Sonoran Desert Eye Center

CONGENITAL CATARACTS

2012-01-19T11:57:00.000-08:00

These cause glare at night and the inability to get perfect 20/20 vision.

NEVUS-LIKE MACULAR LESION

2012-01-10T18:30:00.000-08:00

The dark area in the center is near the center of the vision and correlates with a blind spot in the patient's vision that she says is enlarging.

COMMOTIO RETINAE

2012-01-09T17:16:00.000-08:00

This is like a bruise on the retina. It does effect vision in the area that corresponds to the "bruise". This particular patient got hit the day before with a spiked volleyball.

CONCRETION

2012-01-09T11:44:00.000-08:00

Calcium deposits under the conjunctiva on the inside of the eyelids. They are not dangerous and usually asymptomatic.

ANTERIOR BASEMENT MEMBRANE DYSTROPHY

2011-12-14T13:29:00.000-08:00

Otherwise known as Map, Dot, Fingerprint Dystrophy

IS IT A FOREIGN BODY, OR MATERIAL INTERNALLY WORKING IT'S OUT?

2011-12-07T16:27:00.001-08:00

Palpebral conjunctival Papilloma vs. Granuloma

2011-12-03T08:54:00.000-08:00

This is a lesion under the upper eyelid. The upper lid is everted. The top picture is taken in December 2011 and the bottom picture was taken in July 2011. The lesion appears less vascularized (less blood supply) curretnly, however it does appear like there are is a new nodule to the left and larger nodule to the right. With the evidence of growth, I believe that, although this is likely a benign lesion, it should be removed before it becomes much larger, so that it is easier to remove with less risk of complication than if we wait.

LARGE RETINAL HOLE

2011-11-29T13:25:00.000-08:00

This is a large hole in the retina in a 20 year old patient. It needs fairly urgent attention before it becomes a retinal detachment. There is some fluid under it so part of the retina is already detached. We catch about 2 to 3 patients with retinal holes per week just on routine dilated eye exams. Without dilating, these breaks in the retina cannot be discovered. Therefore the people that go blind from retina detachments are often the ones with perfect vision who don't come in for exams regularly, because they don't get discovered until it's too late.

CORTICAL SPOKING CATARACTS

2011-10-28T12:07:00.000-07:00

These are the kind of cataracts that grow from the outside of the lens, working it's way in. While it looks bad through the microscope, this patient is still able to achieve 20/20 vision, albeit not as sharp as we'd like. It causes glare problems and starbursts at night.

CORNEAL ABRASION

2011-09-30T11:45:00.003-07:00

The patient in the photos below had her hard lens decenter off her eye and in the effort to remove it her cornea was abraded. So her vision is blurry, she's in pain, and she's light sensitive.

WHY SHOULD I REPLACE MY CONTACT LENSES MONTHLY

2011-09-20T18:40:00.000-07:00

Below are photos of the underside of the lids of patients who overwear their contact lenses and don't replace them when they're supposed to. These lids have inflammatory bumps on them that make the contact lenses move, the vision fluctuate, and mucous come out of the eye. Nothing like mucous coming out of your eye when you're on a date!

GPC takes months to get rid of, and sometimes years. We have to use more expensive contact lenses thereafter and you have to use expensive drops and care solutions to try to fix the problem.

Bottom line? Please replace your contact lenses when you're supposed to. If you can't afford to replace your lenses monthly, don't get contact lenses. These are your eyes. Compromise elsewhere!

MAKE UP UNDER THE EYELID

2011-09-19T16:01:00.001-07:00

BITOT'S SPOT

2011-09-13T12:15:00.000-07:00

A Bitot's Spot is an area on the white part of the eye that doesn't wet well and appears keratinized. It is often associated with vitamin A deficiency. It is fairly asymptomatic and patients are unaware they have it when it is discovered. Vitamin A deficiency happens mostly in children in developing countries, but we often see it in college kids for various reasons (including malnutrition and alcohol consumption). Bitot's Spot is often one of the first signs of Vitamin A deficiency. Advanced deficiency can lead to night blindness.

VITREOUS FLOATER

2011-09-12T17:40:00.000-07:00

Our eyes are fluid-filled and you can often see floaters. The arrow points to a floater in this patient's eyes and the dark spot behind it is the shadow of the floater on the retina.

CORNEAL TRANSPLANT

2011-09-09T15:15:00.000-07:00

This is what a cornea looks like after a cornea transplant. Best visual acuity is usually around 20/50 after a transplant with a significant amount of astigmatism. Transplants can become necessary if the cornea is scarred, or is shaped incorrectly, or has opacities or irregularities from genetic corneal diseases.

GLAUCOMA

2011-08-26T14:36:00.000-07:00

One of the things we look at when we dilate the eye is the optic nerve cupping. It's the white area in the middle of the optic nerve in the photo below. The smaller the white area the less the risk for glaucoma. As pressure damages the optic nerve, the white area grows and your peripheral vision decreases until you're blind. The 2nd photo shows an eye with glaucoma. Note the absence of pink area inferiorly.

