PIECE OF METAL UNDER THE EYELID

These are photos of a gentleman in his 60's who came to us with an irritated left eye. He had been out in the wind and dust earlier that day. His eye was irritated. He was light sensitive. He felt something was in his eye.

I put fluorescein dye in the eye and discovered the abrasion at the 2 o'clock location on the cornea. There were also foreign body tracks adjacent to the abrasion. Sure enough, when flipping the lid, there was a small piece of metal embedded under the eyelid. I removed the foreign body, gave the patient antibiotic drops, and called him later that evening. He was doing much better!

COLD SORE ON THE EYELID

Below is a photo of a young 12 year old who has a recurring lesion on his eyelid. It always occurs near the same location with yearly frequency. This is the same condition that causes cold sores (which he also gets) on the lips, only it's a different branch of the trigeminal nerve that serves the face.

Herpes Simplex Virus is airborne as well as spread by body fluids. HSV 1 is the non-venereal version that most people harbor. The virus resides in the trigeminal ganglion, which is where the three branches of the trigeminal nerve meet. It only causes lesions in patients when it is triggered, usually during periods of stress, either physical or psychological. It is impossible to completely eradicate it, but lesions can be treated with anti-viral to prevent permanent tissue damage.

RETINAL EMBOLUS

Below is a photograph of a retinal embolus in a right eye retina arteriole of a 68 year old woman. This patient has not been to her doctor in years. She also had corneal arcus, which is cholesterol deposits on the cornea. She is not being treated for high cholesterol.

Retinal emboli are loose pieces of plaque that travel in the blood stream until the artery diameter becomes smaller than the embolus. There the embolus stops and often will plug up the artery, causing death of the tissue that the artery serves. This is what occurs in strokes and heart attacks. Emboli that get deposited

This patient had no symptoms that something was going wrong with her cardiovascular system. It is so important that people over 55 years old have their regular visits with their primary care providers.

MARGINAL KERATITIS

This is a complication of contact lens overwear. This can be very painful. The white dots are collections of white blood cells. Eventually the cornea can ulcerate in those areas and the patient becomes unable to wear contact lenses any longer, without treatment. Treatment is prescription anti-inflammatory and antibiotic drops, a good pair of glasses with the current prescription, and better contact lenses. The bottom picture is what the cornea looked like on the day of presentation. The top picture is 5 days after treatment. This patient had been wearing Acuvue Oasys lenses. We changed her to better quality lenses that have less incidence of marginal keratitis.

PAPILLEDEMA

Normally the optic nerve disc is flush with the retina. In papilledema, intracranial pressure (pressure in the brain cavity) is so high that the optic nerve protrudes into the eye.

Increased intracranial pressure can occur if there are space-occupying lesions in the brain, such as tumors. There is a condition called pseudotumor cerebri where the intracranial pressure is high but there is no space-occupying lesion. The patient often suffers from headaches and ringing in the ears. It often occurs in young, overweight females. This was a patient I saw this week who came in for a routine eye examination.

A space-occupying brain lesion needs to be ruled out with imaging and often a lumbar puncture is performed to confirm the increased intracranial pressure and rule out other possible problems

PERIPAPILLARY ATROPHY

This is a common occurance in people that are very near sighted. The optic nerve is surrounded by a white area. This area is not useful for vision, so this patient has an enlarged blind spot on their visual field. However, it is not progressive.

ANOTHER CHOROIDAL NEVUS

This is another patient with a choroidal nevus. This is a benign pigmented lesion on the retina that has very low potential for growth to become a malignant melanoma. It is photographed and watched on a regular basis.