Pigment Ring

This is the left eye of a 40 year old man who presented with a red eye, blurred vision and aching pain beginning one week before. Looking inside the front of the eye the aqueous of the anterior chamber was filled with white cells and fibrin, like the inside of a snow globe. This is inflammation in the front of the eye called “iritis.” There was so much inflammation the rim of the pupil was stuck to the front surface of the lens. Treatment consisted of frequent cortisone drops to calm the inflammation and a dilating drop to relax the focusing muscles, thereby reducing pain. After two days the pupil dilated, but left the ring of pigment from the edge of the iris stuck to the lens. It is unlikely to affect vision.

Central Serous Retinopathy on OCT

There are times when we can look into the eye and not be able to see what is wrong. A good example is when there is edema in the retina, which amounts to clear fluid in clear nerve tissue. Like finding glass in a bowl of water. Before OCT (Ocular Coherence Tomography) was available the only way to identify this kind of fluid was with a retinal angiogram. Now we have OCT which uses light to visualize the fine details of retinal structure.

Patient 1. Right Eye. Normal. VA 20/20.             Patient 1. Left Eye. Subretinal Fluid. VA 20/70.

Patient 2. Right Eye. Subretinal Fluid. VA 20/60.

Upper Row. These are the OCT images from a 53 year old woman who had noticed blurred vision in the left eye for one month. The OCT on the left (her right eye) shows the normal appearance of the central retina. The hill and valley contour is the location of central vision. Note the contour is smooth and the retinal layers are even. The OCT on the right (her left eye) shows a dark gap underneath the retina which represents an accumulation of fluid. Vision in this eye is 20/70. This is called central serous retinopathy. An angiogram was done to be sure the fluid did not come from invading new vessels. Most of these cases resolve on their own with time. And indeed 6 weeks later vision had improved to 20/25.

Lower Image. This is the OCT image from the right eye of a 51 year old woman who came in for blurred vision. Vision measured 20/60 in this eye. The OCT shows a large fluid-filled gap under the retina. An angiogram showed no new vessels, so we waited and two months later vision had improved to 20/25.

Disc Hemorrhage in Glaucoma

This is the right optic nerve of a 53 year old woman with elevated intraocular pressures, but no disc or visual field defect. The arrow at 7:00 points to a the red streak which is a hemorrhage in the nerve fiber layer of the retina. It suggests an increment of damage to the optic nerve telling us we need to get her pressure lower.

Subconjunctival Hemorrhage

This is a very common problem. Sometimes associated with injury, sometimes from eye rubbing and sometimes for unknown reasons a blood vessel on the outside of the eye will break. The blood collects in the space between the wall of the eye and the covering layer, the conjunctiva which is essentially clear. If there was any kind of injury we need to carefully check the eye for penetration. If there are multiple recurrences associated with easy bleeding and bruising then you are either on aspirin or anticoagulants or need to have your clotting mechanisms checked. But most of the time the hemorrhage just looks dramatic without causing any harm. Depending on the amount of hemorrhage it can take from a couple of days to over a week to absorb.