CATARACT

2011-08-25T13:20:00.001-07:00

The top photo shows a lens with no cataract and the bottom shows one with a thick nuclear cataract.

COLD SORE ON THE EYE!

2011-08-24T11:17:00.000-07:00

Herpes Simplex Virus resides in the nerve centers of about 95% of the population. It is responsible for cold sores on the lips. When it activates in the eye, it can cause discomfort, decreased vision, pain, light sensitivity, and watering. HSV can reactivate during periods of stress or with extreme exposure to sunlight.

When HSV activates on the eye, we treat it with antivirals and watch very carefully for scarring and secondary inflammatory damage. It can be very serious and even cause blindness if mismanaged.

CORNEA SCAR FROM INJURY

2011-07-29T15:16:00.000-07:00

DILATED BLOOD VESSEL

2011-07-25T17:38:00.000-07:00

This is for my friend Robert

CONGENITAL CATARACTS

2011-07-07T15:06:00.000-07:00

CHRPE

2011-07-01T12:31:00.000-07:00

Congenital Hypertrophy of the Retinal Pigment Epithelium

MYELINATED NERVE FIBERS

2011-06-03T15:02:00.000-07:00

The bottom photograph is of a normal optic nerve. the top four demonstrate myelinated nerve fibers. Nerve fibers are usually insulated with myelin, that aids in transmission of nerve impulses. Usually this insulation ends as the fibers enter the eyeball. But occasionally, as is the case below, the insulation will continue, and you can see it as the white. These usually have no negative consequence to vision or the eye.

EPIRETINAL MEMBRANE

2011-06-01T17:41:00.001-07:00

LASER SCARS FROM A REPAIRED RETINAL HOLE

2011-06-01T11:45:00.001-07:00

EYE DAMAGE FROM ACUVUE LENSES

2011-04-22T18:21:00.000-07:00

Acuvue Oasys lenses are the most comfortable lenses on the market. Unfortunately, they cause more damage than any other lens I've seen. This occurs primarily because the edge of the contact lens steepens. In this case, you can see the damage from the edge hitting the eye. But because it is so comfortable, patients don't let us switch them to anything else, even if they KNOW there's a healthier alternative. These lenses are too dang comfortable! So my advice is to wear Acuvue Oasys lenses no more than 12 hours a day, 5 days a week. Those patients seem to do well with no damage. Whenever I see damage to the eyes, it's always from wearing the lenses longer than that. And don't wait to replace your lenses until the contact lenses are irritating and the eyes are already damaged. That's like waiting to do an oil change until the car smokes. Or waiting to add chlorine to your pool until it's filled with algae.

RETINAL HOLES

2011-04-22T18:15:00.000-07:00

Every day people go blind from retinal detachments that could have been prevented if they had been caught as retinal holes. The retina is so thin that holes can develop in them spontaneously. Then fluid gets under the holds and detaches the retina, and where the retina detaches, you can't see. This is a picture of a patient who gets the eyes checked every year. Never have retinal holes been found before on this patient. It is important to dilate the eyes on your routine eye exam. It is also important that people have eye exams, even if they don't need glasses or contact lenses.

Click on the pictures below to enlarge

ASTEROID HYALOSIS

2011-04-05T14:02:00.000-07:00

Asteroid hyalosis is calcium floating inside the fluid of the eye. It is generally not noticed by patients and does not need to be treated.

BUMP ON THE EYE

2011-03-23T14:41:00.000-07:00

A chalazion is a bump on the lid that is non-tender and non-infectious. It arises because of stagnation of secretions from a clogged meibomian glands. It is initially treated with aggressive hot compresses and steroid drops. Sometimes steroid is injected into it. Often, if these measures don't work, it has to be removed surgically. This is not painful as the surgeon numbs the eye.

ONE REASON YOU SHOULD WEAR SUNGLASSES

2011-03-22T16:15:00.000-07:00

A person who spends a lot of time in the sun should definitely use sunglasses. One of the things that can happen is that scar tissue extends onto the cornea because of UV light exposure. This scar tissue will continue to grow until it covers the whole eye. It can be surgically removed before it does so. This lesion is called a pterygium (pronounced "tuh-RIG-ee-um")

Crusts in The Eyes in the Mornings

2011-03-19T11:53:00.000-07:00

The picture below is the eyelid of an 18 year old boy. He has crusts at the base of his lashes. These crusts are produced from bacteria in the eyelash follicles. This condition is chronic and called blepharitis. It can cause a foreign body sensation, redness, and irritation of the eyes in the mornings. It can be controlled with lid scrubs and occasional antibiotics, but is never eradicated completely.

Red and Irritated Eyes

2011-03-18T10:18:00.000-07:00

Sometimes the eyes feel are red in the mornings and they feel irritated. In the picture below the patient has a lot of debris in their tear film, the eyes are a little red, and there are clogged glands on the lid margin. This is called meibomianitis. This is a chronic condition that comes from overpopulation of the normal bacteria in the eyelid because of glands having a tendency to clog. Treatment ranges from hot compresses (rubbing the eyes well with a very hot cloth a few times a day) to doxycycline pills on a long term basis. Omega-3 fatty acid supplementation may also help. When the eye becomes very inflammed to where it causes light sensitivity and pain, we have to use combination antibiotic/steroid drops.

