UNIVERSITY OF ILORIN, ILORIN

FACULTY OF LIFE SCIENCES

DEPARTMENT OF OPTOMETRY AND VISION SCIENCE

OPT 401
PHYSIOLOGICAL OPTICS LABORATORY II

Group presentation
SUPERVISOR: DR O.M. OJO
DATE: April 2, 2023

ENTOPTIC PHENOMENON

Prepared by: Group 3

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OUTLINE

▪ ENTOPTIC PHENOMENON

• INTRODUCTION

• HISTORY

• OVERVIEW

▪ ENTOPTIC PHENOMENA (As Observed with Different Structure of the Eyes)

▪ EXAMPLES OF ENTOPTIC PHENOMENA

▪ REFERENCES

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INTRODUCTION
Entopic phenomenon is a phrase derived from the Greek words ‘inside’ and ‘light’ or ‘vision’. It was
introduced by Johann Benedict (1808-1882) who described it has the ability of an individual to
perceive substances inside their own eye such as retinal vessels or vitreous opacities. [Mark HH 2014].
Entopic phenomenon can be defined as visual effects and sensations that occur from causes within the
human eye itself. It literally means ‘the eyes seeing itself’. This phenomenon may result from either
normal anatomical component of the eye or pathological imperfections.
It is usually brought about by shining a focused light such as from a penlight or a hand-held
ophthalmoscope on the sclera or in front of the pupil and then rapidly moving it back and forth. For
example, during a slit lamp examination a patient may claim to see the reflection of blood vessels of
his/her own eyes. The image seen by such patient is an example of an entopic phenomenon. [Mark HH
2014].

HISTORY
Entopic phenomenon was first described by Johann Purkinje in the early 1800s. He used this
phenomenon to describe the fleeting, black after-image of the retinal vasculature and later
described “Purkinje tree” using this phenomenon. This particular entoptic phenomenon occurs due
the location and pattern of the branching retinal vascular “tree” in front of the photoreceptor layer,
casting a shadow that is only induced when a segment of the eye is illuminated. [Purkinje J 1819].
Entopic phenomenon has been historically used to determine the photoreceptive layer of the retina and
the visual process.

OVERVIEW
Normally, in day to day life, one is not aware of the imperfections in the ocular media in spite of the
fact that with the exception of the aqueous humour, none of the ocular media are perfectly transparent
since they are composed of cells with nuclei. This is due to the fact that these opacities lie so far in
front of the retina that the umbral portions of their shadows may not fall on the retina.
The factors which influence the entoptic visualization of opacities in the ocular structures includes:
(a) The vergence of light within the eye
(b) The location of opacities within the eye relative to the photoreceptor layer
(c) The optical density of the opacities, and
(d) The refractive nature of the opacities.
Entoptic images have a physical basis in the image cast upon the retina as they are different from
optical illusions produced by the visual system. Entoptic phenomena share a particular feature with
optical illusions and hallucinations because the entoptic images are caused by some phenomena within

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the observer’s own eyes.
Helmholtz described further to differentiate entoptic phenomena from optical illusion:
Helmholtz claimed entoptic images could be easily seen by some observers but could not be easily
seen by others. This is because the variance in the ocular opacities is specific to individuals and is not
the same within two or more people. This means that entoptic phenomena are not produced by
visioning a common stimulus. [Wikipedia, 2019]

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 ENTOPTIC PHENOMENA (As Observed with Different Structure of the Eyes)
The optical density and the refractive index of the structures are important in the formation of entoptic
phenomenon. Different structures inside the eye cause diffraction when light bends from their edges.
The result is a decline in the contrast of the image and the onset of rainbow halos. This phenomenon
can occur in both the normal physiological eye and in pathological condition.

TEAR FILM and CORNEA

Visual effects can be caused by changes in the state of the tear film and cornea.”.
Some Corneal sources of entopic phenomena are:
1. Droplets of tears and mucus on corneal surface which act as convex lens causes the visualization of
bright spot surrounded by dark bands and move up and down when blinking.
2. Folds in corneal epithelium are seen as horizontal bands which change position with narrowing
and widening of the palpebral fissure.
3. Folds and channels in corneal stroma will cause visualization of gently curved vertical lines that
do not change with blink/eye movements.
[A. K Khurana, 2015].

