0:00

As you can see by these tables,

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there is a broad differential diagnosis for a large

0:06

eye macrophthalmia and a small eye microphthalmia.

0:11

I would like to highlight the most common entities

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associated with these various findings.

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For macrophthalmia,

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far and away, the most common etiology

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is axial myopia or nearsightedness,

0:28

leading to elongation of the globe and

0:31

a larger globe in an AP dimension.

0:34

The second most common is going to be the staphyloma,

0:39

which may occur in association with axial myopia, or

0:44

by itself, secondary to trauma and/or infection

0:48

inflammatory disease of the globe.

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Glaucoma is another entity which can lead to enlargement

0:57

of the globe. When we're dealing with microphthalmia,

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we're usually dealing with something that is

1:03

associated with an early childhood event.

1:09

Of these,

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TORCH infections are probably the most

1:14

common of the causes of microphthalmia.

1:18

In the later childhood and young adult situation,

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the most common entity is going to be phthisis bulbi

1:27

and that may be associated again with trauma

1:31

or infection to the globe.

1:34

I've spoken previously about the entity of phthisis bulbi

1:38

and here I'd like to show a couple examples on CT and MRI.

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On the left-hand side, you see a patient who had had

1:47

previous trauma to the left eye and was presenting

1:51

with acute trauma to the right eye.

1:54

We see the ocular shield that was placed over the top

1:59

of the right eye, and we see the ruptured globe.

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However, on the left eye,

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which was the nontraumatized eye,

2:08

we see a small globe with an associated calcification.

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And this was a patient who had previous trauma

2:15

to the left eye and phthisis bulbi.

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In this second example, we are seeing the bone windows

2:23

of a patient who has bilateral phthisis bulbi.

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And you see the calcification of small-sized globes,

2:33

bilaterally, in this patient who had severe diabetic

2:38

retinopathy with multiple retinal detachments

2:41

and shrunken globes on that basis.

2:45

This is the same patient with MRI scanning, and the signal

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intensity of the globe on T2-weighted scanning is irregular.

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It should normally be the same

2:55

as CSF space in the vitreous.

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And we are seeing the entity of phthisis bulbi

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as manifested by abnormal signal intensity

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and small globes bilaterally

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in partially calcified globes seen on the CT scan as well.