Dry Eyes

2011-03-17T15:00:00.000-07:00

The eye below is dry. Instead of a nice smooth tear film it is broken up quickly. You can also see some damage to some corneal surface cells.

"MY CATARACT'S COMING BACK!"

2011-03-10T12:38:00.000-08:00

About 35% of patients that have cataract surgery can develop a film on the implant during the first year after surgery. Sometimes this film can be so bad that it decreases the vision and the patient feels like the cataract is back. Patients feel like they're looking through a film.

These cloudy capsules can be easily cleared with a painless laser procedure called a YAG Capsulotomy. Usually the film never grows back again.

MY CONTACTS FEEL ROUGH

2011-03-09T10:57:00.001-08:00

If you don't replace your lenses when you're supposed to, usually monthly, deposits form on them. These deposits eventually cause the contacts to feel rough. Then inflammatory bumps begin to form under the eyelids that make it rough even with the contacts out of the eye. Follow the doctors prescribed disposable schedule. If you can't afford to wear contacts properly, don't wear contacts. If it's just a matter of forgetting to change them, set your cell phone to alert you on the 30th of every month in the evening to throw your contacts out.

KRUCKENBERG'S WHAT?

2011-03-08T17:56:00.000-08:00

So the eye doctor is looking at your eye with the slit lamp microscope and exclames "Oh, you have Kruckenberg's Spindle!". To which you reply "What?".

Kruckenberg's Spindle is when pigment cells congregate on the backside of the cornea. They are there because of lens zonules scrape pigment cells off the back of the iris and those cells float to the front and become attached to the back of the cornea. Many of these cells can also clog up the drain of the eye causing pressure to rise in the eye. This then can cause damage to the optic nerve and subsequent loss of vision. At that point it is call pigmentary glaucoma. Until then it is called pigmentary dispersion. No need to be alarmed. The patient is just followed once or twice a year depending on his risk.

Cataract

2011-03-05T11:45:00.000-08:00

Can you see the difference between the top and the bottom picture? The bottom two show a cataract in the left eye. . The top is the patient's right eye. The bottom one is the left eye two years prior than in the middle picture.

MORE DAMAGE TO THE EYE FROM CONTACT LENS OVERWEAR

2011-03-02T12:53:00.000-08:00

The little dots on the cornea below are damaged cells from contact lens overwear. These can grow into much higher concentration until it becomes too irritating and blurry.

Fish Oil Good for Vision

2011-03-01T14:22:00.000-08:00

Fish Oil: Good For Vision | Medical News and Health Information

Researchers fed mice a diet high in omega-3 fatty acids, and found it prevented abnormal blood vessel growth in the retina. That means omega 3’s could help prevent eye diseases like retinopathy, which are caused by an overgrowth of leaky blood vessels in the eyes

Irritated Eyes with Contact Lens Wear

2011-03-01T13:49:00.000-08:00

Below shows redness of the top part of the eye. This is called Superior Limbic Keratoconjunctivitis (SLK). In middle-aged women who don't wear contact lenses it can be due to hyperthyroid. In younger patients it is often due to irritation and inflammation stemming from contact lens wear. It can sometimes be difficult to manage with a combination of lubricants, steroids, anti-allergy drops, contact lens and solution change, cylosporin and others.

Brown Spot on Retina

2011-02-26T11:24:00.000-08:00

The photo below shows a brown spot next to the optic nerve in this young patient. The brown spot is a choroidal nevus that corresponds to pigmented spots on the skin that we consider normal. It has potential for growth, even to a malignant melanoma. So we document it with photos and watch it closely. At Sonoran Deseert Eye Center we have the capability to take these photos, rather than have to send you to a specialist to perform these photos.

More Drusen

2011-02-24T10:23:00.001-08:00

The picture below are more drusen deposits along the superior arcade. These drusen are in younger patients and are likely harmless.

Fluffy White Dots in the Eye

2011-02-23T10:15:00.000-08:00

The picture below shows fluffy white dots in the macula area of the eye's retina. The macula serves the center of the vision. This patient came in for a routine eye exam and see's 20/20. These dots are called drusen, and are deposits of waste material that the bloodstream doesn't absorb easily. Since the macula is the area of the retina that has the most metabolic activity, because it serves our central vision, it tends to get more accumulation of drusen. This drusen accumulation causes eventual damage to the macula resulting in vision loss. This vision loss is called macular degeneration. Because we see that she has macular degeneration, we were able to get her on the proper multi-vitamins and diet to help decrease risk of progression.

Clogged Blood Vessel in the Eye

2011-02-22T08:25:00.000-08:00

The eye is often the first place that cardiovascular disease shows up. On a routine examination, an embolus was seen in this eye below. This alerts us to other cardiovascular problems and likely blockage in larger blood vessels, such as the carotid arteries. Eye exams are truly about "seeing the signs" warning us of what's coming up.

