9/18/25, 12:28 PM Eye in Numbers - EyeWiki

Eye in Numbers
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Article initiated by: Joobin Khadamy, MD, FEBO, FEBOS-CR

All contributors: Hoon Jung, MD, Joobin Khadamy, MD, FEBO, FEBOS-CR, S. Grace Prakalapakorn, MD, MPH, Michael T Yen, MD, Hashem
Abu Serhan

Assigned editor: Michael T Yen, MD

Review: Assigned status Up to Date

by Michael T Yen, MD on June 28, 2025.

The significance of numbers in routine clinical practice has grown exponentially. They guide disease diagnoses, treatment choices (in terms of kind, dosage, and
duration), aid in surgical precision, determine implant specifications, and even influence follow-up schedules. Daily clinic procedures involve various biometric
assessments, generating essential numerical data. In the realm of ophthalmology, sometimes, the sole focus for specialists is a single numeric value, such as
normal corneal power, acceptable residual stromal bed levels, or specific anatomical reference values. Despite the advancement of search engines, procuring
normal value ranges and their clinical implications remains a cumbersome task. Therefore, there's a strong appreciation among clinicians for a centralized
repository of reference values in ophthalmology. This initiative aims to collect and present the latest reference values and their clinical relevance across
various ophthalmic conditions. The primary source for these numbers is The American Academy of Ophthalmology's Basic and Clinical Science Course™ book
series. Continuous contributions from all members are vital to maintain the page's accuracy and relevance.

Contents
1 Eye in Numbers
1.1 Adult Eye Volume
1.2 Axial Length (AL)
1.3 Transverse Diameter of the Globe
1.4 Cornea
1.4.1 Corneal Diameter
1.4.2 Consistency
1.4.3 Corneal Power
1.4.4 Corneal Thickness
1.4.5 Endothelial Layer Characteristics
1.4.5.1 Endothelial Cell Density (ECD)
1.4.5.2 Endothelial Cell Morphology
1.5 Conjunctiva
1.6 Sclera
1.7 Anterior chamber
1.7.1 Aqueous humor
1.7.1.1 Chambers
1.7.2 Phakic IOL
1.8 Intraocular pressure (IOP)
1.9 Episcleral venous pressure
1.10 Pupil
1.11 Iris
1.12 Lens
1.12.1 Capsule
1.13 Ciliary body
1.14 Pars plana
1.15 Ora serrata
1.15.1 Vascularization
1.16 Vitreous
1.17 Macula
1.17.1 Fovea
1.17.2 Foveal avascular zone (FAZ)
1.17.2.1 Foveola
1.17.2.2 Umbo
1.17.2.3 ParaFovea
1.17.2.4 PeriFovea

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1.18 Optic nerve

1.19 Retinal pigment epithelium (RPE)
1.20 Choroid
1.20.1 Vascular anatomy
2 Extraocular muscles
2.1 Insertion distances
2.2 Arc of contact
3 Orbit
3.1 Ciliary ganglion
4 Tear and Tear-Film
4.1 Tear Composition
4.1.1 Dry Eye Diagnostics
4.1.1.1 Schirmer Tests
4.1.2 Developmental Timeline
5 Eyelid Anatomy
5.1 Arterial Supply
5.2 Upper Lid Crease
5.3 Blinking Frequency and Clinical Significance
5.4 Levator Function
5.5 Levator Function and Surgical Guidelines
5.6 Meibomian Glands
5.7 Eyelashes
5.7.1 Growth Cycle
6 Biopsy Guidelines
7 Ophthalmic Instruments
7.1 Volk Lens Factors
8 Visual Acuity Testing
8.1 Nystagmus Acuity Estimates
8.2 Preschool HOVT Norms
8.3 Duochrome Testing
9 Time-Critical Ophthalmic Protocols
9.1 Emergency Interventions
9.2 Surgical Timing
9.3 Pharmacological Timelines
9.4 Cycloplegics/Mydriatics (ASH-CT Mnemonic)
9.5 Diagnostic Protocols
9.6 Specialized Procedures
9.7 Disease Timelines & Definitions
9.8 Uveitis Classification
9.9 Diabetic Retinopathy Screening
9.10 Intraocular Gas Dynamics
9.10.1 Gas Selection Guide
10 Critical Ophthalmic Dosages
10.1 Antimalarials
10.2 Toxoplasmosis Management
10.2.1 Prophylaxis
10.2.2 Adult Treatment
10.2.2.1 Alternate Regimens
10.2.3 Vision-Threatening Lesions
10.2.4 Congenital Toxoplasmosis
10.3 Herpesviridae Therapy
10.3.1 HSV Treatment
10.3.2 HZO Treatment
10.4 Intracameral Medications
10.5 Intravitreal Injections
10.6 Fortified Ocular Topicals
11 References:

Eye in Numbers
Adult Eye Volume
Parameter Measurement

Adult eye volume ~6.5–7.0 mL

Axial Length (AL)

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Condition Measurement
Normal adult 23–25 mm
High myopia (> −6 D) >26 mm

Pathologic myopia (> −8 D) 32.5 mm

Microphthalmia <21 mm (adults), <19 mm (1 year of age)
Nanophthalmos <18 mm (highly hyperopic eye)

Clinical Pearls for Axial Length:

* The standard Morcher CTR comes in three sizes based on uncompressed diameter, selected according to axial length (AL):
** 12.3 mm (compresses to 10 mm, Morcher 14): AL < 24 mm
** 13 mm (compresses to 11 mm, Morcher 14C): 24 mm < AL < 28 mm
** 14.5 mm (compresses to 12 mm, Morcher 14A): AL > 28 mm
* Implant size calculation: Axial length − 2 mm = implant diameter
** Subtract 1 mm from implant diameter for evisceration and for hyperopia

Transverse Diameter of the Globe

Parameter Measurement
Transverse diameter (widest point) ~24 mm

Cornea
Corneal Diameter
Category Measurement
Adults (horizontal) 12–12.5 mm

Adults (vertical) 11 mm
At birth 9.5–10.5 mm

Clinical Pearls for Corneal Diameter:

* To calculate ACIOL size: Horizontal white-to-white distance + 1 mm
* Congenital glaucoma:
** >12 mm horizontally in newborns
** >11.5 mm at birth
** >12.5 mm in 1-year-old children
** >13 mm in other children
* Buphthalmos (“bull’s-eye”): Horizontal corneal diameter >13 mm
* Megalocornea: >13 mm
* Microcornea: <10 mm
* The standard Morcher CTR comes in three sizes based on uncompressed diameter, selected according to white-to-white (WTW)
measurements:
** WTW < 11.5 mm: Eyes can be too small for standard Morcher CTR use; caution is advised. Type 14 is 12.3 mm uncompressed / 10 mm
compressed.
** WTW 11.5 – 12.5 mm: Average adult WTW—select Type 14C is 13.0 mm uncompressed / 11 mm compressed.
** WTW > 12.5 mm: For larger eyes, use a Type 14A is 14.5 mm uncompressed / 12 mm compressed.

Note: Adult size is reached by age 2 years.

Consistency

Parameter Composition
Corneal dry weight 70% type I collagen

Corneal Power

Component Power (D)

Average (air-tear interface) 43 D
Anterior 48–49 D

Posterior −5.8 to −6 D

Note: Posterior corneal surface contributes approximately 0.4 D of against-the-rule astigmatism.

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Clinical Pearls for Corneal Power:

* Corneal plana: K < 43 D
* Keratoconus:
** Central K > 47.2 D
** Inferior-superior (I-S) difference: >1.4 D in 3 mm
** Asymmetric K > 0.92 D
* Risk for buttonhole with LASIK: K > 48 D
* Risk for free flap with LASIK: K < 40 D
* Predicting final K after LASIK:
** Myopia: Flattening of 0.80 D per D treated; avoid final K < 35–36 D
** Hyperopia: Steepening of 1.00 D per D treated; avoid final K > 50 D
* Intacs in advanced keratoconus: K > 60.00 D has lower likelihood of functional vision improvement; corneal transplant may be needed

Asphericity: Q value
Normal cornea is prolate −0.26

Corneal Thickness

Structure/Location Thickness
Central corneal thickness (CCT) 540 μm
Near limbus 700 μm – 1.0 mm
Limbal relaxing incision (LRI) depth 500–550 μm

Epithelium 50 μm (10% of corneal thickness)

Bowman layer 10 μm (8–14 μm)
Descemet membrane (at birth) 3 μm

Descemet membrane (adults) 10–12 μm

Clinical Pearls for Corneal Thickness:

* Risk for decompensation after intraocular surgery: CCT > 640 μm
* Limbal/corneal relaxing incisions (LRI/CRI) depth: 500–600 μm (90% depth)
* Arcuate or straight incisions (AK) depth: 99% depth (avoid >90° arc due to decreased efficacy and increased instability)
* Radial keratotomy depth: 85–90% corneal thickness
* Phototherapeutic keratectomy (PTK) depth: Ablate pathology in anterior 1/3 (~180 μm)
* Contraindication for LASIK residual stromal bed (RSB): RSB < 250 μm or < 50% of original CCT
* Contraindication for LASIK: CCT < 480 μm
* Intacs: Lamellar channel at ~70% stromal depth (CCT − 50–60 μm)
* Contraindication for ring/ICR: Thickness < 450 μm
* Raindrop Near Vision Inlay: Placed at depth ≥ 200 μm
* Contraindication for crosslinking (CXL): Thickness < 400 μm (some protocols allow > 300 μm)
* LASIK flap thickness:
** Ultrathin: 80–100 μm
** Thin: 120 μm
** Standard: 120–180 μm
* Using same microkeratome blade for fellow eye: Flap 10–20 μm thinner
* Automated therapeutic lamellar keratoplasty: Microkeratome set for 130–450 μm

Endothelial Layer Characteristics

Endothelial Cell Density (ECD)

Age/Group ECD (cells/mm²)

At birth 4000

Young adults 3000

Healthy 60 years old 2500–1500

Endothelial Cell Morphology

Parameter Normal Range

Mean cell size/area 150–350 μm²
Coefficient of variation (CV) index <0.40

Hexagonality (6A) >50%

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Clinical Pearls for Endothelial Layer:

* Not appropriate for donation: ECD < 2000 cells/mm²
* Risk for decompensation after intraocular surgery: ECD < 1000 cells/mm²
* Contraindication for intraocular surgery: ECD < 500 cells/mm²
* Risk for corneal decompensation after intraocular surgery:
** Polymegathism: CVI > 0.4
** Pleomorphism: Hexagonality < 50%
* Note: ECD decreases approximately linearly until age 60, then at a lower rate, so older adults (70–80 years) may have more cells than
expected.

