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Central Retinal Artery Occlusion - 2 months old by history1568 views77-year-old man was doing fine. His left eye was a little worse than the right eye, and then in the 2 months ago he had sudden severe vision loss in the right eye. Vision OD is 3/200; OS is 20/60. IOP: OD 30, OS 15.
OD: Vertical C/D ratio is 0.4. The macula is white from ischemia. The arteries are narrow.
Photos confirm clinical findings.
OCT SCAN: OCT scan of the right eye shows retinal thickening, consistent with macular edema associated with a central retinal artery occlusion. The left eye has severe inferior retinal thinning, consistent with an old hemicentral retinal artery occlusion in the left eye. The fovea in the left eye is a little bit thin but not too bad.
IMPRESSION: 1. CENTRAL RETINAL ARTERY OCCLUSION RIGHT EYE
2 OLD HEMICENTRAL RETINAL ARTERY OCCLUSION LEFT EYE
3 DIABETES WITHOUT RETINOPATHY
4 ELEVATED INTRAOCULAR PRESSURE RIGHT EYE STATUS POST INJECTION RIGHT EYE A WEEK AGO
DISCUSSION: I explained to the patient that the right eye unfortunately has had a central retinal artery and unfortunately we do not have anything to treat that. His vision will probably improve some over time. He needs to be watched though. It is possible he is developing rubeotic glaucoma, although it is probable the intraocular pressure is high from the injection last week. I asked him to restart the Alphagan, to stop the other two drops, and to return here in three weeks to make sure his pressure is more acceptable.
At this point, having lost almost all the retinal circulation in the right eye and half of the retinal circulation in the left eye, he only has half a retina in the left eye he is working off of. I told him it is very important he keep seeing you and anything that can be done to keep his blood pressure low and his cholesterol reasonable would be helpful to what remains of his retinal circulation.
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Optic Nerve Drusen in 7 Year Old Child - Miminal Calcification1568 views7-year-old child difficulty seeing the blackboard in school. She was checked for glasses and it was noted at that time that she had unusual looking optic nerves. Vision OU is 20/50.
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Total Retinal Detachment1564 viewsTotal Retinal Detachment
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Normal Spectral Domain Optical Coherence Tomography (SD-OCT)1564 views48-year-old woman has had a problem with light and dark adaptations. She notices when she sees a point source of light like a cell phone in a dimly lit room and then she turns the cell phone off, that subsequently her vision is very dark until she goes back into a well lighted area. OD 20/20, OS 20/25.
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Gonioscopy; Scattered Peripheral Anterior Synechiae1564 viewsPatient comes in for evaluation for glaucoma. Patient also has a history of Uveitis. Last flare up was back in 1990. Patient's VA was 20/30, Right eye and 20/40-1, Left eye. Slit Lamp Gonioscopy reveals iris bow with scattered PAS around the angles of the anterior chamber. You can also see pigmentation in the trabecular meshwork. Patient will follow up in 3-months.
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Small vessel vasculitis causing cystoid macular edema - right eye - late frame fluorescein angiography 1562 views36 year old female with no significant past medical history noted painless, progressive loss of vision over one month. BCVA was 20/100 in her right eye. Dilated fundus exam, OCT and FA identified small vessel vasculitis associated with cystoid macular edema. Left eye was also involved with less marked findings.
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Drusen Maculopathy - Confluent Subfoveal Soft Hydrophobic Drusen - Yellow Drusen in Center of the Macula1561 views
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1560 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40
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Choroidal Melanoma1560 views
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Optic Nerve (Disc) Drusen - Fundus Autofluorescence1560 views34 Year Old woman no headaches normal vision
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Macular Demarcation line and Symptomatic Distortion 3 years following Asymptomatic Retinal Detachment Repair1558 views 41-year-old man had an asymptomatic retinal detachment repair in the left eye on New Years Eve in December of 2007 in Wake Forest, North Carolina (3 years ago). Since then he has had problems with distortion and pinching. When he looks at long words, the very center letters are abnormal.
OD is 20/20, OS is 20/80
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CHRPE lesion in the left eye - Irregular pigmentation1554 views63 year old female with normal vision and CHRPE lesion in the right eye.