Other visual effects observed due to the cornea are colored halos [pathologic halos] and are typically
due to some pathological changes in the cornea [e.g. corneal edema].

LENS
Lens particles, lens gratings are the visual effects arising from within the lens. Some entoptic
phenomenon that occurs in the physiological eye and affects the lens includes; ciliary corona and
lenticular halo.
◼ Ciliary corona: This occurs when watching a singular illuminated object in the dark, for example; a
street light. The illumination source is surrounded by a halo with slightly coloured needles(Fig.1). This
is the result of the light reflecting from numerous tiny particles (proteins) in the lens nucleus and the
tiny irregularities in the structure of other ocular parts e.g. deposits on the corneal endothelial cells or
the cells in the anterior chamber and the anterior lens capsule.
◼ Lenticular Halo: This may occur when the pupil is dilated in a dim area. A ribbon of colour around
the illumination source will appear(Fig.2). It is caused by light bouncing from the zonular and anterior
parts of the lens.

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Source: Semanticscholar.org Fig.1 Source: fxfactory.com Fig.2

VITREOUS
The most well-known entoptic phenomenon related to the vitreous is Moore's lightning streaks,
which many patients experience in cases of anomalous posterior vitreous detachment, where vitreous
liquefaction precedes the weakening of vitreoretinal adhesions, resulting in instances of retinal traction.
This results in photopsia often referred to as; “flashes of light”.

Most trouble with patients who complain of entoptic shadows arises from shadows thrown by strands
in the vitreous. They cause blurred vision which comes and goes, but the opacities are not focused as
sharply defined strands but appear as bright, beaded, curly bands known as Musca volitantes (Latin
for ‘hovering flies’), which are dark against the sky and semi-transparent against a bright light. It is
commonly referred to as ‘floaters’. It is a ubiquitous entoptic phenomenon of fly-, cobweb- or thread-
like condensations that are best seen against a pale background. It is thought to predominantly represent
tiny embryological remnants in the vitreous gel. A sudden exacerbation can occur due to vitreous
hemorrhage or, more commonly, a change in the conformation of the gel, such as a posterior vitreous
detachment. [Elmore W. Brewton 1990].
The best method of demonstrating this phenomenon clearly is to look at a bright light with the lids
nearly closed. It is better to close the lids completely and then to open them slowly until a minute chink
of light is seen through a bead of moisture between the lids. Most people can see many bright strands
of a beaded character with dark borders, some with bright spots in them, also with dark borders. Some
of these strands are large, evidently magnified by being some distance from the retina; others, which
are close to the retina, are extremely small. They all appear to move more or less.
With the electric ophthalmoscope, slit lamp and a dilated pupil, much more of the stroma of the vitreous
can be seen and used to determine whether the shadows are pathological or physiological. With the old
Morton ophthalmoscope, if the patient saw them clearly and the doctor could not, they were
physiological and of no importance. Also, if the patient sees these floating strands sharply defined
against the sky and the vitreous appears transparent to the observer, with an ordinary ophthalmoscope,
the trouble can be disregarded. [Elmore W. Brewton 1990].

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CHORIOCAPILLARY CIRCULATION
A retro-retinal circulation sometimes limited to the choriocapillary circulation maybe indistinctly
perceived after experience of its normal appearance have been gained by gazing intently with relaxed
accommodation at any brightly lit uniform field. The luminous points are the most easily seen but on
continued gaze, these may disappear and be replaced by a darkened field in which circulation is
observed.
Choriocapillary circulation was first seen while under the influence of mescaline but was only
recognized as such after prolonged investigation with the microscope. It was observed as surging
circulation in irregular sinuses, somewhat “fern-like” in appearance of a dark reddish grey colour
bounded by a black ground meshwork and covering the whole field. These effects only last for a few
seconds but it may usually be repeated several times.
Choriocapillary circulation can be perceived as blue field phenomenon(Fig.3) and as pressure
phosphene(Fig.4)

F.