Seeing double in one eye

2011-02-21T16:21:00.000-08:00

The picture below is a patient who had cataract surgery and an implant put in their eye. Usually cataract surgery goes smoothly with no complication. In this case, the patient's intraocular implant moved a little so that the edge of it appears in the patient's visual axis. We call this subluxation or a subluxated implant. It can be fixed by the surgeon.

My Eye is Red

2011-02-18T08:27:00.000-08:00

Redness in the eyes can be caused by infection, inflammation, high blood pressure, allergy, dry eye, foreign body, growths, and others. It can be difficult to determine the cause of inflammation treating for one thing may not be appropriate for another.

This patient woke up with redness on the top part of the eye. It is mildly uncomfortable. There is actually a nodule or bump and there are no abrasions on the surface. There is no mucous coming out of the eye. This is an episcleritis, specifically nodular episcleritis. It is treated with topical steroids and/or oral non-steroidal anti-inflammatories. It is a non-infectious inflammation, although I have seen herpes simplex virus masquerade as episcleritis. That is why is it very important for a doctor to follow a patient using topical steroids very very closely, as steroids will make herpes simplex much worse. Doctors must feel comfortable managing this or they should refer.

Anterior Vitreous Detachment

2011-02-17T17:57:00.000-08:00

Birth defect in eye

2011-02-15T13:30:00.000-08:00

The picture on top is a normal looking optic nerve. The one on the bottom is one that has a coloboma. This is a birth defect that occurs because of inadequate closure of the fetal fissure. Fortunately, this patient has normal vision.

Flakes in The Eye

2011-02-14T10:21:00.000-08:00

You can see a white, flaky, ring on the surface of the lens in the picture below. In some people of Scandinavian descent, a flaky material will form on the front of the lens. Then as the pupil constricts it pushes this flaky material into this ring. In some situations this flaky substance can actually block fluid drainage in the eye, causing the pressure to rise and increasing the risk of glaucoma. This flaky material is called pseudoexfoliation and patients with this condition have to be watched closely for glaucoma.

Irritated Eyes

2011-02-10T15:46:00.000-08:00

The picture below shows the cause of irritated eyes. I dyed the tears and the picture shows how the tears break up. There are also some damaged cells at the bottom of the cornea. These are signs of dry eye, which can be treated.

I can't see!

2011-02-09T08:51:00.000-08:00

The virus that causes cold sores on the lips can also cause "cold sores" on the eye. The picture below is not an ulcerative herpes simplex lesion but is an inflammation that occurs because of the virus, without the primary infection . After initial infection the virus harbors itself in the nerves and remains inactive. During periods of stress, the virus is triggered and activated and causes problems in the eye.

In the case below the patient cleared with a combination of anti-virals and steroid drops. This condition has to be managed very very carefully.

There's a Bump on My Eye!

2011-02-08T17:25:00.000-08:00

The bump in the corner of the eye is called a pinguecula. It is scar tissue from years of exposure to sun, dust and wind. It usually has a yellowish color to it. It can become red and inflammed sometimes. It can also feel dry on top of it causing a sandy foreign body sensation in the eye. An inflammed pinguecula can be treated with drops. It is recommended you use sunglasses outside.

EYELASH STUCK IN MEIBOMIAN GLAND

2011-02-05T11:28:00.000-08:00

This obviously irritates and scratches the eye and won't come out with rubbing the eyes. It seems very unlikely a loose lash would ever fall into a meibomian gland but it is surprisingly a common occurrence. It is really easy to remove with a jeweler's forceps in the microscope.

VITREORETINAL TUFT

2011-02-04T15:20:00.000-08:00

A tuft on the retina is a small elevation where the bag of gel that fills the eye is pulling on a focal part of the retina. However there is no tear in the retina. It is higher risk for a tear and the patient should know to come in if they see flashes of light, spiderwebs in their vision. or a shadow or curtain coming over their vision. Otherwise we should monitor it yearly.

Cornea Scar

2011-02-04T10:15:00.001-08:00

There is a scar on this patients' cornea, presumably from a scratch. However, this patient doesn't remember scratching the eye.

Whitened arterioles

2011-02-04T09:54:00.000-08:00

The arterioles in the retina on the top picture are normal. The bottom arterioles appear to have some whitening. In someone in their 30's we become a little concerned about cholesterol levels.

The effects of 2 week senofilcon—A silicone hydrogel contact lens daily wear on tear functions and ocular surface health status

2011-02-03T15:07:00.000-08:00

The effects of 2 week senofilcon—A silicone hydrogel contact lens daily wear on tear functions and ocular surface health status

Objective tests for dry eye appear worse with silocone hydrogel contact lens use.

A Randomized Trial of Brimonidine Versus Timolol in Preserving Visual Function: Results From the Low-pressure Glaucoma Treatment Study

2011-02-03T15:01:00.000-08:00

A Randomized Trial of Brimonidine Versus Timolol in Preserving Visual Function: Results From the Low-pressure Glaucoma Treatment Study

Brimonodine is better than timolol at preserving visual function.