Conjunctiva
Feature Measurement/Note
Limbus integrity At least 25%–33% must remain intact for normal resurfacing
Giant papillae size >1 mm

Margin of excision with SCC Wide excision (4 mm margin)

Clinical Pearls
Note: Limbus integrity is critical in chemical burns or ocular surface tumor surgeries.

Sclera
Location Thickness (mm)
Posterior to recti insertions (thinnest) 0.3

At the equator 0.4–0.5

Anterior to muscle insertions 0.6
Around optic nerve head (thickest) 1.0

Clinical Pearls for Sclera:

* The thinnest part (0.3 mm, posterior to recti insertions) is significant in blunt trauma and scleral laceration.
* For drainage of suprachoroidal hemorrhage, sclerotomy is placed 5–6 mm posterior to the limbus, primarily in the inferotemporal
quadrant.

Anterior chamber
Parameter Measurement
Anterior chamber depth (ACD) 3 mm

Critical angle for total internal reflection (air-tear interface) 46 degrees

Clinical Pearls
* If ACD <2.0 mm: Risk factors for angle closure
* If ACD <3.2 mm: Increased risk of endothelial/iris trauma with phakic IOL placement

Aqueous humor

Parameter Measurement
Total volume 260 μL
Daytime production rate 2-3 μL/min (renews every 100 min)

Nighttime production rate 1 μL/min (renews every 200 min)

Ascorbic acid concentration 10-50× plasma levels

Chambers

Chamber Volume
Anterior chamber (AC) 200 μL
Posterior chamber (PC) 60 μL

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Clinical pearls:
AC tap/paracentesis Withdraw 0.05-0.1 cc using 27-30G needle near limbus

Phakic IOL
Parameter Measurement
Vault 250-750 μm (0.5-1.5× CCT)

Clinical pearls:
* Vault <90 μm increases anterior subcapsular cataract risk

Intraocular pressure (IOP)

Population Normal range (mmHg)

Adults 10-21
7-year-olds 14
Newborns 10-12

* Pediatric glaucoma: IOP >10-15 mmHg considered abnormal

* Congenital glaucoma infants: Typically 30-40 mmHg (20 mmHg under anesthesia)

Episcleral venous pressure

Measurement Value
Normal EVP 6-9 mmHg

Pupil
Parameter Measurement
Light reflex development ≥30 weeks GA

Diameter (light) 2-4 mm

Diameter (dark) 4-8 mm
Airy-disk size 1.2 mm
Anisocoria threshold >1 mm difference

Iris
Parameter Measurement
Thickness 0.35-0.45 mm[1]

Clinical pearls:
* Abnormal thickness: >0.7 mm
* Iridotomy size: ≥150-200 μm (ideal 500 μm)[2]

Lens
Parameter Measurement
Refractive index 1.4
Dioptric power 20 D
Diameter (neonate) 6.5 mm

Diameter (adult) 8.54-9.70 mm

Capsule
Location Thickness

Anterior 14.0-15.5 μm
Posterior (thinnest) 2.8-4.0 μm
Post. pre-equatorial (thickest) 23 μm

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Clinical pearls:
* Optimal capsulorhexis: 5.5-6 mm
* Piggyback IOL: 1.2× RE (myopia), 1.5× RE (hyperopia)

Ciliary body
Feature Count
Ciliary processes 70

Pars plana
Population Injection site
Phakic adults 3.5-4 mm posterior

Pseudophakic/aphakic 3-3.5 mm posterior

1-6 months 1.5 mm
6-12 months 2 mm

1-2 years 2.5 mm

2-6 years 3 mm

Ora serrata
Location Distance from limbus
Nasal 5.75 mm

Temporal 6.50 mm

Clinical pearls:
* Prefer temporal quadrant for intravitreal injections

Vascularization
Event Timing

Nasal retina maturation 36 weeks GA

Temporal retina maturation 40 weeks GA*
Full vascularization 3 months postnatal

Choroid development 16 weeks GA

Clinical pearls:
* Begin ROP screening from observing temporal area.

Vitreous
Structure Volume
Vitreous cavity 5-6 mL
Vitreous body 4 mL

Clinical pearls: Vitreous sampling

* Pars plana vitrectomy: 0.2-0.5 mL
* Vitreous tap: 0.1-0.3 mL

Consistence %
water 90

Macula
Parameter Measurement
Diameter 5.5 mm

* Distance between optic disc-macula >3 DD suggests optic nerve hypoplasia

Fovea
Feature Measurement
Diameter 1.5 mm (5°)
Photostress recovery time >90 seconds indicates maculopathy

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Clinical pearls:
* Monovision syndrome: 8 prism diopter deviation
* Rhodopsin sensitivity: 510 nm (green light)

Foveal avascular zone (FAZ)

Parameter Measurement

Diameter 500 μm (1:40°)

Clinical pearls: Avoid laser therapies in FAZ

Foveola

Parameter Measurement
Macula, perifovea, parafovea, fovea, foveola.
Location (temporal to disc) 4.0-4.5 mm (15°)

Location (inferior to disc) 0.8 mm (2:10°)

Diameter 350 μm

Umbo

Parameter Measurement
Diameter 150 μm

ParaFovea

Parameter Measurement
Ring width 0.5 mm
Outer radius 2.5 mm

Inner radius 1.5 mm

PeriFovea

Parameter Measurement

Ring width 1.5 mm

Outer radius 5.5 mm
Inner radius 2.5 mm

Optic nerve
Parameter Measurement

Adult axons 1.2-1.5 million

Gestational axons (16 weeks) 3.7 million
Head diameter 1.5-2.2 mm

Cup-to-disc ratio (normal) <0.5

Total length 50 mm

Clinical pearls:
* NAION risk: Cup-to-disc ratio ≤0.2 ("disc-at-risk")
* Enucleation in retinoblastoma: Excise ≥10 mm ON
* Atrophy timeline: 6 weeks post-damage