Source: Shutterstock.com Fig.3 Source: commons.m.wikimedia.org Fig.4

RETINA
It has been observed that the movement of this blood vessels across the retinal capillaries in front of
the retina leads to formation of entopic images e.g." The moving dots we see when staring at the sky
are created by your own white blood cells flowing through our eyes"
Also, interaction of our eyes “retina" with bright featureless background (such as the sky) leads to
formation of floaters (spot in vision) and casting of shadows.
Preferential absorption of blue polarize light by xanthophyll pigment (a pigmented molecule of the
fovea that is yellowish in colour) leads to seeing yellow subtle structure by the observer when white
light enters the eyes and leads to seeing grey subtle structure by observer when blue light enters the
eyes. (Haidinger’s Brush). [Wikipedia, 2023].

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EXAMPLES OF ENTOPTIC PHENOMENA

A. BLUE LIGHT ENTOPIC PHENOMENON

Blue light entopic phenomenon is also known as Scheerer's Phenomenon, it was discovered by a
German Ophthalmologist, Richard Scheerer in 1924. This Phenomenon is characterized by the
appearance of tiny bright dots (nicknamed blue-sky sprites) moving quickly along squiggly lines in
the visual field, especially when looking into bright blue light like the sky. The dots are short-lived,
visible for a second or less, and traveling short distances along seemingly random, curvy paths. Some
of them follow the same path as predecessors. The dots may be elongated along the path like tiny
worms(fig.5). The speed of the dots varies in sync with the pulse. The dots appear in the central field
of view, within 15 degrees from the fixation point. The left and right eye see different dots; someone
looking with both eyes sees a mixture. [Wikipedia 2021].
Most people are able to see this phenomenon in the sky, although it is rather weak, and many people
do not notice it until asked to pay attention. The dots are highly visible against a monochromatic blue
background (430 nm) instead of the sky. [Blom, J.D. 2010]
The dots are white blood cells moving in the capillaries in front of the retina of the eye. Blue light is
absorbed by the red blood cells that fill the capillaries. The eye and brain "edit out" the shadow lines
of the capillaries, partially by dark adaptation of the photoreceptors lying beneath the capillaries. The
white blood cells, which are larger than red blood cells, but much rarer and do not absorb blue light,
create gaps in the blood column, and these gaps appear as bright dots. The gaps are elongated because
a spherical white blood cell is too wide for the capillary. Red blood cells pile up behind the white blood
cell, showing up like a dark tail. [Snodderly, D.M; Weinhaus, R.S.; Choi, J.C 1992].
This behavior of the blood cells in the capillaries of the retina has been directly observed in human
subjects by adaptive optics scanning laser ophthalmoscopy, a real time imaging technique for
examining retinal blood flow. The dots will not appear at the very center of the visual field, because
there are no blood vessels in the foveal avascular zone.

Fig.5 Fig.6
Source: Earthlymission.com Source: Shutterstock.com

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Blue field entoptoscopy: This effect is used to estimate the blood flow in the retinal capillaries. The
patient is alternatingly shown blue light and a computer-generated picture of moving dots; by adjusting
the speed and density of these dots, the patient tries to match the computer-generated picture to the
perceived entoptic dots.

DIFFERENCE BETWEEN BLUE LIGHT ENTOPIC PHENOMENON AND OTHER

PHENOMENA:
▪ Blue light entoptic phenomenon can be easily distinguished from floaters (Muscae volitantes),
because it consists of corpuscles of identical diameter and visual sharpness, of a simple dot or
worm-like shape, brighter than the background. If the eye stops moving, the dots keep darting
around. If the eye moves, the dots follow instantaneously, because they are contained in the retina.
While, floaters are specks or threads of variable diameter and variable visual sharpness, some of
complex shape, darker than the background. If the eye stops moving, the floaters settle down. If
the eye moves, the floaters follow sluggishly, because they are contained in the vitreous humor,
which is subject to inertia.
▪ Blue light entoptic phenomenon can be distinguished from visual snow because it appears only
when looking into bright light, whereas visual snow is constantly present in all light conditions
including the dark.