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Reticular pigment degeneration1551 views78 year old man with wet AMD- Peripheral retina show reticular pigment degeneration
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Cone-Rod Dystrophy 1550 views34-year-old woman who is having some difficulty seeing at night, especially navigating through dark movie theaters and dark restaurants. OD is 20/30, OS is 20/30
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Giant Cell Arteritis - 85 year old woman sudden vision loss left eye - AION - Pale Swollen Optic Nerve1549 views 85-year-old woman has felt sick and weak for about the last two months. She is having headaches, jaw claudication, and her eyes ache. Then, three days ago she had sudden vision loss in the left eye. You saw her with optic nerve swelling and suggested she come in here for evaluation. She had coronary bypass surgery in 2004.
VISUAL ACUITY: Vision OD is 20/80, OS is light perception
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Emulsified silicone oil in anterior chamger1547 views
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)1536 views77-year-old woman with CLL who had shingles on the left side of her face about 6 weeks ago then she developed a dendrite in the cornea which was treating about four weeks ago. She noticed severe vision loss in the left eye just a few days ago and you saw retinitis and she comes in because of that. Vision OD is 20/25, OS is hand motion
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Giant Cell Arteritis - 85 year old woman sudden vision loss left eye - AION- Pale Swollen Optic Nerve1527 views 85-year-old woman has felt sick and weak for about the last two months. She is having headaches, jaw claudication, and her eyes ache. Then, three days ago she had sudden vision loss in the left eye. You saw her with optic nerve swelling and suggested she come in here for evaluation. She had coronary bypass surgery in 2004.
VISUAL ACUITY: Vision OD is 20/80, OS is light perception
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Amelanotic Nevus Initial Visit1526 views
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Weiss Ring1523 views
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Vitreous Hemorrhage from Retinal Tear - Acute Posterior Vitreous Detachment1522 views
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1517 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - SD-OCT Line Scan Inner retinal edema1513 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1512 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40
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Commotio Retinae - One Day following Basketball to Eye1511 views43-year-old man was playing basketball last night. He was hit straight in the left eye with the ball. Initially he had darkness in his inferior vision and now he has darkness inferonasally in the left eye.
Vision OD is 20/16, vision OS is 20/32
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Best Disease - SD OCT Line Scan1508 views
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Flower Cataract1507 viewsPatient with ahmed tube and flower cataract
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Correctopia - before laser iridoplasty - 20/60 vision1504 viewsIris is occluding visual axis
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Equatorial Drusen Fundus Photo Left Eye1501 views
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Juxtafoveal Retinal Telangiectasia (Telangiectasis) - MacTel - Striking Gray Ring in Macula1501 views59-year-old woman decreasing vision in the right eye for a few years. She has had diabetes for five years. OD 20/100, Pinhole 20/40. OS 20/20
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Acute Annular Outer Retinopathy - VA loss 2 days Right Eye Only - 25 Year Old Woman1500 viewsInitial visit (June 11, 2011): 2 days of vision loss right eye. Wedge suddenly of VA loss OD, too dardkto see through. No flashes or floaters. VA 20/20 OU.
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Wet AMD OS - Dry AMD OD SD-OCT1500 views84-year-old woman has wet age-related macular degeneration in the left eye and dry macular degeneration in the right eye. She takes the eye vitamins and her vision is stable since she was treated three months ago with Avastin. OD 20/50, OS 20/32
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"Jelly Bumps" Soft Contact Lens1496 viewsYoung female patient comes in wearing overnight contact lenses. Complains of irritation in both eyes. Denies sleeping in SCL. Slit lamp exam shows little jelly bumps underneath the contact lens in both eyes. Was issued a new pair and lectured on handling them.
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Sturge-Weber Encephalotigeminal Angiomatosis - Facial Hemangioma and Asymptomatic Ipsilateral Diffuse Choroidal Hemangioma1490 views61-year-old man with Sturge-Weber syndrome with a hemangioma on the left side of his face.
VISUAL ACUITY: Vision OD is 20/50, PH 20/30; OS 20/80, PH 20/30. IOP: OD 16, OS 19.
