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.