B. BLUE ARCS OF THE RETINA

When a dim light is viewed in a dark room, what will be seen are faint blue-gray arcs which occupy
that part of the visual field corresponding to the retina where the arcuate nerve fiber bundle passes
from macular ganglion cell bodies to the optic nerve(Fig.7). These faint blue-gray arcs of the retina
are an entoptic phenomenon in which action potentials of the arcuate nerve fiber bundle presumably
excite adjacent neurons. The light stimulus initially evoking the faint blue-gray arcs excites cones and
not rods as has been generally believed until now. Another commonly held idea is that the faint blue-
gray arcs are produced by bioluminescence or fluorescence associated with the action potentials in the
arcuate nerve fiber bundle.

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Source: Benediktehinger.de Fig.7

C. PHOSPHENE
A phosphene is the phenomenon of seeing light without light entering the eye. The word phosphene
comes from the Greek words phos (light) and phainein (to show). The name "phosphene" was coined
by J. B. H. Savigny, better known as the ship's surgeon of the wrecked French frigate Méduse. It was
first employed by Serre d'Uzes to test retinal function prior to cataract surgery. [Serre, H. Auguste
1853].
Phosphenes that are induced by movement or sound may be associated with optic neuritis. They are
the luminous floating stars, zigzags, swirls, spirals, squiggles, and other shapes that you see when
closing your eyes tight and pressing them with your fingers. Basically, these phenomena occur when
the cells of the retina are stimulated by rubbing or after a forceful sneeze, cough, or blow to the head.
[Wikipedia 2023]

Fig.8 -An artist's representation of phosphenes by retinal stimulation

Source: Wikipedia.org

In addition to the causes already mentioned, it is not uncommon for this phenomenon to be experienced

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by someone who has gone a long time without visual stimulus. This has given phosphene the nickname
of "prisoner's cinema” [Klüver, Heinrich 1996].
People who are under the influence of hallucinogenic drugs also report seeing these types of lights, but
they are not to be confused with hallucinations, which take place solely in the brain rather than the eye.

CAUSES OF PHOSPHENE
Phosphenes can be induced by mechanical, electrical, or magnetic stimulation of the retina or visual
cortex:
a) Mechanical stimulation: This is also referred to as pressure phosphene, they are the most
common type, and these occur when mechanical pressure is placed on the retina, such as by
rubbing the eyes. These effects were detailed by the ancient Greeks and Isaac Newton, among
others. Experiences include a darkening of the visual field that moves against the rubbing, a
diffuse colored patch that also moves against the rubbing, well defined shapes such as bright
circles that exist near or opposite to where pressure is being applied, a scintillating and ever-
changing and deforming light grid with occasional dark spots, and a sparse field of intense blue
points of light. Sellman It can persist briefly after the rubbing stops and the eyes are opened,
allowing the phosphenes to be seen on the visual scene. One example of a pressure phosphene
is demonstrated by gently pressing the side of one's eye and observing a colored ring of light on
the opposite side, as detailed by Isaac Newton. [Newton; McGuire, J.E; Tammy, Martin 2001].
Another common phosphene is "seeing stars" from a sneeze, laughter, a heavy and deep cough,
blowing of the nose, a blow on the head or low blood pressure (such as on standing up too
quickly or prior to fainting). It is possible these involve some mechanical stimulation of the
retina, but they may also involve mechanical and metabolic (such as from low oxygenation or
lack of glucose) stimulation of neurons of the visual cortex or of other parts of the visual system.

b) Electrical Stimulation: Phosphenes have been created by electrical stimulation of the brain,
reported by neurologist- Otfrid Foerster as early as 1929. Brindley and Lewin (1968) inserted
a matrix of stimulating electrodes directly into the visual cortex of a 52-year-old blind female,
using small pulses of electricity to create phosphenes. These phosphenes were points, spots, and
bars of colorless or colored light. Brindley and Rushton (1974) used the phosphenes to create a
visual prosthesis, in this case by using the phosphenes to depict Braille spots. In recent years,
researchers have successfully developed experimental brain computer interfaces or
neuroprocessing that stimulate phosphenes to restore vision to people blinded through accidents.
A noninvasive technique that uses electrodes on the scalp, transcranial magnetic stimulation,
has also been shown to produce phosphenes. Experiments with humans have shown that when
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 the visual cortex is stimulated above the calcarine fissure, phosphenes are produced in the lower
part of the visual field, and vice versa.

