FOREIGN BODY TRACKS POINT TO THE PROBLEM

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

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

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

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

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!!!!!

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

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.