Retinal pigment epithelium (RPE)

Clinical pearls:
* PED >600 μm height risks RPE tear post anti-VEGF
* EOG Arden ratio:
- Normal: >2
- Best disease: ≤1.5

Choroid
Feature Risk Threshold

Nevus thickness >2 mm (melanoma risk)

Vascular anatomy
Structure Count

Short posterior ciliary arteries 20

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Short posterior ciliary nerves 10

Long ciliary arteries/nerves 2

Extraocular muscles
Muscle Active Length Tendon Length*
Rectus muscles 40 mm 4.5-7 mm
Superior oblique 32 mm 26 mm

Inferior oblique 37 mm 1 mm
Levator 40 mm 14-20 mm

(*)Shortest tendon (I M SIL Live So):

IO:1 mm
MR:4.5 mm (shortest between rectus muscles)
Overal length:
Longest: SO (58 mm) >Levator>others>Shortest: IO (38 mm)

Insertion distances
Muscle Distance from Limbus
MR 5.5 mm

IR 6.5 mm
LR 6.9 mm
SR 7.7 mm

Arc of contact
Muscle Contact Length
IO* 15 mm
LR 12 mm

SO 7-8 mm
MR** 7 mm

(*)IO:(Longest) (**)MR:(Shortest)

LR inserts 2 mm more superior than MR.

EOM penetrate the tenon capsule 10 mm posterior to their insertions.

Orbit
Parameter Measurement
Volume <30 cm³

Posterior globe-optic foramen 18 mm

Interpupillary distance 60-62 mm
Intercanthal distance 30-31 mm

Clinical pearls:
* Exophthalmos: ≥2 mm asymmetry
* Hypertelorism: IPD >2 SD above mean
* Telecanthus: Intercanthal >2 SD

Ciliary ganglion
Location Measurement

Anterior to annulus of Zinn 1 cm

Tear and Tear-Film

Parameter Measurement
Tear lake volume 7-10 µL

Eyedrop retention rate 20% (10 µL of 50 µL)

Tear production onset 20 days postnatal
Lacrimal gland maturation 6 weeks postnatal

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Clinical pearls:
* One eyedrop bottle = 5 mL ≈ 100 drops (50 µL/drop)
* Atropine 1% example: 0.5 mg/drop → 50 mg/bottle
* Artificial tears ideal properties:
- pH 7.0-8.2
- Osmolarity ≤302 mOsm/L

Tear Composition
Layer Component Percentage
Water 98%
Total protein 2%

Lysozyme 30% of protein

Aqueous
Lactoferrin -
Immunoglobulins IgA, IgG

pH 7.2
Osmolarity 302 mOsm/L
Basal secretion 2 µL/min

Layer Production Rate

Mucin (inner) 2-3 mL/day

Dry Eye Diagnostics

Test Normal Abnormal
Dye disappearance test (DDT) ≤5 min >5 min (NLDO)
Tear breakup time ≥10 sec <10 sec

Tear meniscus height ≥0.3 mm <0.2 mm

Phenol red thread ≥10 mm/15s <10 mm/15s
MMP-9 level ≤40 ng/mL >40 ng/mL

Schirmer Tests

Test Method Interpretation

Basic Secretion Anesthetized <3 mm/5 min = ATD

Schirmer I Non-anesthetized <5.5 mm/5 min = ATD

Schirmer II Nasal stimulation <15 mm/2 min = Reflex defect

Key:
ATD = Aqueous Tear Deficiency
NLDO = Nasolacrimal Duct Obstruction
MMP-9 = Matrix Metalloproteinase-9

Developmental Timeline
Milestone Timing Clinical Significance

First tears 20 days NLDO signs appear

Lacrimal function 6 weeks Full secretory capacity

Eyelid Anatomy
Structure Measurement

Upper tarsal height 11 mm (3× lower tarsus)

Lower tarsal height 4 mm
Palpebral fissure height 10-11 mm (women: 9-11 mm, men: 7-8 mm)
MRD1 3-4 mm

MRD2 5 mm
Eyelid length 30 mm

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Clinical pearls:
* MRD1 ↑ with lid retraction, ↓ with ptosis

Arterial Supply

Vascular Structure Location

Marginal arcade* 2-3 mm superior to lash line
Superior peripheral arcade Within/between Müller's muscle & levator aponeurosis

Clinical pearls:
(*) Marginal arcade avoid them while performing tarsoraphy.

Upper Lid Crease

Measurement Distance
Brow to crease 10 mm

Crease to margin (women) 8-10 mm

Crease to margin (men) 6-8 mm

Clinical pearls:
** Congenital ptosis: Absent lid crease
**Involutional ptosis: Elevated crease position

Blinking Frequency and Clinical Significance

Blinking Frequency Normal Range Clinical Significance
12-20 blinks per
Normal Maintains tear film stability, prevents dryness, and clears debris from the ocular surface.
minute

Seen in Parkinson’s disease, ocular surface disease, or neurogenic causes; increases risk of dry eye syndrome and
Reduced (Hypoblinking) <10 blinks per minute
exposure keratopathy.
Increased >20-25 blinks per
Associated with blepharospasm, ocular irritation, tic disorders, or psychological stress.
(Hyperblinking) minute
Asymmetrical Blinking Varies between eyes Suggests facial nerve palsy (e.g., Bell’s palsy) or neuromuscular dysfunction affecting one eyelid.