c) Magnetic Stimulation: Phosphenes have been produced by intense, changing magnetic fields,
such as with transcranial magnetic stimulation (TMS). These fields can be positioned on
different parts of the head to stimulate cells in different parts of the visual system. They also can
be induced by alternating currents that entrain neural oscillation as with transcranial alternating
current stimulation. In this case they appear in the peripheral visual field. Phosphenes created
by magnetic fields are known as magneto phosphenes. Astronauts exposed to radiation in space
have reported seeing phosphenes. Phosphenes can be caused by some medications, such as
Ivabradine. Less commonly, phosphenes can also be caused by some diseases of the retina and
nerves, such as multiple sclerosis. The British National Formulary lists phosphenes as an
occasional side effect of at least one anti-anginal medication.

MECHANISM
Most vision researchers believe that phosphenes result from the normal activity of the visual system
after stimulation of one of its parts from some stimulus other than light. For example, Grüsser et al.
showed that pressure on the eye results in activation of retinal ganglion cells in a similar way to
activation by light. An ancient, discredited theory is that light is generated in the eye. A version of this
theory has been revived, except, according to its author, that "phosphene lights are [supposed to be]
due to the intrinsic perception of induced or spontaneous increased biophoton emission of cells in
various parts of the visual system (from retina to cortex)". [Wikipedia 2023].

D. MOORE’S LIGHTNING STREAKS

Moore's lightning streaks are lightning type streaks (photopsia) (seen to the temporal side) due to
sudden head or eye movement in the dark. They are generally caused by shock waves in the vitreous
humor hitting the retina or traction on the retina from fibers in the vitreous humor. The implication is
that the vitreous is softer than normal, generally this is not a cause for alarm provided they are
momentary, occur only in the dark, are due to sudden head movements (acceleration) and do not occur
along with many new tiny black floating specks in the vision. Professional advice should be sought in
cases of doubt, as retinal detachment, a serious condition, also can cause flashes in the eye.
They are named after Robert Foster Moore (1878–1963), a British ophthalmologist.
They are recurrent stereotypic vertical visual phenomena that must be distinguished from similar
symptoms due to retinal ischemia, optic disk abnormalities, or mechanical retinal or optic nerve
stimulation. These brief flashes are oriented vertically and are perceived in the temporal visual field
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after eye movement. Senescent posterior vitreous changes induce collapse and detachment with
persistent vitreoretinal adhesions through which mechanical forces exert traction on the macula and
retina, inducing photopsia. Clinical recognition of these symptoms avoids unnecessary diagnostic
interventions. [pubMEd 1985].

Fig.9
Source: Semanticscholars.org

E. FLOATERS
Floater has a scientific name known as “Muscae Volitantes”, Latin name for “Flying flies”, while in
French it is called “Mouches Volantes”.
They exist in the eyeball and assume to be alive since they move and change shape, but they aren't.
Floaters are slowly drifting blobs of varying size, shapes and transparency, which are particularly
noticeable when viewing a bright, featureless background (such as the sky) or a point source of diffuse
light very close to the eye OR They are tiny objects that cast shadows on the retina. They can be a bit
of tissue red blood cells, clumps of protein suspended in the vitreous humor.

Fig.10
Source: Wikipedia.org

The common type of floater, present in most people's eyes, is due to these degenerative changes of the
vitreous. The perception of floaters, which may be problematic or annoying to some people, is known
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 as myodesopsia or the less commonly as myiodesopsia, myodesopsia, or myiodesopsia. They may
appear as spots, threads, strands or fragments of “cobwebs” which float slowly before the observer’s
eye and moves in the direction in which the eye moves. [Wikipedia 2023]

