Triads in Ophthalmology: 30 Classic Triads by Subspecialty
Last updated: October 2026
Examiners love a triad: three findings that together point to one diagnosis. Here they are grouped by subspecialty, each with the one clue that clinches it.
Cornea, lens and anterior segment
| Condition | Triad | Remember |
|---|---|---|
| Pigment dispersion syndrome | Krukenberg spindle; radial mid-peripheral iris transillumination defects; heavy trabecular pigmentation | Young myopic men; reverse pupil block |
| Intraoperative floppy iris syndrome (Chang and Campbell, 2005) | Billowing flaccid iris; prolapse towards incisions; progressive miosis despite dilating drops | Tamsulosin and other α1-blockers |
| UGH syndrome | Uveitis; glaucoma; hyphaema | IOL chafing (classically iris-fixated and AC lenses; now sulcus single-piece IOLs) |
| Pharyngoconjunctival fever | Fever; pharyngitis; acute follicular conjunctivitis | Adenovirus types 3 and 7 |
| Reactive arthritis (Reiter) | Arthritis; urethritis; conjunctivitis (acute anterior uveitis in some) | HLA-B27; after Chlamydia or gut infection |
| Sjögren syndrome (original description) | Dry eyes; dry mouth; arthritis | Anti-Ro and anti-La; raised lymphoma risk |
Glaucoma
| Condition | Triad | Remember |
|---|---|---|
| Primary congenital glaucoma | Epiphora; photophobia; blepharospasm | Plus buphthalmos and Haab striae |
| Sturge–Weber syndrome | Facial port-wine stain (V1, respecting the midline); ipsilateral glaucoma; contralateral seizures (leptomeningeal angioma) | Raised episcleral venous pressure |
| Schwartz (Schwartz–Matsuo) syndrome | Rhegmatogenous retinal detachment; anterior chamber "cells" (photoreceptor outer segments); raised IOP | IOP normalises after the RD is repaired |
| Ocular ischaemic syndrome | Mid-peripheral blot haemorrhages; dilated (not tortuous) retinal veins; iris neovascularisation | Severe carotid stenosis |
Retina and uvea
| Condition | Triad | Remember |
|---|---|---|
| Behçet disease (1937) | Oral ulcers; genital ulcers; hypopyon uveitis | Occlusive retinal vasculitis; HLA-B51 |
| Presumed ocular histoplasmosis syndrome | Peripapillary atrophy; "punched-out" chorioretinal spots; macular CNV or disciform scar | No vitritis |
| Congenital toxoplasmosis | Retinochoroiditis; hydrocephalus; intracranial calcification | Sabin tetrad adds convulsions |
| Congenital rubella (Gregg, 1941) | Cataract; deafness; congenital heart disease (PDA) | Salt-and-pepper retinopathy |
| Cone dystrophy | Falling central acuity; colour vision loss; photophobia | Cone ERG reduced; bull's eye maculopathy |
Neuro-ophthalmology
| Condition | Triad | Remember |
|---|---|---|
| Horner syndrome | Ptosis; miosis; anhidrosis | Painful new Horner = carotid dissection until proven otherwise |
| Kearns–Sayre syndrome | CPEO; pigmentary retinopathy; heart block (onset before 20) | Mitochondrial deletion: check an ECG |
| Miller Fisher syndrome | Ophthalmoplegia; ataxia; areflexia | Anti-GQ1b antibodies; Guillain–Barré variant |
| Ocular tilt reaction | Skew deviation; ocular torsion; head tilt (all towards the lower eye) | Utricular pathway lesion (brainstem) |
| Optic nerve sheath meningioma (Hoyt–Spencer) | Painless progressive visual loss; optic atrophy (after disc swelling); optociliary shunt vessels | Tram-track calcification on CT |
| Bálint syndrome | Simultanagnosia; optic ataxia; ocular motor apraxia | Bilateral parieto-occipital lesions |
| Spasmus nutans | Asymmetric pendular nystagmus; head nodding; torticollis | Exclude chiasmal glioma with MRI |
| De Morsier syndrome (septo-optic dysplasia) | Optic nerve hypoplasia; absent septum pellucidum; pituitary hormone deficiency | Check growth, cortisol and thyroid |
| Cerebral Whipple disease | Dementia; ophthalmoplegia (vertical gaze palsy); hypersomnia | Oculomasticatory myorhythmia is pathognomonic |
| Lambert–Eaton myasthenic syndrome | Proximal weakness; autonomic dysfunction; reduced reflexes (improve after exercise) | Small cell lung cancer |
Systemic and genetic
| Condition | Triad | Remember |
|---|---|---|
| Osteogenesis imperfecta (van der Hoeve) | Brittle bones; blue sclerae; deafness | Type I collagen |
| Pierre Robin sequence | Micrognathia; glossoptosis; cleft palate | Linked with Stickler syndrome |
| Fechtner syndrome | Nephritis; sensorineural deafness; cataract | MYH9 disorder with giant platelets |
| Gaucher disease (type 2) | Trismus; strabismus; opisthotonus | Supranuclear horizontal gaze palsy in type 3 |
A triad from anatomy
In the outer plexiform layer, each rod spherule and cone pedicle forms a synaptic triad: one presynaptic ribbon, two lateral processes from horizontal cells and one central process from a bipolar cell. A rod spherule has one triad; a cone pedicle has several.
Where residents slip
- Calling the Horner triad "ptosis, miosis, enophthalmos": the enophthalmos is only apparent; the third sign is anhidrosis.
- Writing Schwartz syndrome as uveitis: the "cells" are photoreceptor outer segments, not inflammatory cells.
- Forgetting the third Kearns–Sayre sign: always order an ECG.
Related: Pathognomonic signs, Eponymous signs, Confusers in ophthalmology, Classifications.
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📘 Want the exam-ready deep dive? This topic, and much more is covered in Ophthalmology Explorer (A High-Yield Clinical Reference for Ophthalmology Residents, Fellows & Board Exams) — available on Kindle. See all my books.
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