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Nonproliferative Diabetic Retinopathy with Circinate Hard Exudates1489 views
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Basal Laminar Drusen - Cuticular Drusen - Equatorial Drusen - 70 Year Old Woman 1487 views70 year old woman has had macular drusen since her thirties and she said her sister has a similar problem. Recently the vision in the left eye has substantially declined. OD 20/16, OS 10/200.
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment1486 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye1484 views52-year-old man has been diabetic for nineteen years developed substantial vision loss over the last month or two. OD 20/70, OS 20/200.
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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram 1484 views34-year-old man noticed about five days ago decreased vision in the right eye. He was having difficulty playing video games and seeing with that eye. He thought maybe his refractive error was shifting.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/16
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Ectopia Lentis - Marfan's Syndrome - Intermittent Pupillary Block Glaucoma Right Eye1481 views41-year-old woman decreased vision right eye and intermittent pupillary block glaucoma for 6 months from a dislocated natural lens in the eye, probably associated with Marfan syndrome.Vision OD is 20/160, PH 20/40; OS is 20/30, PH 20/25
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Proliferative Diabetic Retinopathy - Moderate - mild NVD with NVE 1481 viewsVenous beading, vascular loops and NVE are visible on photos
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Eales Disease1478 views
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1477 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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Morning Glory Syndrome, Optic Nerve1472 viewsPatient comes in for cataract evaluation. VA 20/60, right eye and 20/150, left eye. Fundus photo shows "morning glory syndrome" of the optic nerve in the left eye.
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1471 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40
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Weiss Ring -Vogt Ring - Posterior Vitreous Detachment1469 viewsChronic Floater - 10 years
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Gonioscopy, Pigment Dispersion Syndrome1469 viewsPatient comes in with elevated pressures. Goinoscopy shows heavy pigment dusted off the iris into the trabecular meshwork. Laser procedure was done to break up the pigment for more aqueous flow.
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Pigmented Peripheral Retinal Degeneration1468 views42-year old male comes in for routine eye exam and to follow up on peripheral retinal degeneration in both eyes. VA is 20/20, right eye and 20/25, left eye. Patient is asymptomatic with no visual complaints.
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Capillary Non-Perfusion - Severe Non-Proliferative (Background) Diabetic Retinopathy - Type I - 20 Year Old Man Diabetic 16 years1467 views20 year old diabetic with poor vision for the past three or four years. He has been diabetic for sixteen years and hemoglobin A1C of 10.0. 20/25 OD, 20/30 OS.
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Retinal Detachment with Dislocated IOL Lens1466 views47-year old male who had trauma to the right eye. Patient had retinal detachment surgery in the past (Scleral Buckle), to the right eye. Patient came in with another retinal detachment with dislocated PC IOL lens. Notice the haptics tearing the retina. Patient underwent vitrectomy with gas exchange. VA was hand motion 1-day post op.
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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram 1465 views34-year-old man noticed about five days ago decreased vision in the right eye. He was having difficulty playing video games and seeing with that eye. He thought maybe his refractive error was shifting.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/16
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Central Serous Retinopathy Acute - Fundus Autofluorescence1462 views42-year-old man was seen in the office on October 5, 2011. He had noticed starting in August after a course of antibiotic and steroids, that he developed new spots in his vision in the right eye. He may have had an episode like this sometime in the past. He did take steroids a few years ago and his vision did change at that time, but then returned.
VISUAL ACUITY: OD 20/32, OS 20/32
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Myelinated Nerve Fiber Layer Right Eye (white area)1460 views62-year-old man myelinated nerve fiber layer in the right eye. OD 20/25, OS 20/30.
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Macular Branch Retinal Vein Occlusions (2) Left Eye - No Macular Edema (yet) 1458 views77-year-old woman with two macular branch retinal vein occlusions in the left eye OD 20/25
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Dilated Conjunctival Blood Vessels1458 viewsPatient comes in for routine eye exam. VA 20/20 in both eyes. Fundus exam was normal. Dilated blood vessels are shown temporal inferiorly in the left eye.
