Routine Eye Exam Reveals Increased Brain Pressure

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

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

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

TORTUOUS RETINAL VESSELS

GLAUCOMA SHUNT

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

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

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.