Clinical Pearls:
* Normal blinking occurs every **3-5 seconds**, with complete closure ensuring corneal hydration.
* Incomplete blinking: can lead to exposure keratopathy and is commonly seen in lagophthalmos or after aggressive ptosis surgery.
* Patients with neurogenic hypoblinking (e.g., Parkinson’s) may require lubricating drops or eyelid training exercises to prevent
corneal damage.

Levator Function
Classification Excursion
Normal >12 mm

Fair 6-11 mm
Poor <6 mm

Levator Function and Surgical Guidelines

Levator Function Recommended Surgery Indications

Excellent (>12 Mild ptosis: Müller’s muscle resection or small levator
Small droop, strong muscle, good phenylephrine test response
mm) advancement
Good (8-12 mm) Levator advancement/resection for moderate ptosis Aponeurotic or mild congenital ptosis with functional levator
Fair (5-7 mm) Moderate-to-severe ptosis: Levator resection (maximal if needed) Levator has some function, can attempt resection but results may vary

Severe congenital ptosis, third-nerve palsy, muscular dystrophy-related

Poor (<4 mm) Frontalis sling (bypassing weak levator function)
ptosis

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Clinical pearls:
* Levator resection indicated when LF >4 mm
* Normal excursion: ~15 mm (range 12-18 mm)

Meibomian Glands
Location Gland Count Secretory Rate
Upper eyelid 25-40 1.0-1.4 μL/min
Lower eyelid 20-30 0.8-1.2 μL/min

Eyelashes
Parameter Measurement

Upper lid count 90-150

Lower lid count 70-80
Growth rate 0.12-0.15 mm/day

Full regrowth time 6 weeks (intact follicle)

Clinical pearls:
* Post-epilation recovery: 6-12 weeks for full growth
* Repeated extension use may reduce lash density by 30-50%
* Bimatoprost increases length by 25-30% but may cause periocular pigmentation

Growth Cycle
Phase Duration Characteristics
Anagen 30-45 days Active growth

Catagen 2-3 weeks Follicle regression

Telogen 30-45 days Resting/shedding

Biopsy Guidelines
Clinical pearls: Biopsy size and width of margins should be based on clinical presentation, level of suspicion, and risk factor
analysis.

Ophthalmic Instruments
Device Specification
3.06 mm applanated area
Goldmann tonometer
1.25g weight (5.5g total force)

LASIK plume particles 0.22 µm size

Surgical mask filtration 0.1 µm efficiency

Clinical pearls:
* LASIK safety:
** A canister mask will filter these particles down to 0.1 µm.
** The average particles produced in the LASIK plum are 0.22 µm.
** N95 masks filter 95% of 0.3µm particles

Volk Lens Factors

Lens Magnification Factor Field Width

60D 1.0× 70°
78D 1.1× 85°

90D 1.3× 100°

Clinical pearls:
* 60D lens: 1:1 papilla-to-slit beam ratio at 16× magnification

Visual Acuity Testing

Test Parameter Specification

Pinhole Optimal diameter 1.2 mm (corrects ≤3D)

Pinhole Diffraction limit 20/40 at 1.0 mm

Nystagmus Acuity Estimates

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Type Visual Acuity Characteristics

Vertical OKN ≥20/400 Vertical nystagmus overlay
Searching <20/200 Roving eye movements

Pendular >20/200 Sinusoidal oscillation

Jerk 20/60-20/100 Fast/slow phases

Preschool HOVT Norms

Age Snellen Decimal
2.5y 20/63-20/30 0.33-0.66

5y 20/30-20/20 0.66-1.0

Duochrome Testing
Source Chromatic Interval Wavelength Difference
Commercial filters 0.50D 490nm vs 630nm
Human eye (Fraunhofer) 1.5-3.0D 486nm (F) - 656nm (C)
Human eye (Helmholtz) 1.8D Photopic sensitivity peak

Clinical pearls:
* 80% patients prefer green focus at 0.25D over red
* 1.0D hyperopia correction improves duochrome balance by 40%

Time-Critical Ophthalmic Protocols

Emergency Interventions
Condition Time Window Specifics
Myocardial Infarction/Stroke/CRAO ≤90 min Door-to-balloon/thrombolysis
Sympathetic Ophthalmia 4-8 weeks (65% 2-8w, 90% <1y) Latent period post-trauma
Hyphema (Pediatric) 4-5 days Surgical intervention threshold

Hyphema (Sickle Cell) >24h IOP >25 mmHg Immediate surgery

Perforating Trauma 5-14 days Vitrectomy for PVR prevention

Surgical Timing
Procedure Minimum Wait Details
LASIK Re-treatment 3 months Refractive stability required

Surface Ablation Repeat 6-12 months Haze resolution period

Nerve Palsy Repair 9-12 months Allow spontaneous recovery
**Refractive Surgery Post-Pregnancy** **3 months postpartum + breastfeeding cessation** Hormonal stabilization

Congenital Cataract (Uni) <6 weeks Prevent sensory nystagmus

Congenital Cataract (Bi) <8-10 weeks Sequential within 2w (<2y) /4w (>2y)
Artificial Iris Implant ≥16 years Pediatric contraindication

