DIABETIC RETINOPATHY

Diabetic retinopathy has been the number one cause of preventable blindness in the United States.  Fortunately treatments have improved through the years.

The pictures below show patients with moderate non-proliferative diabetic retinopathy.  There are various types of hemorrhages.  Cotton wool spots are areas of focal oxygen deprivation.  microaneurysms are outpouchings of capillaries that can leak.  Exudates are the leakage of blood serum from capillaries.

If the oxygen deprivation is severe enough, new blood vessels (neovascularization) will begin to form in the attempt to reperfuse the retinal tissue.  However, these new blood vessels are very leaky and certain contents from the blood destroy the retina, thereby causing severe vision loss.   When new blood vessels grow, retina specialists often will perform pan-retinal photocoagulation, or PRP.  PRP selectively destroys much of the peripheral retina, thereby decreasing the oxygen deman in the eye.  This decreased oxygen demand allows the most important central part of the eye to receive enough oxygen to prevent neovascularization.   The photo below shows the laser scars that result in the peripheral retina from PRP.

TREATED RETINAL TEAR

This picture shows laser scars around the tear in the retina that would have ended up as a detached retina with accompanying permanent loss of vision.

ASTEROID HYALOSIS

Asteroid hyalosis is small white opacities that float in the eye.  They uysually occur in one eye more than the other, as is the case with the picture below.  It occurs in humans, dogs, cats, and horses. Ocular asteroids are different from the more common typical vitreous floaters. The cause of asteroid hyalosis is unknown, but it has been associated with diabetes , high blood pressure, and high cholesterol. The asteroid bodies are made up of calcium and phospholipids.  While asteroid hyalosis is quite impressive, surprisingly most patients never notice them in their vision.  They cause no problems, but may interfere with visualization of the retina during eye exams. Treatment of asteroid hyalosis is unnecessary unless better visualization of the retina is needed, such as in cases of diabetic retinopathy.  

TREATED RETINAL HOLE

The image above is the treated hole with laser.  The image below is the original hole. 

BRANCH RETINAL ARTERY OCCLUSION

Branch retinal artery occlusion in a 54 year old male.  It caused retinal neovascularization which then lead to a vitreous hemorrhage.  

BEAR TRACKS

The image below displays higher concentrations of pigment in the retinal pigment epithelium layer.  They have the appearance of "bear tracks" and are harmless.

SCUBA DIVING MASK SQUEEZE

A patient presented after a scuba trip with the following presentation:

Failure to equalize the mask on a dive descent will result in suctioning of the mask, which will cause blood vessels to enlarge and leak, resulting in the bleeding and swelling.  This is called "mask squeeze".  The bleeding is harmless and will resolve on it's own within weeks.