Vitamin A Deficiency

2011-02-03T14:08:00.000-08:00

Vitamin A deficiency can occur in aloholics and can cause dry, keratinized spots on the surface of the eye. These spots are called Bitot's Spots.

WHY IS THIS EYE TEARING?

2011-02-02T08:25:00.000-08:00

There is a canal that goes from our eyes to our nose. Every time we blink, tears get pumped into the canal, so that they don't flow out onto our cheek.

In the case below, the patient was complaining of excessive tearing. In the corner of his eye, on the lower lid, you can see the opening of the canal. You may also see that the opening is not flush against the eyeball. The excess tears have no way of getting down into the canal.

In this case, if the excessive tearing bothers the patient enough, a surgical procedure can be performed to bring the opening of the canal back against the eyeball where the tears are.

This condition, called ectropion, happens mostly as we age and the lid becomes lax. It just falls away from the eye. It can also occur in the case of injury or growing lid lesions.

Tearing in the eye can sometimes be very difficult to diagnose. It can occur from dry eyes, clogged tear drainage, allergy, viral infection, or other inflammations.

For more information, contact us at Sonoran Desert Eye Center 480-812-2211, or visit our web page at www.SonoranDesertEye.com

Choroidal Folds

2011-02-01T11:26:00.000-08:00

The picture below is of the retina on the back of the eye. The arrow points to a horizontal line. If you click on the picture you can see the lines more distinctly. These lines are choroidal folds, or folds in a layer of the eye. These folds occur when there is something behind the eyeball pushing forward on the eye. This can be an orbital tumor. The patient may be otherwise asymptomatic.

Routine Eye Exam Reveals Increased Brain Pressure

2011-01-31T12:09:00.000-08:00

Papilledema is a swollen optic nerve head in the eye. The optic nerve connects the eyeball to the brain. If there is pressure in the brain, it will cause the optic nerve to swell where it enters the eye. The bottom picture below is the normal optic nerve and the top one is a swollen optic nerve head. Note the indistinct margins of the optic nerve on top.

Increased pressure in the brain can occur with or without a space-occupying brain lesion. It is important to rule out any kind of space-occupying lesion such as a brain tumor. This patient had no symptoms. She was just coming in for a routine eye examination. Sometimes patients with papilledema complain of headaches and ringing in the ears.

Lens Zonules

2011-01-29T08:20:00.000-08:00

This is a patient with an iridodialysis, which is a section of the iris that has a hole in it near it's insertion. Through that hole you can see the edge of the lens and the zonules that support the lens. The zonules are thousands of thin strings that surround the lens and connect it to the ciliary body, the muscle that is responsible for focusing. It's interesting that the lens of the eye is actually suspended in the by these cords. When the muscle contracts for focusing at near, the zonules relax, allowing the lens to fatten in the middle, changing it's refractive power. We don't often get to see the zonules. If you click on the picture to enlarge it you may see the zonules more.

Conjunctival Nevus

2011-01-28T12:33:00.000-08:00

A nevus is a cluster of pigmented cells and just needs to be photographed and watched.

TORTUOUS RETINAL VESSELS

2011-01-28T09:46:00.001-08:00

GLAUCOMA SHUNT

2011-01-26T09:59:00.000-08:00

Glaucoma occurs when high pressure in the eye damages the optic nerve, causing gradual loss of vision. It is normally treated with eyedrops. If eyedrops aren't sufficient then there are laser procedures that can help the fluid in the eye drain faster, decreasing the pressure in the eye. If that does not lower the pressure enough, there is a bypass procedure that creates an alternate path for fluid to leave the eye.

If drops and surgery is not enough to lower pressure sufficiently, a shunt can be placed in the eye. The shunt is placed at the top of the eye and a tube extends from the shunt into the anterior chamber of the eye. This procedure is reserved for those with significant, uncontrolled glaucoma and is considered a last-ditch effort to saving the eye and whatever vision is left.

DRY EYE

2011-01-25T13:47:00.000-08:00

The picture below was taken with dye in the eye to stain the tears. You can see that the tear layer is very thin in places. This causes irritation on people's eyes. You can also see the lower part of the cornea is stained in spots. This is damage that occurs to the surface cells because of dryness.

Dry eye is managed first with different types of artificial tears, then with plugs or Restasis eye drops.

Cataract

2011-01-24T15:53:00.000-08:00

The picture below shows what a cataract looks like through the eye doctor's microscope. A slit of light coming from the side shows a cross-section of the lens, where you can see a cloudy center. Of course that cloudy center causes blurred vision and glare. Cataract surgery is very successful with few complications and often people are less dependent on glasses after cataract surgery.

Why not wear a two week lens for two months?

2011-01-21T10:38:00.000-08:00

During this rough economy everyone is trying to save a buck. What's wrong with making a 2-week disposable contact lens last for a month or two?