Pharmacological Timelines
Medication Critical Duration Effects

>2w use → 5% IOP >31mmHg at 6w

**Topical Steroids** Monitor IOP q2w, If > 3 drops/d>3mo consider systemic
≥18mo → Permanent damage

Systemic Steroids (Immunosuppression) >7.5mg/d >3mo Threshold for alternative therapy

Tetracaine 10-20s onset 10-20min duration
**Retrobulbar Lidocaine (0.5-2%)** 5min onset 1-2hr akinesia

Δ9-THC (Marijuana) 3-4hr Impractical IOP control

Cycloplegics/Mydriatics (ASH-CT Mnemonic)

Agent Duration Full Effect Onset
**A**tropine 7-14d 60-120min
**S**copolamine 4-7d 45min

**H**omatropine 3d 30min
**C**yclopentolate 24hr 60min
**T**ropicamide 4-6hr 30min

Diagnostic Protocols
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Test Protocol Positive Criteria

**Tensilon (Edrophonium)** 2+4+4mg IV + **Atropine pre-treatment** ≥2mm lid elevation
**Neostigmine** 1.5mg IM + Atropine 0.6mg IV Improvement in 30-45min

Sleep Test 30min nap Lid elevation + resolution

Ice Pack Test 2min application ≥2mm improvement

Specialized Procedures
Technique Exposure Time Clinical Application
Absolute Alcohol (20%) 10–45s Epithelial debridement

Mitomycin C (0.02%) 12s–2min Haze prevention

**Photodynamic Therapy** N/A **5d strict sun avoidance**

Clinical Pearls:
1. **Steroid Response Gradation:**
- <2w: Rare IOP spikes
- 6w: 5% >31mmHg
- ≥18mo: 22% permanent damage
2. **MG Crisis Protocol:**
- Neostigmine 1.5mg IM + Atropine 0.6mg IV q4-6h
3. **ONTT Steroid Taper:**
- Prednisone 1mg/kg/day ×11d → 20mg day 12 → 10mg days 13-15
4. **GCA Biopsy:**
- 2-3cm specimen length (skip lesion prevention)

Disease Timelines & Definitions

Condition Time Criteria Clinical Significance

Apparent Optic Atrophy 6 weeks post-injury Final functional assessment window

Uveitis Classification
Type Duration Recurrence Pattern
Acute <3 months Single episode
Recurrent <3 months/episode >3 months between flares

Chronic >3 months Persistent inflammation

Diabetic Retinopathy Screening

Population Initial Exam Pregnancy Protocol
Type 1 DM 3-5 years post-diagnosis 1st trimester
Type 2 DM At diagnosis 1st trimester

Clinical pearls:
* 15% of Type 1 DM develop DR within 5 years
* 20% of Type 2 DM have DR at diagnosis
* Monthly exams for proliferative DR in pregnancy

Intraocular Gas Dynamics

Gas Effective Tamponade Retention Time Key Properties

SF₆ 6 days 13 days (2-3w) Non-expansile concentration

C₂F₆ 15 days 35 days (3-4w) 18% concentration expands 2×
C₃F₈ 30 days 65 days (6-8w) 14% concentration expands 4×

Clinical pearls:
* SF₆: Requires 5-day face-down positioning
* C₃F₈: 20% risk of transient IOP >30mmHg (monitor q4h first day)
* Gas-filled eyes contraindicated for air travel until 10% residual

Gas Selection Guide

Clinical Scenario Preferred Gas Rationale

Macula-on RD SF₆ Short-term tamponade needed

Giant retinal tear C₂F₆ Moderate duration support

Proliferative vitreoretinopathy C₃F₈ Long-term stabilization

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Key:
RD = Retinal Detachment
IOP = Intraocular Pressure
w = weeks
DM = Diabetes Mellitus
DR = Diabetic Retinopathy

When different antiplatelets or anticoagulants should be paused before various intraocular or oculoplastic surgeries:

Intraocular Surgery (e.g., Oculoplastic Surgery (e.g.,

Medication Comments
Cataract, Glaucoma, Vitrectomy) Blepharoplasty, Ptosis repair)

*May continue in minor surgeries if risk of

Aspirin * 7-10 days before
thromboembolism is high.
Consider bridging with low-dose aspirin if thromboembolic
Clopidogrel (Plavix) 5-7 days before 5-7 days before
risk is high.
Bridging therapy might be considered depending on the
Ticagrelor (Brilinta) 5-7 days before 5-7 days before
thromboembolic risk.

Typically requires longer cessation than clopidogrel due to

Prasugrel (Effient) 7-10 days before 7-10 days before
higher potency.
INR should be normalized (<1.5); consider bridging with
Warfarin (Coumadin) 3-5 days before 3-5 days before
LMWH if high risk.
Consider longer cessation (4-5 days) in patients with renal
Dabigatran (Pradaxa) 2-3 days before 2-3 days before
impairment.
Discontinue 2 days before surgery for normal renal
Rivaroxaban (Xarelto) 2-3 days before 2-3 days before
function; may require more if renal function is impaired.

May consider 48-hour cessation, longer if impaired renal

Apixaban (Eliquis) 2-3 days before 2-3 days before
function.
Similar considerations as for other direct oral
Edoxaban (Savaysa) 2-3 days before 2-3 days before
anticoagulants.
Heparin (Unfractionated) 4-6 hours before 4-6 hours before Short-acting; can be paused closer to the surgery.