Signs and Symptoms

Eye floaters are suspended in the vitreous humor (gel-like fluid in the posterior segment of the eye)
Thus, floaters follow the rapid motions of the eye, while drifting slowly within the fluid. When they
are first noticed, the natural reaction is to attempt to look directly at them, however attempting to shift
one’s gaze towards them can be difficult as they follow the motion of the eye, i.e. remain to the side
of the direction of gaze.
Though they are called floaters, they have the tendency of sinking toward the bottom of the eyeball in
which way the eye is oriented. Floaters present at birth usually remain life long, while those that appear
later in life may disappear in weeks or months.
Floaters become unbearable when the spots seem constantly to drift through the field of vision. The
shapes are shadows projected onto the retina by tiny structures of protein or other cell debris discarded
over the years and trapped in the vitreous humor. Floaters can even be seen when the eyes are closed,
especially on bright days, when sufficient light penetrates the eyelids to cast the shadows.
Younger individuals who are myopic are also faced with this floater in addition to the elders, also after
cataract operations or after trauma.

Source: Eyerounds.org Fig11

Causes of Floaters
■ Due to refractive error e.g., myopia
■ Due to age; i.e., eye ages as one age
■ Due to vitreous syneresis(Fig.11) (99% h20, 1% solid (collagen and hyaluronic acid))

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■ Sign of vitreous detachment and retinal detachment
■ Cystoid macular edema and asteroid hyalosis

Diagnosis
■ Floaters are readily observed by an ophthalmologist or an optometrist with the use of an
ophthalmoscope or slit-lamp.
Note: If the floater is near the retina, the examiner might not see it though the patient may report it
large.
■ You can make use of a pinhole or by increasing background illumination to effectively decrease pupil
diameter, may allow a person to obtain a better view of his or her own floater.
■ Patients with new onset flashes or floaters, especially when associated with visual loss or restriction
in the visual field, should seek urgent ophthalmologic evaluation.

Treatment
■ Surgeries i.e., vitrectomy do exist to correct for severe cases of floaters. We have no medications to
correct vitreous deterioration.
■ Laser vitreolysis can be used in the treatment of floaters.

Vitrectomy: is done for severe cases and it involves making 3 openings through the part of the sclera
known as par plana. One is an infusion port to resupply a saline solution and maintain the pressure of
the eye, the second is a fiber optic light source and the third is a vitrector (which has a reciprocating
cutting tip attached to a suction device) (Fig.12)

(Fig.12)
Source: neoretina.com/blog

Laser vitreolysis: has to do with making use of ophthalmic laser (low-energy laser) to evaporate the
vitreous opacities(floaters).
Ophthalmic laser is usually a “yttrium aluminum garnet” (YAG) which was traditionally designed for
the use in the anterior portion of the eye e.g., posterior capsulotomy and iridotomy.

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Enzymatic vitreolysis trailed is used to treat vitreomacular traction and anomalous posterior vitreous
detachment.
Note: There isn't any evidence yet that shows that laser treatment is effective due to the fact that only
few specialists make use of vitreolysis.

F. HAIDINGER’S BRUSH
Haidinger brushes (HB) are named after Wilhelm Karl Ritter von Haidinger, who first described the
entoptic phenomenon in several publications between 1844 and 1854. Haidinger brushes can be
observed when the gaze is directed at the sky or other sources comprising short-wavelength linearly
polarized light. [Coren S 1971].
Polarization is one of the most important factors that influence the ability of a subject to perceive the
Haidinger’s brush.
This “brush “may be seen by subjects as a yellowish horizontal bar or bow-tie shape (with "fuzzy"
ends, hence the name "brush"). Fainter bluish or purplish areas may be visible between the yellow
brushes. (fig.13)
[Wikipedia 2023].

Fig.13
fig.14
Source: Wikipedia.org Source: ilorentz.org

When the light source is broadband, the perceptual quality is usually described as a dark-yellowish
hourglass-shaped figure flanked by bright bluish spots forming brushes of approximately 4 degrees of
visual angle around the locus of fixation. If the plane of polarization relative to the eye does not change,
the visual phenomenon vanishes after 2 to 3 seconds. The Haidinger’s brush can be visualized by some
people in the center of the visual field against the blue sky viewed while facing away from the
sun(fig.14) however this image is very faint and disappears due to local adaptation after a few seconds.
The rays of light from the sun are only partially polarized, hence the phenomenon cannot be observed
clearly and may be hard to perceive by most people. In order to perceive the Haidinger’s brush better,
all the conditions for the phenomenon has to be met especially polarization.

