HORSESHOE RETINAL TEAR WITH RETINAL DETACHMENT

Below is a photo of the left eye of a 46 year old male patient who presented with the chief complaint of some haziness in his left eye vision.  He has a retinal horseshoe tear with a macula-on detachment that required immediate referral to a retinal specialist for surgery. 

CENTRAL SEROUS RETINOPATHY (CSR) BEFORE AND AFTER

These are photos of central serious retinopathy in the right eye of a patient in his 30's, taken one year apart.   The best visual acuity when the CSR presented was 20/60 and one year later is 20/20.  He reports some subjective change in color perception that likely will remain permanent.  You can see that there is some residual pigment mottling left over. 

The photos below are the autofluorescent photos captured at the same times.  There is mild hyperautofluorescence at initial presentation and some hypoautofluorescence remaining the long-term effect on the retina of the CSR.

PAN-RETINAL PHOTOCOAGULATION

MACULAR SCAR

Pavingstone Degeneration

From JAMA: "Of importance in the evaluation of the peripheral fundus is a distinctive and fairly common disease process termed paving-stone degeneration of the retina. In its typical form, this condition is located between the ora serrata and the equator and is characterized by small, discrete, rounded areas of depigmentation and retinal thinning. These lesions are yellow-white in color, frequently reveal prominent underlying choroidal vessels, and often possess a pigmented margin. Occurring singly or in groups, the lesions of paving-stone degeneration not uncommonly become confluent and may even coalesce to form bands."

From OpticianOnline: "DIFFERENTIAL DIAGNOSIS. Gyrate atrophy; Lattice degeneration; Congenital hypertrophy of the retinal pigmentary epithelium; Retinal holes; Inactive chorioretinitis lesions...No treatment is required for pavingstone degeneration. The main issue is the differential diagnosis."

RETINAL HOLE AND LATTICE DEGENERATION

This patient came in for a routine eye examination.  Retinal exam demonstrated a moderate sized retinal break in the right eye.  You can also see areas of lattice degeneration superiorly.  The patient is to undergo laser photocoagulation to prevent retinal detachment.  THIS is why we dilate or perform the Optomap.  People go blind every day from retinal detachments that could have been prevented if they had been caught as a small retinal break. 

Another large superior retinal hole with an operculum floating above it. 

RETINAL HOLE

A great picture of an atrophic retinal hole.