator of hypercholesterolemia. J Am Optom Assoc. 1990 Jan;61(1):44-49.


Kaiser-Fleischer Ring

Corneal Neovascularization

Corneal Iron Ring/Line


J Cataract Refract Surg. 2000 Nov;26(11):1684-6.  Related Articles, Links 

Comment in:

J Cataract Refract Surg. 2001 Jul;27(7):965.


Corneal iron ring associated with iatrogenic keratectasia after myopic laser in situ keratomileusis.

Ozdamar A, Aras C, Ustundag C, Bahcecioglu H, Ozkan S.

Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul, Turkey. aozdamar@iris.com.tr

A 23-year-old woman had bilateral myopic laser in situ keratomileusis (LASIK). Two months postoperatively, she reported decreased visual acuity. Biomicroscopic examination revealed a corneal epithelial iron ring around the central keratectasia on both corneas. The appearance of the ring pattern was similar to the iron deposits of the Fleischer ring of keratoconus.

Publication Types:

Case Reports

PMID: 11084280 [PubMed - indexed for MEDLINE]


Cornea. 1995 Sep;14(5):540-2.  Related Articles, Links 

Epithelial iron line in juvenile corneal arcus lipoides.

Junemann A, Kuchle M, Naumann GO.

Department of Ophthalmology, University Erlangen-Nurnberg, Germany.

Iron lines of the corneal epithelium are well-described phenomena in both normal and pathologic conditions. We found a bilateral corneal epithelial iron line at the inner edge of a juvenile corneal arcus lipoides in an otherwise normal eye of a 38-year-old white man. Possible mechanisms that may have led to the development of this new iron line are discussed.

Publication Types:

Case Reports

PMID: 8536471 [PubMed - indexed for MEDLINE]

Signs in Sclera Images

Scleral Neovascularization

Pigmentary Deposits

Jaundice and Liver Disorders

Signs in Eyelid Images



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