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 Physiological causes:
The exact physiological origin of this entoptic phenomenon is not entirely understood, and a few
possible explanations have been put forward. What is commonly accepted is that HB visibility requires
birefringent structures in the eye. Such double-refracting properties have been described for the
xanthophylls lutein, zeaxanthin, and meso-zeaxanthin, which together constitute the macular pigment.
The perception of Haidinger’s brush can be attributed to the dichroism of the xanthophyll pigment
found in the macula lutea. As described by the Fresnel laws, the behavior and distribution of oblique
rays in the cylindrical geometry of the foveal blue cones produce an extrinsic dichroism. [Wikipedia
2023]
Some authors also proposed that the polarization properties of Henle fiber layer around the fovea may
also evoke HB visibility.
The size of the HB perceived is consistent with the size of macula and macular pigment and a
relatively preserved foveal function are necessary for the perception of HB. Haidinger brushes are
usually not perceived by subjects with macular telangiectasia type 2, likely due to their characteristic
foveal depletion of macular pigment. [Atsuki Higashiyama, Tasashi Yamazaki, 2022]

Seeing the Haidinger’s Brush

Most people cannot perceive the Haidinger’s Brush by looking at the blue sky while facing away from
the sun. Even when perceived, it tends to appear and disappear and can’t be sustained.
The image cannot be seen and sustained unless it is made to move, this can be achieved by tilting one’s
head while looking at a white textureless background.
A more accurate way is to use an apparatus that consists of a rotating polarizer (a polarizing lens can
be used and rotated manually) which polarizes the light that bounces back from a plane textureless
background is used to enables subjects to visualize it.
The backlight of an LCD flat panel computer screen can also be used to simulate the conditions
necessary for perceiving the Haidinger’s Brush, subject is asked to look directly into the white screen
while slowly tilting the head (Note that CRT monitors (cathode ray monitors-old) do not have a built-
in polarizer and would not work for this purpose unless a separate polarizer is used., hence, LCD screen
e.g. the screen of a laptop is a model apparatus for visualization HB).
[Wikipedia 2023]

Clinical Relevance/uses of the Haidinger’s Brush:

▪ The principles of HB perception can be utilized in visual training to check for eccentric fixation and
also to help people to be able to fixate on objects using their fovea.
People with some level of strabismus who have developed a kind of adaptive condition in which one
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 eye fixates using another location instead of the macula (a condition known as eccentric fixation).
The apparatus for this visual training includes; a rotating polarized plate backlit with a bright white
light. blue spectacles (to enhance the Haidinger’s brush image) and an occluder over the other eye.
The goal of this setup is to make the Haidinger’s brush image overlap with the image of the test object.
(Fig.15).

Source: Chegg.com Fig.15

▪ Haidinger brushes have also been used for diagnosis and pleoptic therapy in amblyopia. Also, their
perception has been suggested to be a favorable prognostic marker in patients undergoing cataract
surgery, as media opacity has limited influence on HB visibility.
HB visibility’s correlation with eye anomalies have been a bit challenging since visibility varies due
to other unknown variables even in healthy patients hence there is a limitation to the use of Haidinger’s
brush as a diagnostic tool. [Atsuki Higashiyama, Tasashi Yamazaki, 2022]

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 G. MAXWELL’S SPOT
Maxwell’s spot is an entopic phenomenon that appears as a red spot in the central visual field. It occurs
due to preferential absorption of light by the macular pigment, which is most sensitive in the blue
portion of the spectrum. Due to the macular pigment, two versions of colour matching functions exist:
those that relate to the central (2°) visual field and those encompassing the periphery (10°). This means
that colour coordinates can be metameric in the peripheral visual field, but may not be in the central,
and this is evidenced by the appearance of Maxwell’s spot. This phenomenon was first reported when
observing blue light (Maxwell, 1856) and can be simulated with the use of dichroic filters (Miles, 1954;
Isobe & Motokawa, 1955)
Maxwell’s spot has been reported in other systems utilizing a short-wavelength primary (Palmer, 1978;
Spitschan, 2017). Applications of receptor silent substitution to modulate melanopsin typically avoid
such problems by blocking the central visual field (e.g. Barrionuevo & Cao, 2016; Spitschan, 2014;
Tsujimura & Tokuda, 2011; Zele et al., 2018a) however, this is not a viable solution under conditions
of free-viewing.