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Correctopia - before laser iridoplasty - 20/60 vision1456 viewsIris is occluding visual axis
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Bilateral Diffuse Uveal Melanocytic Proliferation - BDUMP - Paraneoplastic Syndrome1453 views80-year-old man vision loss for one year. He died about one year after these photos from Metastatic Poorly Differentiated Large Cell Carcinoma of unknown primary. He was a smoker.
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Juxtafoveal Telangiectasis - MacTel - Retinal Telangiectasis - Both Eyes - Crystals1453 views61-year-old man has idiopathic juxtafoveal retinal telangiectasis type II in both eyes OD is 20/40, OS is 20/25
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Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - FAF1453 views14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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Bilateral Papilledema 1452 viewsYoung male presents with decreased vision in both eyes. Fundus photos reveal swollen optic nerves in both eyes.
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Myelinated Nerve Fiber Layer Right Eye (white area)1450 views62-year-old man myelinated nerve fiber layer in the right eye. OD 20/25, OS 20/30.
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Ectopia Lentis and Cataract - Marfan's Syndrome1447 views40-year-old woman has had dislocated lenses since she was a child. The right eye is seeing well with an aphakic correction. The left eye unfortunately has declining vision for 4 months. OD 20/32, OS 20/125. Pinhole 20/50
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Hypertrophy of the Retinal Pigment Epithelium1445 viewsPatient comes in with vision changes in the right eye. VA is 20/30 in the right eye. Fundus and FAF photos show a large area of Hypertrophy in the right eye.
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Uveitis - Iris Nodule - Koeppe Nodule1443 views29-year-old woman has had problems with uveitis in the right eye for about the last two years. Her symptoms are usually floaters. Occasionally the eye gets red, it has not been very uncomfortable, and it has always been in the right eye. Has had Iris Nodule like one in photo in left eye and Right eye. They clear with or without steroids after about a month.
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RD with PVR1443 viewsRD with Proliferative Vitreoretinopathy
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Recurrent Macula Off Retinal Detachment - Corrugated Shallow Appearance1438 views
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Ophthalmomyiasis interna1437 viewsOphthalmomyiasis interna
track of Ophthalmomyiasis like linear
rarely image
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Peripheral Bullous Retinoschisis Fundus Photo (superotemporal)1436 views64-year-old man with peripheral retinal problem noted during comprehensive eye examination. OD 20/32, OS 20/25
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Normal Fundus Autofluorescence1436 views48-year-old woman has had a problem with light and dark adaptations. She notices when she sees a point source of light like a cell phone in a dimly lit room and then she turns the cell phone off, that subsequently her vision is very dark until she goes back into a well lighted area. OD 20/20, OS 20/25.
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1436 views
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Horseshoe Retinal Tear with bridging blood vessel1435 views
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Frosted Branch Angiitis1435 views
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Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1434 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred.
VISUAL ACUITY: Vision OD is 20/160, OS is 20/60
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Choroidal Melanoma1434 views
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Optic Nerve Head Drusen B-Scan 1433 views57-year-old woman has optic nerve drusen in both eyes.
VISUAL ACUITY: OU 20/20.
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Low Tension Glaucoma - Arrows show nerve fiber layer defect1432 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
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Asteroid Hyalosis - Benign Calcified Deposits in the Vitreous1432 views75 year old woman with 20/30 vision and dense asteroid haylosis
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Rubeosis Iridis1432 viewsPatient presents with Rubeosis Iridis in the right eye due to neovascular glaucoma. VA is 20/40 in the right eye. Will follow up in 3-months.
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Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Nerve Fiber Layer Scan shows swelling1431 views14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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Diabetic Retinopathy1431 viewsAnnual diabetic exam. VA 20/30, right eye and 20/50, left eye. Fundus photos shows hemorrhages with cotton wool spots. Exudates are visible around the macula in the right eye. Scattered hemorrhages in the left eye.
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Eales Disease - Fluorescein Angiogram1430 views
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Gonioscopy- Pigmentary Glaucoma Suspect1427 viewsPatient with no family history of glaucoma, comes in with elevated IOP. During Gonioscopy exam. brown pigment overlying the trabecular meshwork. Also, trans-illumination defects on the iris.