Well there are certainly a lot of people who do this without problems. But when there are problems, it is always these people.

What are the problems that develop? On the picture below you can see protein deposits from the tear film that develop on the surface of the contact lens. You can also see blood vessels growing in to the cornea, demonstrating that the cornea is starved for oxygen from contact lens overwear.

These deposits not only make the lens perform less, both in comfort and in vision, but they cause an inflammatory reaction in the eye. Inflammatory bumps begin to form under the eyelid (see picture below). The eyes begin to feel itcy and irritated. The bumps pull on the contact lenses causing them to move more, which causes greater discomfort and fluctuating vision.

Not only do protein deposits form on the contact lenses, but excretions from bacteria in the glands of the eyelids also begin to concentrate on the contact lenses. The eye will have an acute reaction to this, causing ulceration, pain, light-sensitivity, and contact lens intolerance. This occurs without warning. Both these conditions take time to treat and sometimes result in inability to wear contact lenses again in the future.

These situations are very common in the office. The bottom line is, follow the directions of your eyecare provider. There's a reason we want you to replace your contact lenses. Your eyes are worth it!

Subconjunctival Hemorrhage

2011-01-20T12:17:00.000-08:00

So you wake up and you see your eye is really red like this picture below. It scares you to death! The eye doesn't hurt and it doesn't seem to be affecting the vision. So what's the problem?

Although this looks awful, it is one of the most harmless things that can happen to your eye. It is what we call a subconjunctival hemorrhage. The blood vessels on the white part of the eye can be very brittle and may burst with the slightest pressure change. So it can happen when a person coughs, sneezes, bends over to pick something up, lifts something heavy, or hangs upside down. It can also happen spontaneously.

It clears up within days to weeks without any insult to the eye. If it recurs, then we have to consider blood tests to rule out decreased platelet count that can occur in people with anemia and other disorders. If there's any pain, vision decrease, swelling, or discharge, then it's more than just a bleed and should be seen.

HABITUAL PULLING OF EYELASHES

2011-01-19T09:40:00.000-08:00

This is a picture of a patient who has the nervous habit of pulling on their eyelashes. As you can tell, many of the eyelashes are missing. This is called trichotillomania. It can often be overcome with behavior feedback.

MYELINATED NERVE FIBERS AND VITREORETINAL TUFT

2010-12-31T11:07:00.000-08:00

Myelinated nerve nerve fibers have a whitish look as they emerge from the optic nerve in the eye. Myelination is like insulation around electrical wires. That myelination exists on the nerves when they exit the eye, but in the eye they are unmyelinated. Sometimes the myelination will extend in to the eye. It doesn't cause any problems.

Vitreoretinal tuft is a traction on the retina from the vitreous bag that fills up the inside of the eye. As this bag pulls on the retina, it can sometimes be adherent to the retina in a localized place and pull the retina up a little. A small percentage of these become retinal tears, which can then turn in to detachments which would cause loss of vision. Therefore they need to be watched with dilated eye exams closely.

CORNEAL ULCER FROM CONTACT LENS OVERWEAR

2010-12-29T11:19:00.000-08:00

The photos below are of a corneal ulcer in a patient who frequently sleeps in their "extended wear" contact lenses and doesn't have a good pair of glasses that they like.

This patient is lucky because the ulcer was just outside the visual axis, meaning that most of her vision should return to normal once the infection is gone and the eye is healed. This ulcer will take high dosage of very potent topical antibiotics to resolve, followed by anti-inflammatory drops to minimize scarring and maximize vision.

TREATED RETINAL TEAR

2010-12-22T17:15:00.000-08:00

Below is a photo of a treated retina tear. You can see the piece of retina that is broken off. There is a tear underneath it. There are laser scars surrounding it, preventing it from becoming a retinal detachment.

PSEUDOEXFOLIATION GLAUCOMA

2010-12-22T17:13:00.001-08:00

Pseudoexfoliation occurs primarily in patients of Scandinavian descent. It is a flaky material that exists on the anterior lens capsule and can also flake off and block the fluid drainage of the eye. This patient ha significant loss of vision in this eye from damage to the optic nerve (as demonstrated by it's lack of good blood perfusion in the bottom picture).

CONJUNCTIVAL CYST

2010-12-14T13:28:00.000-08:00

This is a cool picture of a conjunctival cyst. The patient is looking to his left. The cyst grew overnight and stretched the blood vessels, causing a few of them to bleed.

ABMD

2010-12-13T12:47:00.000-08:00

This is anterior basement membrane dystrophy, a genetic disease that causes an irregular corneal surface resulting in blurred vision and eye discomfort upon awakening.

"EYELASHITIS"

2010-12-08T15:10:00.000-08:00

That is what this 9 year old patient calls this. It's actually blepharitis, a chronic infection of the eyelids.

BEAR TRACKS

2010-12-08T15:06:00.000-08:00

Basically bear tracks are pigment on the retina. Kind of like a birth mark.

