Triads in Ophthalmology

·         BÁLINT'S SYNDROME  is loosely associated with a triad of visuospatial dysfunctions: simultanagnosia, optic ataxia, and ocular motor apraxia

·         BEHÇET'S DISEASE was initially described by Behçet in 1937 as a triad of oral ulcers, genital ulcers and hypopyon uveitis.

·         CEREBRAL WHIPPLE'S DISEASE includes a triad of somnolence, dementia and ophthalmoplegia.

·         CONE DEGENERATION includes the hallmark triad of progressive central acuity loss, color vision disturbances and photophobia.

·         CONGENITAL GLAUCOMA includes the commonly described triad of epiphora, blepharospasm and photophobia .

·         CONGENITAL RUBELLA RETINOPATHY includes the triad of cataracts, deafness and congenital heart disease which was first described by Gregg in 1941

·         CONGENITAL TOXOPLASMOSIS includes the classic triad of retinochoroiditis, hydrocephalus and intracranial calcifications although other signs such as fever, rash, hepatosplenomegaly, and seizures may occur if the infection is acquired earlier than the third trimester.

·         DE MORSIER'S SYNDROME, the congenital syndrome of septo-optic dysplasia includes the clinical triad of short stature, nystagmus and optic disc hypoplasia.

·         FECHTNER'S SYNDROME includes triad of nephritis, sensorineural hearing loss and eye abnormalities

·         GAUCHER DISEASE, classic Gaucher triad consists of trismus, strabismus, and opisthotonus.

·         HORNER'S SYNDROME includes classic triad of ptosis, miosis and ipsilateral anhidrosis of the face

·         INTRAOPERATIVE FLOPPY IRIS SYNDROME described by John Campbell and David F. Chang in 2005 which includes the triad by 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 and progressive intraoperative pupil constriction despite standard preoperative pharmacologic measures designed to maximize dilation (topical cycloplegics, phenylephrine, and nonsteroidal anti-inflammatory medications).

·         KEARNS–SAYRE SYNDROME includes the triad of external ophthalmoplegia, pigmentary retinopathy and cardiac conduction block during the first or second decade of life

·         LAMBERT–EATON MYASTHENIC SYNDROME includes triad of muscle weakness, autonomic dysfunction and hyporeflexia

·         MILLER-FISHER SYNDROME consists of the triad of ataxia, ophthalmoplegia and areflexia .It is described as a variant of Guillain-Barré syndrome.

·         OCULAR ISCHEMIC SYNDROME includes the classic triad includes midperipheral dot hemorrhages, dilated retinal veins and iris neovascularization.

·         OCULAR TILT REACTION consists of the triad of skew deviation, cyclotorsion of both eyes and paradoxical head tilt, all to the same side—that of the lower eye

·         OPTIC NERVE SHEATH MENINGIOMA are characterized by the clinical triad of the presence of optociliary venous shunts on the disc, when accompanied by diffuse disc edema (eventually replaced slowly by pallor) and insidious visual loss

·         OSTEOGENESIS IMPERFECTA originally described late in the 18th century, osteogenesis imperfecta (Van der Hoeve's syndrome, brittle bone disease) was not well described as a clinical syndrome until 1918 by Van der Hoeve. The syndrome includes triad of brittle bones, blue scleras and deafness (otosclerosis) .

·         PHARYNGOCONJUNCTIVAL FEVER by Adenoviruses sometimes produces the classic triad of fever, pharyngitis and acute follicular conjunctivitis.

·         PIERRE ROBIN SYNDROME includes the diagnostic triad of micrognathia, glossoptosis and cleft palate.

·         PIGMENTARY GLAUCOMA includes the classic triad consists of corneal pigmentation (Krukenberg's spindle); slit-like, radial, midperipheral iris transillumination defects; and heavy accumulation of pigment in the trabecular meshwork.

·         PRESUMED OCULAR HISTOPLASMOSIS SYNDROME includes the triad: peripapillary atrophy, “punched-out” chorioretinal lesions and disciform macular scarring in young and middle-aged adults

·         REITER'S SYNDROME was originally described by the classic triad of arthritis, urethritis and conjunctivitis. In 1981, the American Rheumatism Association expanded this original set of criteria .

·         SCHWARTZ'S SYNDROME includes triad of rhegmatogenous retinal detachment, uveitis and glaucoma

·         SJÖGREN'S SYNDROME Sjögren's syndrome originally was described as a triad of dry eyes, dry mouth, and Arthritis (dry joints). It subsequently has become apparent that Sjögren's syndrome may coexist with a variety of other connective tissue diseases

·         SPASMUS NUTANS occurs in the first year of life and includes triad of pendular nystagmus, head nodding and torticollis.

·         STURGE-WEBER SYNDROME includes triad of port wine facial telangiectasis (nevus flammeus) in the distribution of the trigeminal nerve that respects the vertical midline, ipsilateral glaucoma(ipsilateral buphthalmos)and contralateral seizures caused by ipsilateral leptomeningeal hemangiomatosis.

·         UGH SYNDROME, an IOL-related inflammation which involves the triad of uveitis, glaucoma and hyphema. UGH syndrome occurred more frequently in the 1970s, when iris-fixed lenses were commonly used.

·         Triads …from Eye Anatomy
The rod and cone terminals are organized as invaginating synapses, termed triads, each containing a single presynaptic ribbon, two lateral processes from horizontal cells, and a single central process from a bipolar cell. Each rod spherule contains a single triad; each cone pedicle contains several triads.

- compiled & published by Dr Dhaval Patel MD AIIMS