MYELINATED NERVE FIBERS

Myelin is the insulation around the nerves in our bodies. This myelin helps the electric signal to travel down the nerve in greater efficiency. As the nerve fibers enter the eye, however, they lose their myelin. Sometimes the myelin continues into the retina as an interesting anomoly. Usually the myelin is near the optic nerve. But in this case, there is myelin around the nerve fibers in the peripheral retina, as you can see in the photo. This myelin has no consequence to this patients vision and there is no danger in this small extent.

MYELINATED NERVE FIBERS

This is the optic nerve of a young man. The optic nerve is normally orangish and round. But you can see there's some white material just below this optic nerve (it's actually above since the image is reversed in the photo). You can see the retina blood vessels overlying the white material. This material is "myelination". Myelin is the insulation of the nerves in our bodies. When the optic nerve enters the eye, the nerve fibers lose their insulation. But in this case you see a little of the myelin coming into the retina a little. This does not cause any harm at all in thsi small extent.

IRIS

This is the iris of a young patient I saw. There's nothing abnormal here. The patient just wanted me to put it on the web page so she could look at it later.

The iris is the aperture of the eye. It constricts in bright light to limit the light entering the eye, and it dilates in dark environments to maximize the light entering the eye.

While the iris appears innocent enough, it is often involved in many diseases of the eye. It can be become inflammed and cause significant pain in arthritic-like conditions. It can grow new blood vessels and cause severe pressure rise in the eye in diabetes. It can degenerate or be absent altogether in some congenital disorders. It can grow tumors on both the front and the back.

RETINAL HOLE

This is a photo of a retinal hole taken from my slit lamp camera. There is an "operculum" that used to be where you see the hole. This operculum is the white floating object below the hole. If you look close the operculum casts a shadow on the retina.

Retina holes can lead to retina detachments. In this case, it appears that this hole has been around a long time. It is likely that some retina specialists would just watch this without treatment. Others would treat it.

Since it is an old one that is inferior, this one doesn't need to be seen by the retina specialist on an emergency basis. I am, however, having this patient see the retina specialist within a few weeks to see if he wants to laser it. Lasering around the hole or using cryotherapy (freezing), essentially welds the retina down to prevent it from becoming a detachment.

SUBCONJUNCTIVAL HEMORRHAGE

This is an eye with a subconjunctival hemorrahge. A "subconj" hemorrhage is one of the most common eye conditions that brings patients in to the clinic. It appears very scary to the patient when they look in the mirror and see all this blood in the eye.

The reality is that this is one of the least damaging condition for the eye. It does not threaten the eye or the vision and it clears up within a week or so without any treatment. Sometimes there may be some mild discomfort that can be addressed using artificial tears.

So what causes a subconjunctival hemorrhage? Basically it is just a broken blood vessel under the conjunctiva layer of the eye (this is the saran-wrap-like layer over the white part of the eye). These blood vessels are very sensitive and brittle. They can break easily for any reason, or no reason at all. Sometimes lifting something heavy, getting up rapidly, straining, bending over, coughing, sneezing, or low platelet count as may occur on blood thinners can contribute.

If they recur, blood tests can be done to assess the platelet count to make sure the patient is not anemic. That is not necessary on a first time occurence since this is such a common condition that occurs in most people at some point in their lives.

STAIN HELPS

This is a picture of a flipped upper eyelid of a patient who complained of discomfort after something flew into his eye. The eye in this photo actually looks pretty good. The picture below shows what happens when fluorescein stain is put in the eye and a special filter is used to visualize it.

Now you can see there is staining. This is where the outer protective cells of the conjunctiva have been abraded away.

PIGMENT ON ANTERIOR CAPSULE

This patient has pigment cells on her anterior capsule. The pigment cells came from the iris. About 5 years ago she had "uveitis" which is internal inflammation in the eye. When that happens, the iris and the lens become sticky and adhere to one another. After the inflammation resolved, these pigment cells remained. Her case was bilateral, worse in the right eye. The picture on top is the right eye.

EPIRETINAL MEMBRANE

This is almost impossible to see. You almost have to click on the photo and enlarge it to see what I'm trying to show here. This patient has an "epiretinal membrane". It is a little wrinkle near the center of the macula. The macula is the part of the retinal that see's your central vision. When you look at an object, that object is focused on your retina.

An epiretinal membrane is like a wrinkle that occurs on the innermost layer of the retina (actually the surface of the retina). This wrinkle occurs because of traction of the vitreous bag against the retina. The vitreous bag is the bag of liquid gel that fills up your eyeball.

If this wrinkle gets worse to the point where it disturbs the vision enough, surgery can be performed to "peel" the wrinkled membrane. Resulting vision is usually very good after this procedure.

CORNEAL SCAR

Here you can see a corneal scar in the patients central vision. It does bring the vision to about 20/30 in this eye.

BITOT'S SPOT

There is a little "rought spot" right next to the cornea (the patient is looking to the side). It causes minor irritation. It is called a "Bitot's Spot" and is most often associated with Vitamin A deficiency. Treatment, therefore, is vitamin A supplementation.

The top picture is the patient's left eye and the rest are his right eye. The top picture is a cataract on the posterior surface of the left lens. The next one is a pterygium, a growth going over the cornea, due mostly from years of exposure to sunlight. The right lens has three types of cataracts, a posterior subcapsular cataract, a nuclear cataract (in the middle of the lens), and an anterior polar cataract. I scheduled him to get cataract and pterygium surgery.

NORMAL NERVE

This young man wanted me to post the picture of his optic nerve. Very healthy looking! This is the right eye.