CONCRETION

Calcium deposit on the palpebral conjunctiva.  Generally doesn't bother patients but sometimes it breaks through the conjunctiva and can feel like a foreign body in the eye.  In that case it can be removed. 

DERMATOCHALASIS

When the skin goes over the eyelid it's called dermatochalasis, and when it gets to a certain point it can be surgically fixed. 

POSTERIOR VITREOUS DETACHMENT

The top arrow points to the top of the Weiss' Ring and the middle arrow points to the bottom of it.  The bottom arrow points to the optic nerve (blurry because it's behind the Weiss' Ring. 

LAMELLAR CATARACT

 Anterior lamellar cataracts form in a layer of the anterior portion of the lens.  they can have different forms.

FUCH'S ENDOTHELIAL DYSTROPHY

The photo below shows endothelial guttata, pigment, and stromal haze associated with Fuch's corneal dystrophy

CONTACT LENS RELATED PUNCTATE EPITHELIAL STAINING

Punctate staining represents damaged or devitalized epithelial cells from contact lens overwear. 

PTERYGIUM

This picture below is of a pterygium.  This is scar tissue from sun exposure that encroaches on the cornea.  It will continue without surgical intervention.  This patient has a recurrence after surgery and her last eye doctor said this could just be watched.  But this pterygium needs to be removed very soon. 

CONTACT LENS RELATED CORNEAL DAMAGE

The photo below shows corneal neovascularization.  This occurs because the cornea is starved for oxygen from contact lens overwear. 

The patient's vision is compromised because the surface cells are damaged as shown below.

The other eye has good vision in the other eye, but there are significant signs of damage in the peripheral cornea.

FOREIGN BODY UNDER UPPER LID

This patient was complaining of a foreign body sensation in the eye after getting his hair cut the day before.  With white light, without dye nothing could be seen.  but with dye and  red-free illumination with a Wratten Filter foreign body tracks could be seen on the cornea. 

When the upper lid was everted, a hair could be seen (it's a little blurry but the arrow points it out).  

SCAR FROM CONTACT LENS RELATED CORNEAL ULCER

Here is the scar from a resolved corneal ulcer.  This occurred in a patient who overwore their Acuvue Oasys

contact lenses.  It is common to overwear these lenses because they are very comfortable.

The majority of these cases are in patients in their 20's.  One reason may be that individuals in their 20's have less money generally and so they wear their contact lenses longer, they often don't have a good pair of glasses, and they extend the life of the lens until the lenses start to bother them.  The problem with this is that once the lenses bother the eyes, damage has already occurred to the corneal epithelium.

The scary thing about these corneal ulcers is that most of the time they don't give any warning.  All of a sudden the eyes hurt and the patient is very light sensitive and intolerant of the contact lenses.  It's interesting to me how patients sometimes still try to wear their lenses until they can tolerate it no longer.  

This particular patient is VERY lucky.  This scar is just off the visual axis.  It is close enough so that the patient will have streaks of light and haloes during night driving, but far enough that they can still get 20/20 vision.  But if the ulcer had been more in the visual axis, vision would have been PERMANENTLY decreased.  There may be some slight fading of the scar over decades, but he gets to keep this scar for life. 

Bottom line:  Don't over wear your contact lenses unless you wear the Air Optix Night and Day lenses.  Those are the only lenses I feel comfortable having patients wear more than 12 hours a day because they breath enough oxygen. 

ASTEROID HYALOSIS

You can see the eyelid and pupil and the slit lamp is focused behind the lend of the eye.  The brilliant reflections are calcium soaps and some of them are attached to vitreous strands.  This is asteroid hyalosis and remarkably it very rarely affects vision or is noticed. 

HERPES SIMPLEX KERATITIS

 The first photo is of a herpes simplex dendritic keratitis in a 15 year old male who had been using topical steroid chronically.

The second photo is two days after the start of topical antivirals. 

The third photo below is taken with fluorescein and a Wratten Filter about 6 days after presentation.  There are still epithelial defects but it is improving.

The photo below is taken day 4 as well. The patient is complaining of a little haze in their vision. As expected, a slight infiltrate haze has deepened, representing increased inflammation. Unfortunately, I am uncomfortable adding a steroid to the regimen at this point, considering the epithelial lesions aren't fully healed.  We are continuing the topical antiviral at this stage and watching very very closely.  As soon as epithelial is healed, we will consider the very judicious use of steroid drops.