Low Molecular Weight Enoxaparin typically paused 24 hours prior; consider renal
24 hours before 24 hours before
Heparin (LMWH) function.
NSAIDs (e.g., Ibuprofen) 48-72 hours before 48-72 hours before Avoid in cases where bleeding risk is significant.

Timing of Pausing Antiplatelets and Anticoagulants Before Intraocular or Oculoplastic Surgery

Discontinuing aspirin before cataract surgery is a practice driven by theoretical risks of bleeding, despite strong evidence from large-scale studies and
meta-analyses showing that continuing aspirin does not significantly increase serious complications but poses real thrombotic risks and unnecessary
healthcare disruptions.[3] [4]

Critical Ophthalmic Dosages

Antimalarials
Parameter Hydroxychloroquine Chloroquine

Daily Dose 5.0 mg/kg (actual body weight) 2.3 mg/kg (actual body weight)
Cumulative Toxicity Threshold >1000 g total >460 g total
High-Risk Duration >5 years >5 years

Clinical pearls:
* Use actual body weight for all BMI categories
* Annual retinal screening mandatory after 5 years of use
* Discontinue if retinal toxicity suspected

Toxoplasmosis Management
Prophylaxis
Scenario Regimen Duration
Paramacular recurrence TMP-SMX 800/160mg q3d Long-term
Perioperative (LASIK/Phaco) TMP-SMX 800/160mg daily 2 days pre-op → 1 week post-op

Adult Treatment
Medication Loading Dose Maintenance Adjuncts
Pyrimethamine 200mg Day 1 50mg daily ×4wk Folinic acid 15mg BIW

Sulfadiazine 2g Day 1 1g QID ×4wk Hydration + NaHCO₃

Alternate Regimens

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Option Dose Frequency

Azithromycin 500mg Daily ×4wk
Clindamycin 300-450mg q6h ×4wk

TMP-SMX DS 1 tablet BID ×4wk

Vision-Threatening Lesions
Medication Dose Administration
Prednisone 1-1.5 mg/kg/day 4-week taper

Triamcinolone 40mg Single periocular injection

Clinical pearls:
* Start steroids 72h after antimicrobial initiation
* Prepare TMP-SMX DS as double-strength tablets (160/800mg)

Congenital Toxoplasmosis

Medication Dose Frequency

Pyrimethamine 1mg/kg q3d ×3wk
Sulfadiazine 50-100mg/kg BID ×3wk

Folinic Acid 3mg BIW during treatment

Clinical pearls:
* Pregnancy management: Spiramycin 1g TID for acute maternal infection
* Corticosteroid taper duration: 2-4 weeks based on response

Herpesviridae Therapy
HSV Treatment
Medication Acute Therapy Prophylaxis
Acyclovir 400mg 5×/day 400mg BID

Valacyclovir 1000mg TID 500-1000mg daily

Famciclovir 250mg TID 250mg BID

HZO Treatment
Medication Dose Duration

Acyclovir 800mg 5×/day 10-14 days

Valacyclovir 1g TID 10-14 days
Famciclovir 500mg TID 10-14 days

Clinical pearls:
* Recurrent HZO: Extend antiviral course to 21 days
* Topical steroids: Prednisolone 1% q2-6h based on severity
* Chronic prophylaxis: Reduce dose by 50% after 6 months

Intracameral Medications
Medication Concentration Volume Preparation Notes

Cefuroxime 1 mg 0.1 mL Standard reconstitution

Moxifloxacin 150 µg/0.1 mL 0.3-0.4 mL 3 mL Vigamox + 7 mL BSS[5]

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Clinical pearls:
* Inject moxifloxacin as final surgical step
* Maintain strict aseptic technique during dilution

Intravitreal Injections
Medication Dose Indication Notes
Bevacizumab 1.25 mg/0.05 mL Off-label use 0.675 mg/0.03 mL for ROP
0.5 mg/0.05 mL nAMD/RVO
Ranibizumab Myopic CNVM
0.3 mg/0.05 mL DR/DME

Aflibercept 2.0 mg/0.05 mL VEGF-mediated diseases -

Brolucizumab 6 mg/0.05 mL nAMD -
Faricimab 6 mg/0.05 mL DME/nAMD -
2 mg/0.05 mL
Triamcinolone Off-label Use Triesence®/Trivaris® for FDA-approved
4 mg/0.1 mL

Ganciclovir 4 mg/0.1 mL CMV retinitis 2 mg/0.05 mL twice weekly ×14d

Clindamycin 1 mg/0.1 mL Toxoplasmosis -
Foscarnet 2.4 mg/0.1 mL Viral retinitis 1.2 mg/0.05 mL dose

Fomivirsen 330 mcg/0.05 mL CMV retinitis -

Methotrexate 400 mcg/0.1 mL Intraocular lymphoma -
Vancomycin 1 mg/0.1 mL Endophthalmitis -

Ceftazidime 2.25 mg/0.1 mL Bacterial infections -

Amikacin 0.4 mg/0.1 mL Gram-negative coverage -
Amphotericin B 5 mcg/0.1 mL Fungal infections -
Voriconazole 50-100 mcg/0.1 mL Fungal endophthalmitis -

Dexamethasone 0.4 mg/0.1 mL Inflammation -

Clinical pearls:
* Use 30G needles for all intravitreal injections
* Confirm needle position in mid-vitreous
* Monitor IOP post-injection

Fortified Ocular Topicals

Medication Concentration Preparation Method
Bacitracin 10,000 IU/mL Reconstitute powder with sterile water
Cefazolin 50 mg/mL (5%) 500mg vial + 10mL sterile saline

