CHORIORETINAL SCAR

Below is a chorioretinal scar in the macula of the right eye.  differential diagnosis includes presumed ocular histoplasmosis syndrome (POHS) and toxoplasmosis, toxocara, macular coloboma among others. 

RPE DETACHMENT

Below is an OCT of the right eye macula.  An OCT takes a cross-sectional view of the retina.  The macula is the part of the retina that serves the center of your vision.  You can see the dome-shaped space under the retina by the fovea (the exact center of the macula).  This dome-shaped space is focal detachment of the retinal pigment epithelium.  The patient see's 20/20.  Below that is an RPE detachment from another patient.  Notice the double dome. 

OCT IN GLAUCOMA

Optical Coherence Tomography (OCT) measures the thickness of the nerve fiber layers, which are thinned in glaucoma.  The image below shows what glaucoma does to the nerve fiber layer around the optic nerve (top graphs) and the ganglion cell layer around the macula area. 

OPTIC DISC DRUSEN

Here's a picture of optic disc drusen lifting up the optic nerve.  Notice the globulated look to the optic nerve rim. 

GEOGRAPHIC ATROPHY

Here's a good picture of geographic atrophy from macular degeneration. 

GRANULOMA FORMING AROUND A PALPEBRAL CONJUNCTIVAL FOREIGN BODY

This was a very interesting case because the patient had reported getting something in his eyes months before.  He resisted coming in and said it felt better as time went on.  However he still feels something is under his eyelid, albeit not painful.  

Upon examination he had a foreign body that was tucked into a crevice of this granuloma.  I took the foreign body out before taking the photo (I was half tempted to tuck it back in when I realized it would have made a good photo...LOL).  

So theoretically what happened is the foreign body was smooth enough to keep him from being miserable, but rough enough for the conjunctiva to form a granuloma around it...a natural reaction of the eye to protect itself.  I thought it was interesting.  I wish I'd gotten that photo with the foreign body included.  

CENTRAL SEROUS RETINOPATHY (CSR)

Central Serous Retinopathy (CSR) usually effects only one eye and occurs from fluid leakage under the macula. Visual acuity can be effected and patient often complain of a smudged gray spot in their central vision.  CSR typically effects males between 20 and 50 years old and can be associated with higher cortisol levels (such as occurs in Cushing's Syndrome) or stress.  

CSR usually resolves between 3 to 6 months and visual acuity often returns to normal, although there can be some subjective vision loss and subtle macular scarring seen on ophthalmoscopy. 

There have been some proposed treatments in the attempt to shorten the duration of symptoms or prevent possible recurrence with somewhat limited results. The condition usually resolves spontaneously over a period of a few months. 

TOXOPLASMOSIS SCAR

GEOGRAPHIC ATROPHY FROM MACULAR DEGENERATION

3-9 STAINING FROM IMPROPER RIGID GAS PERMEABLE CONTACT LENS FIT

Notice the staining at 3:00 and 9:00 on the cornea.  also notice the excessive bearing of the contact lens on the cornea almost 360 degrees in the mid-periphery towards the last contact lens curve. Flattening the center curve can cause excessive bearing on the center.  The simplest solution for me is to put this lens in a scleral lens, but that's not the only solution. 

CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM (CHRPE) WITH LARGE LACUNAE

CENTRAL CORNEAL ULCER

Patients who don't follow their doctor's instructions for wearing their contact lenses are at higher risk of developing infectious corneal ulcers.  If an ulcer is out of the visual axis, a remaining scar will not affect the vision.  But a central ulcer, like this one, is at high risk of developing permanent loss of vision to some degree.  Culturing becomes important in case chosen treatment isn't effective.   In addition to proper antibiotic treatment, the best chance of minimizing the scar is the use of an amniotic membrane and possibly the very judicious use of topical steroids as the infection is controlled. 

SEVERE DRY EYE

This photo demonstrates decreased tear break up time, punctate staining, and corneal filaments associated with severe dry eye.  This patient is a great candidate for a scleral lens. 

MITTENDORF DOT

Mittendorf Dot is a congenital opacity on the posterior capsule of the lens of the eyes.