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Fundus Flavimaculatus - Stargardt Disease - 20/50 OD 20/200 OS 61 Year old Color Photo1420 views61-year-old decreasing vision for about the last five years. OD 20/50, OS 20/200.
Pisciform Lesions and Macular Atrophy
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Pigmented Choroidal Mass Right Eye - Melanoma vs. Nevus vs. Unilateral Melanocytic Proliferation - Initial Visit B Scan1420 views71-year-old man is vision has been bothering him for about a month. He does not notice one eye particularly worse than the other. OD is 20/40, OS is 20/25 - Initial Visit
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Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision1419 views15-year-old slowly developing cataract in the left eye over about the last three years. His cataract was already dense when it was removed August 3rd of 2009. The preoperative ultrasound suggested the retina might be abnormal and then once the retina was detached, it was clear that he had a retinal detachment. Because of the amount of scarring the retina was impossible to unfold and it was reattached in a closed funnel formation.
VISUAL ACUITY: OD 20/30, OS: NLP.
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Posterior Staphyloma and Geographic Atrophy Myopic Degeneration1418 views54-year-old man . He is a high myope. He has posterior staphylomas. He has had gradually changing vision for the last month or two. OD is 20/40, OS is 20/50.
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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis1416 views61 year old man with inflammation after cataract surgery who ultimately needed removal of intraocular lens and capsule to quiet eye.
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Vitreous Hemorrhage from Retinal Tear - Acute Posterior Vitreous Detachment1416 views
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Normal Infrared Image1414 views48-year-old woman has had a problem with light and dark adaptations. She notices when she sees a point source of light like a cell phone in a dimly lit room and then she turns the cell phone off, that subsequently her vision is very dark until she goes back into a well lighted area. OD 20/20, OS 20/25.
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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram 1414 views34-year-old man noticed about five days ago decreased vision in the right eye. He was having difficulty playing video games and seeing with that eye. He thought maybe his refractive error was shifting.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/16
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Choroidal Osteoma1414 viewsPatient with decreased vision within the past 2-years. VA 20/100 in the right eye. Fundus photo shows atrophic scar temporal to the macula in the right eye.
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Hemi Central Retinal Vein Occlusion 35 year old non-compliant man1412 views35-year-old man hazy vision in his left eye for about the last three days. OD 20/20, OS 20/30
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Optic Nerve Drusen - Line Scan over Optic Nerve1412 views72-year-old woman has had optic nerve drusen for sometime and has visual field abnormalities. OD 20/32, OS 20/32.
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Juvenile Xanthogranuloma1408 viewsPresented with hyphaema after minor trauma
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Retinal Pigment Epithelial Detachment with no Sub-Retinal Fluid...1408 viewsA 38-year old male who comes in with blurred vision in the left eye. VA is 20/30. Notices a defect inferior of his central vision. Did an Fluorescence Angiogram to determine an RPE with no sub retinal fluid. Also OCT confirms. Patient was injected with Avastin.
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Gonioscopy; Scattered Peripheral Anterior Synechiae1408 viewsPatient comes in for evaluation for glaucoma. Patient also has a history of Uveitis. Last flare up was back in 1990. Patient's VA was 20/30, Right eye and 20/40-1, Left eye. Slit Lamp Gonioscopy reveals iris bow with scattered PAS around the angles of the anterior chamber. You can also see pigmentation in the trabecular meshwork. Patient will follow up in 3-months.
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1404 views
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wyburn-mason sydrome1403 views28 year old female, visual acuity OS 20/200
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Pigmented Peripheral Retinal Degeneration1403 views42-year old male comes in for routine eye exam and to follow up on peripheral retinal degeneration in both eyes. VA is 20/20, right eye and 20/25, left eye. Patient is asymptomatic with no visual complaints.
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Gonioscopy; Scattered Peripheral Anterior Synechiae1403 viewsPatient comes in for evaluation for glaucoma. Patient also has a history of Uveitis. Last flare up was back in 1990. Patient's VA was 20/30, Right eye and 20/40-1, Left eye. Slit Lamp Gonioscopy reveals iris bow with scattered PAS around the angles of the anterior chamber. You can also see pigmentation in the trabecular meshwork. Patient will follow up in 3-months.
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