Triads, Dots, Spots, Lines

Compiled by : Dr. Parthopratim Dutta Majumder
Published Online: July 19th, 2021 | Read Time: 6 minutes, 5 seconds


Bitot's spot=White, foamy area of keratinizing squamous metaplasia of bulbar conjunctiva, seen in vitamin A deficiency.
Brushfield spot=Whitish grey spot in peripheral iris, seen in Down's syndrome.
Elschnig spot=Yellow patches overlying area of choroidal infarction in hypertension.
Fischer-Khunt spot=Senile scleral plaque, area of hyalinised sclera anterior horizontal rectus muscle insertion. Seen in old age.
Fuch's spot=Pigmented (RPE hyperplasia) macular lesions in pathological myopia.
Roth spots=haemorrhageswith white centers, seen in SABE, severe anemia, collagen vascular disorders.


Gunn's dot=light reflection from the internal limiting membrane around disc and macula
Horner-Trantras Dot=Collections of eosinophils at the limbus in vernal conjunctivitis.
Kayes' dot=subepithelial infiltrates seen in corneal graft rejection
Mittendorf's dot=whitish spot at the posterior lens surface, the remnant of the hyaloid artery.


Arlt's Line =conjunctival scar in sulcus subtarsalis.
Ehrlich-Turck Line =linear deposition of KPs in uveitis
Ferry's Line =corneal epithelial iron line at the edge of filtering blebs.
Hudson-Stahil Line=Horizontal corneal epithelial iron line at the inferior one-third of the cornea due to aging.
Khodadoust Line =corneal graft endothelial rejection line composed of inflammatory cells.
Paton's Line =Circumferential retinal folds due to optic nerve edema.
Sampaoelesi line =Increased pigmentation anterior to Schwalbe's line in pseudoexfoliation syndrome.
Scheie's Line =pigment on lens equator and posterior capsule in pigment dispersion syndrome.
Schwalbe's Line =Angle structure representing the peripheral edge of Descemet's membrane.
Stockers Line =Corneal epithelial iron line at the edge of a pterygium
White lines of Vogt =Sheathed or sclerosed vessels seen in Lattice degeneration

Triads in Ophthalmology

Triads are usually a combination of three clinical features or signs, often used to describe various clinical conditions or diseases. Here we have compiled some of these triads used in ophthalmology. Care should be taken while interpreting these triads, as many of them were described while reporting the particular clinical entity and are not considered as a tell-tale sign of that entity anymore. For example, Behçet's disease was described as a triad of oral ulcers, genital ulcers and hypopyon uveitis by Huluci Behcet. However, now we know that hypopyon can occur only in one-third of patients with the disease and is not included in diagnostic criteria for the Behçet's disease.

Bálint's Syndrome= Simultanagnosia+ Optic ataxia+ Ocular motor apraxia

Behçet's Disease= Oral ulcers + Genital ulcers + Hypopyon uveitis

Cerebral Whipple's Disease= Somnolence + Dementia + Ophthalmoplegia.

Cone Degeneration= Progressive central acuity loss + Color vision disturbances + Photophobia.

Congenital Glaucoma= Epiphora + Blepharospasm+ Photophobia

Congenital Rubella Retinopathy= Cataracts+ Deafness + Congenital heart disease

Congenital Toxoplasmosis= Retinochoroiditis+ Hydrocephalus+ Intracranial calcifications

De Morsier's Syndrome= Short stature+ Nystagmus + Optic disc hypoplasia

Fechtner's Syndrome= Nephritis+ Sensorineural hearing loss+ Eye abnormalities

Gaucher Disease= Trismus+ Strabismus+ Opisthotonus

Horner's Syndrome= Ptosis+ Miosis + Ipsilateral anhidrosis of the face

Intraoperative Floppy Iris Syndrome=A flaccid iris stroma that undulates and billows in response to ordinary intraocular fluid currents+ A propensity for the floppy iris stroma to prolapse toward the phaco and side-port incisions, despite proper wound construction + Progressive intraoperative pupil constriction despite standard preoperative pharmacologic measures designed to maximize dilation

Kearns–Sayre Syndrome=External ophthalmoplegia + Pigmentary retinopathy + Cardiac conduction block during the first or second decade of life

Lambert–Eaton Myasthenic Syndrome=Muscle weakness+ Autonomic dysfunction+ Hyporeflexia

Miller-Fisher Syndrome=Ataxia+ Ophthalmoplegia+ Areflexia

Ocular Ischemic Syndrome=Midperipheral dot hemorrhages+ Dilated retinal veins + Iris neovascularization

Ocular Tilt Reaction=Skew deviation+ Cyclotorsion of both eyes + Paradoxical head tilt

Optic Nerve Sheath Meningioma=Optociliary venous shunts on the disc+ Diffuse disc edema (eventually replaced slowly by pallor)+ Insidious visual loss

Osteogenesis Imperfecta=Brittle bones+ Blue sclera+ Deafness (otosclerosis)

Pharyngoconjunctival Fever=Fever+ Pharyngitis + Acute follicular conjunctivitis

Pierre Robin Syndrome=Micrognathia+ Glossoptosis+ Cleft palate

Pigmentary Glaucoma=Corneal pigmentation (Krukenberg's spindle)+ Slit-like, radial, mid-peripheral iris transillumination defects+ Heavy accumulation of pigment in the trabecular meshwork

Presumed Ocular Histoplasmosis Syndrome=Peripapillary atrophy+ “Punched-out” chorioretinal lesions + Disciform macular scarring in young and middle-aged adults

Reiter's Syndrome=Arthritis+ Urethritis+ Conjunctivitis

Schwartz's Syndrome=Rhegmatogenous retinal detachment+ Uveitis+ Glaucoma

Sjögren's Syndrome=dry eyes+ dry mouth+ Arthritis (dry joints)

Spasmus Nutans=pendular nystagmus+ head nodding+ torticollis

Sturge-Weber Syndrome=Port wine facial telangiectasis (nevus flammeus) in the distribution of the trigeminal nerve that respects the vertical midline+ Ipsilateral glaucoma (ipsilateral buphthalmos)+ Contralateral seizures caused by ipsilateral leptomeningeal hemangiomatosis

UGH Syndrome=Uveitis+ Glaucoma + Hyphema

Published in 2010
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