UNUSUAL RETINOSCHISIS

2010-10-30T13:20:00.000-07:00

The photo below is of a retinoschisis. A retinoschisis is a separation of inner layers of the retina from the outer layers of the retina. Usually a retinoschisis is dome shamed. This one, however, is unusual in that it has a steep ridge. This one looks like the head of a wood golf club.

COLOBOMA

2010-10-30T13:17:00.000-07:00

The above picture is what the normal optic nerve looks like.

This is a picture of an optic nerve coloboma. It occurs when the eye doesn't develop completely. A coloboma is like a huge crater with the optic nerve on one of the slopes. This patient's vision is only mildly decreased.

CORNEAL ULCER

2010-09-18T11:02:00.001-07:00

This is a 29 year old patient who wears her Acuvue Oasys Contact Lenses from the time she gets up until she goes to bed, every day. She complained of pain, redness, and light sensitivity.

Examination shows a single corneal ulcer. This is a bacterial ulcer, similar to what occurs with stomach ulcers. It must be treated very aggressively with a high initial dosage of very potent topical antibiotics and the patient must be followed nearly every day until resolution.

This patient is very fortunate. The ulcer is located peripherally enough that any scar will not effect her vision. She also came in early enough to limit it's progression before it became worse. These ulcers can cause permanent decrease in vision, due to scarring along the visual axis. Aggressive, poorly managed ulcers can cause complete loss of the eye.

People with problems like this are always those who over-wear their contact lenses and they don't dispose of their lenses when they're supposed to. For some reason the patients I see coming in to my office are usually wearing Acuvue Oasys lenses.

The people who do the best in contact lenses are those who rest their eyes from the contacts a few hours a day and a day or two a week.

FOREIGN BODY TRACKS POINT TO THE PROBLEM

2010-09-14T12:56:00.000-07:00

A patient of mine showed up one Monday morning complaining of pain in his eye. He said the wind was blowing two days earlier and he thinks that something flew into his eye. No matter how much he flushes the eye out, he can't get rid of it.

When I first looked at him, I couldn't see anything wrong. The cornea looked normal and the eye wasn't red. I flipped the eye lid to look under it and didn't see anything there. So then I put dye in the eye and under red-free light I saw the following on the cornea:

If you magnify the above picture and dim the lights, you'll see several vertical lines in the cornea. These lines represent scratches on the surface of the cornea caused by something trapped under the upper lid. So I knew there had to be something there. Usually a foreign body is metallic and easily identifiable.

On closer look I was able to identify a clear piece of plastic under the lid. I pulled it out and the patient had immediate relief.

CONTACT LENS LOOKING LIKE A PETRI DISH

2010-09-09T17:07:00.000-07:00

This is a patient who wears his Purevision Toric contact lenses longer than a month and doesn't remove them. When your contact lenses look like a Petri Dish, you know you're abusing your contact lenses...and your eyes!

SCLEROSING BASAL CELL CARCINOMA

2010-08-20T11:09:00.001-07:00

This older gentleman has irritation in the left eye from lashes poking in his eyes. Why are they poking. You can see the irregularity in the lower lid. This can be caused by a deep basal cell carcinoma. If it grows, it will need to be excised and the lower lid would have to be reconstructed.

CONTACT LENS OVERWEAR

2010-08-04T18:13:00.001-07:00

This patient overwears their contact lenses and you can see blood vessels growing into the cornea. This is a common problem and people are surprised to see that contact lenses are causing this kind of damage to their eyes.

NUCLEAR CATARACT

2010-08-04T18:11:00.001-07:00

The right lens shows barely any cataract at all.

The left lens shows a clouding which changed the patient's eyeglass prescription rapidly and will eventually cloud the vision to the point where he needs cataract surgery.

WASH YOUR HANDS BEFORE PUTTING IN CONTACT LENSES!!!!!

2010-07-23T16:30:00.001-07:00

This is the case of a young lady who may not have washed her hands to put her contact lenses in after she had used some facial cream. The cream may be alkaline which is NOT good for the tissues of the eye. Alkaline substances tend to start damaging the cornea and working it's way deeper and deeper into the tissue.

On her way to work she started seeing hazy, but it didn't hurt. She came into the office and she really didn't look that bad, just a little damage to some surface cells of her cornea and a lot of corneal swelling. I had her irrigate her eye and use a lot of artificial tears the rest of the day to wash out everything and lubricate the eye. She called me last night in pain and I prescribed an antiobiotic/steroid combination eyedrop to calm down the inflammation and prevent bacterial infection.

Today she feels a lot better, and although her corneal swelling is a lot better, she has a lot of damage to the epithelial cells and her vision is worse. You can see that damage in the pictures.

Steroids can delay wound healing so, after consulting with my favorite corneal specialist, who concurs with me, I am having her use antibiotic drops only.

She will heal and I will watch her closely to make sure she heals with minimal or no scarring. However, the lesson is learned to WASH YOUR HANDS before putting contact lenses in. Washing hands is not just to prevent infection, but to wash off anything that the hands touched that could be toxic to the cornea.

Below is right eye yesterday.