Visualizing Maxwell’s Spot – [MAXWELL’S TEST]

A reddish spot is seen around the fixation point when a uniform white surface is looked at by a normal
observer through a purple filter transmitting red and blue lights. This phenomenon is due to an extra-
high loss of the blue component of the purple light by a yellow pigment standing in front of the
receptor layer, thus permitting the red component to be observed by itself. The blue component
assumed to have been filtered away by the yellow macular pigment.
The non-vascularized part of the retina at the posterior pole of the human eye—the so-called macula
lutea—shows anatomically a yellow colour. Assuming that the same colour was prevalent in the living
eye, a number of visual phenomena difficult to explain otherwise were ascribed by many investigators
(1, 2, 3) to the local filtering action in the yellow pigment.

H. PATHOLOGIC HALOS
They are of three types which are;
▪ Coloured halos of corneal edema [coloured halos of glaucoma]
▪ Coloured halos of corneal mucus,
▪ Coloured halos of immature cataract

▪ Coloured halos of corneal edema are basically caused by edema of the deeper layer of corneal
epithelium. Their diameter is about 7° - 12°.
▪ Coloured halos of corneal mucus are seen with patients with conjunctivitis and produced by mucus,

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 pus / particulate matter on the corneal surface. Diameter = 12° - 14°.
▪ Coloured halos of immature cataract are distinct but smaller than those produced by corneal edema
and can be differentiated from each other by using the Emsley - Finchamstenopaeic slit test and
Simpson pinhole test.

I. PHYSOLOGIC HALOS
Physiologic halos refer to a normal variation in the appearance of the optic disc, which is the part of
the eye where the optic nerve enters the retina. This variation is due to the presence of a thin, translucent
ring around the optic disc, which can be seen when the eye is examined using an ophthalmoscope.
The ring is caused by a difference in the refractive index of the nerve fibers and the surrounding tissue,
which creates a slight bending of the light as it passes through. This bending effect creates the
appearance of a halo or ring around the optic disc. [J. Mellerio, D.A. Palmer 1972]
Physiologic Halos differ from pathologic halos in that they have a diameter 7-8 degree smaller than
pathologic halos.
Examples of physiologic halos include the ciliary corona and lenticular halos [see page 5 -6].

J. PURKINJE TREE
The Purkinje tree is named after Jan Evangelista Purkyně, the same anatomist who discovered
Purkinje cells in the cerebellum. The tree consists of the capillaries that supply blood to the
retina, which are normally hidden from view by other layers of the eye. However, when a bright
light is shone into the eye, the blood vessels become visible as a branching network that
resembles the dendritic tree of Purkinje cells(Fig.16). [Purkyně, J. E. 1823]
The Purkinje tree is not a common entoptic phenomenon, and is only visible under certain
conditions. It is most easily seen when looking at a bright blue or white sky, or when looking into
a bright light source such as the sun or a flashlight. The effect is more pronounced when the eye
is dilated, such as in low light conditions or after taking certain medications. [Kanski, J. J. 2016]

Source: commons.wikimedia.org Fig.16

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CONTRIBUTORS:

ADEWARA, Aderonke. 18/55DZ006

AMAO, Ganiyat. M 18/55DZ013

BABATOLA, Mubarak. O 18/55DZ022

HARUNA, Agnes. F 18/55DZ032

JACOB Taiwo 18/55DZ040

LAWRENCE, Evangeline. K 18/55DZ044

LAZARUS Mercy. A 18/55DZ045

OGWUCHE Noah 18/55DZ049

OJO, Deborah. A 18/55DZ050

OKOYA, Liad O 19/55DZ061

OLADIJA, Damilola .M 18/55DZ051

OPAWALE Adedolapo. A 18/55DZ055

VICTOR Ojima 19/55DZ063

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