Ceftriaxone 50 mg/mL (5%) 1g vial diluted in 20mL artificial tears

Ceftazidime 50 mg/mL (5%) 1g vial + 10mL BSS + 10mL vehicle
Vancomycin 50 mg/mL (5%) 500mg vial + 10mL sterile water

Linezolid 2 mg/mL (0.2%) IV solution diluted 1:10 with saline

Gentamicin 14 mg/mL (1.4%) 80mg injectable + 5mL commercial drops
Tobramycin 14 mg/mL (1.4%) Same as gentamicin
Amikacin 40 mg/mL (4%) 500mg vial + 12.5mL vehicle

Clarithromycin 10 mg/mL (1%) 500mg tablet dissolved in 50mL vehicle

Azithromycin 10 mg/mL (1%) Reconstitute powder with sterile water
Co-trimoxazole 16/80 mg/mL (TMP/SMX) 80/400mg tablet in 50mL vehicle

Clinical pearls:
* Refrigerate at 4°C; discard after 7 days (14 days for vancomycin)
* Use preservative-free artificial tears as base vehicle
* Shake suspensions vigorously before administration
* Monitor corneal epithelium daily with aminoglycosides
* TMP/SMX ratio maintained at 1:5 (16mg:80mg)

References:
1. 2022-2023 Basic and Clinical Science Course, Section 01: Update on General Medicine by Herbert J. Ingraham , ISBN: 9781681045412 , Publication Date:
2022-08-30

2. 2022-2023 Basic and Clinical Science Course, Section 02: Fundamentals and Principles of Ophthalmology by Vikram S. Brar Section 2 , ISBN:
9781681045429, Publication Date: 2022-08-30

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3. 022-2023 Basic and Clinical Science Course, Section 03: Clinical Optics and Vision Rehabilitation by Scott E. Brodie , ISBN: 9781681045436, Publication
Date: 2022-06-20

4. 2022-2023 Basic and Clinical Science Course, Section 04: Ophthalmic Pathology and Intraocular Tumors by Nasreen A. Syed ISBN: 9781681045443,
Publication Date: 2022-06-20

5. 2022-2023 Basic and Clinical Science Course, Section 05: Neuro-Ophthalmology by M. Tariq Bhatti, ISBN: 9781681045450, Publication Date: 2022-06-
20

6. 2022-2023 Basic and Clinical Science Course, Section 06: Pediatric Ophthalmology and Strabismus by Arif O. Khan, ISBN: 9781681045467, Publication
Date: 2022-06-20

7. 2022-2023 Basic and Clinical Science Course, Section 07: Oculofacial Plastic and Orbital Surgery by Bobby S. Korn, ISBN: 9781681045474, Publication
Date: 2022-06-20

8. 2022-2023 Basic and Clinical Science Course, Section 08: External Disease and Cornea by Robert W. Weisenthal, ISBN: 978168104548, Publication Date:
2022-06-20

9. 2022-2023 Basic and Clinical Science Course, Section 09: Uveitis and Ocular Inflammation by H. Nida Sen, ISBN: 9781681045498, Publication Date:
2022-06-20

10. 2022-2023 Basic and Clinical Science Course, Section 10: Glaucoma by Angelo P. Tanna, ISBN: 9781681045504, Publication Date: 2022-06-20

11. 2022-2023 Basic and Clinical Science Course, Section 11: Lens and Cataract by Linda M. Tsai, ISBN: 9781681045511, Publication Date: 2022-06-20

12. 2022-2023 Basic and Clinical Science Course, Section 12: Retina and Vitreous by Stephen J. Kim, ISBN: 9781681045528, Publication Date: 2022-06-20

13. 2022-2023 Basic and Clinical Science Course, Section 13: Refractive Surgery by M. Bowes Hamill Restricted Resource, ISBN: 9781681045535,
Publication Date: 2022-06-20

14. Nixon HK. Preparation of fortified antimicrobial eye drops. Kerala J Ophthalmol [serial online] 2018 [cited 2022 Dec 23];30:152-4. Available from:
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15. https://eyewiki.aao.org/Herpes_Simplex_Uveitis#Medical_therapy

16. https://www.aao.org/current-insight/management-of-ocular-toxoplasmosis

1. Li Q, Zong Y, Wen H, Yu J, Zhou C, Jiang C, Liu G, Sun X. Measurement of Iris Thickness at Different Regions in Healthy Chinese Adults. J Ophthalmol. 2021
May 11;2021:2653564. doi: 10.1155/2021/2653564. PMID: 34055394; PMCID: PMC8131156.
2. Fleck BW. How large must an iridotomy be? Br J Ophthalmol. 1990 Oct;74(10):583-8. doi: 10.1136/bjo.74.10.583. PMID: 2285680; PMCID:
PMC1042224.
3. Abo Zeid M, Elrosasy A, Alkheder A, et al. Do We Need to Hold Aspirin Before Cataract Surgery? A Systematic Review and Meta-Analysis of 65,196
Subjects. Semin Ophthalmol. Published online November 1, 2024. doi:10.1080/08820538.2024.2420969
4. Benzimra JD, Johnston RL, Jaycock P, et al. The Cataract National Dataset electronic multicentre audit of 55,567 operations: antiplatelet and anticoagulant
medications. Eye (Lond). 2009;23(1):10-16. doi:10.1038/sj.eye.6703069
5. https://eyewiki.aao.org/Intracameral_Medications_Following_Cataract_Surgery
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