Below is right eye today, showing the damaged epithelium cells.

This photo below is the left eye yesterday showing mild damage to surface cells.

The picture below is the left eye today, showing two heavily damaged areas of epithelium.

Below is the OS lesion using white light.

MACULAR SCAR

2010-07-13T16:05:00.000-07:00

This is a scar from childbirth near the macula. The macula is that portion of the retina that serves the center of our vision. Because this scar is so close to the macula, this patient's best vision is 20/40. He has to eccentrically view, which means that he has to look off to the side a little to see something. Luckily his left eye is perfect 20/20.

SNAIL-TRACK DEGENERATION

2010-06-30T10:58:00.000-07:00

This area of white is on the retina in the far periphery. It can only be seen when the eye is dilated. This occurs often as an inherited trait in near-sighted people. People that have this are more susceptible to developing retinal holes and detachments. This picture is of a young patient with the condition. It was discovered without any symptoms on routine dilation. She was educated to watch for flashes of light, floaters, or a curtain coming over her vision. We will follow up with her on a yearly basis.

METAL IN THE EYE

2010-06-29T14:09:00.000-07:00

This mechanic's eye started bothering him on Tuesday. He thought it would go away on it's own but everyday it got worse until I saw him in my office on Saturday. He had metal embedded on his cornea. Removal was quick, will leave no scar, and provided instantaneous relief.

AIR HOCKEY INJURY

2010-06-29T13:54:00.001-07:00

This patient was watching an air hockey match when the puck flew off the table and hit his eyelid. It lacerated his lid, which will heal rapidly. I dilated the eye to make sure there was no serious injury to the retina and found this area of whitening on the retina corresponding to the location he was hit.

The whitened area of the retina is what we call Commotio Retinae. It is caused by swelling in the retina from trauma. It resolves in about 6 weeks without any consequence to vision or health of the eye.

RETINAL HOLE

2010-06-25T14:37:00.001-07:00

The photo below is of a retinal hole, found on routine dilation during a regular eye exam. Fluid can get under these and lift the retina off. Where ever the retina gets lifted off you can't see. So this patient likely will need laser to sort of "weld" around the hole so that if fluid does get under it, it won't spread.

This case illustrates the importance of routine eye examinations, even for people who don't need glasses or contact lenses.

MORE CONTACT LENS OVER WEAR

2010-06-23T13:25:00.001-07:00

This is another patient who overwears Acuvue contact lenses. The above arrow points to where the blood vessels should stop. The lower one points to where they extend into this patient's cornea. Ideally contact lens wearers should give their eyes a few hours a day to breath and a couple days a week. We can replace our cars. We can't replace our eyes! These blood vessels will forever be there. But hopefully, with proper lens wear, they can become "ghost" vessels, with no blood in them.

RETINAL TEAR

2010-06-23T13:00:00.000-07:00

Below is a retinal tear discovered on routine eye dilation. The arrow points to the tear which, in 3 dimensions, comes out into the vitreous cavity of the eye. The dark area just above it is actually the shadow of the operculum. Retinal tears eventually cause retina detachments. This can lead to complete and irreversible blindness if not caught in time. This patient had no symptoms.

Every week I catch someone with a retinal tear who had no symptoms. We can only catch these when we dilate the eye. Dilation is no extra charge at Sonoran Desert Eye Center.

RETINAL TEAR

2010-06-21T14:40:00.001-07:00

You can enlarge this photo to see the retinal tear. Fluid can get under tears and lead to a retinal detachment quickly if not treated. You should call your eye doctor immediately if you notice sudden flashes of light or unusual floaters.

CONTACT LENS OVER WEAR

2010-06-19T09:11:00.000-07:00

This is an example of what happens when people over wear their contact lenses. The cornea is the only structure in the body that gets it's oxygen directly from the air. When we wear contact lenses, unless we have enough waking hours of not wearing the lenses, the cornea becomes starved from oxygen. Blood vessels start to grow into the cornea to feed the starved cells. Over time the health of the cornea becomes compromised, leading to inflammations and vision-threatening infections that can cause permanent loss of vision.

These blood vessels should stop at the limbus, the junction between the white part of the eye and the cornea. As you can see, these blood vessels go much further!

CORNEAL SCRATCHES

2010-05-28T10:48:00.000-07:00

The two little marks are abrasions from an eyelash separator (not while driving, or it would have been much worse). It healed with no scarring because we did a balance of steroid and antibiotic drops.

GLASS BEAD EMBEDDED ON THE EYE

2010-05-05T16:28:00.001-07:00

This gentleman sandblasts the calcium ring on tile using glass beads. He came in complaining of irritation in the eye. This glass bead was stuck on his cornea. It was easy to remove and antibiotic drops will keep it from getting infected.

ARTIFICIAL RETINA SEE'S ABOUT 20/8000

2010-04-29T11:08:00.000-07:00

The Best of Ophthalmology.....EyeWorld News Magazine

Nice article about a lady implanted with an artificial retina and how she went from seeing no light to seeing about 20/8000...enough to see a bus go by.