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Central Retinal Artery Occlusion - 2 months old by history1427 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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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1422 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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360-Degree's Pseudoexfoliation1420 viewsFollow-up on glaucoma. Patient has sever pseudoexfoliation in the right eye. VA is 20/25 with IOP at 27. Patient will return in 6-months for re-evaluation.
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Papilledema 10 year old child1417 views10-year-old child has uveitis in both eyes. She probably has tubulointerstitial nephritis-uveitis syndrome, and she apparently also independently has idiopathic elevated intracranial pressure. VISUAL ACUITY: Vision OU is 20/20.
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Clinically Significant Diabetic Macular Edema both Eyes with Exudates1417 views56-year-old woman with diabetes for twelve years. She has noticed blurring of the vision in the right eye for about six months. OD is 20/70, OS is 20/25.
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Choroidal Melanoma1415 views
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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram - Antimated .GIF1413 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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Acute Annular Outer Retinopathy - VA loss 2 days Right Eye Only - 25 Year Old Woman1411 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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late phase mushroom cloud, acute CSR1408 viewsFocus is on the peri-foveal vessels illustrates the extremely bullous RD from this mushroom cloud of leakage. The RD was substantially improved after 2 weeks of oral rifampin. Visual acuity improved from 20/200 to 20/70 OD.
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Anterior Ischemic Optic Neuropathy - Non-Arteritic - AION1406 views72-year-old woman sudden vision loss in the right eye about four days ago. She also has noticed that things are dim out of that eye. She has no headaches. She does feel a little tired. She has no pain in her jaw when she chews and she has no fevers.
OD is 20/80, PH 20/25; OS is 20/25
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Basal Laminar Drusen - Cuticular Drusen - Equatorial Drusen - 70 Year Old Woman 1401 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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Vitreous Hemorrhage from Retinal Tear - Acute Posterior Vitreous Detachment1398 views
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Wet AMD OS - Dry AMD OD SD-OCT1397 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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Proliferative Diabetic Retinopathy both Eyes Neovascularization of the Disc1391 views63-year-old woman has been diabetic for twenty one years who sees new floaters in the right eye. OD 20/40, OS 20/40.
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Hemi-retinal Vein Occlusion1389 views81 year old female seen in 2009 for a Hemi-retinal vein Occlusion OS with vision of 20/25.
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Melanoma1388 viewsYoung male with large Melanoma
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Drusen Maculopathy - Confluent Subfoveal Soft Hydrophobic Drusen - Yellow Drusen in Center of the Macula1387 views
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Commotio Retinae - One Day following Basketball to Eye1386 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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Correctopia - before laser iridoplasty - 20/60 vision1385 viewsIris is occluding visual axis
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Peripheral Bullous Retinoschisis Fundus Photo (superotemporal)1384 views64-year-old man with peripheral retinal problem noted during comprehensive eye examination. OD 20/32, OS 20/25
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Reticular pigment degeneration1383 views78 year old man with wet AMD- Peripheral retina show reticular pigment degeneration
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Weiss Ring1380 views
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Equatorial Drusen Fundus Photo Left Eye1378 views
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1378 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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Total Retinal Detachment1375 viewsTotal Retinal Detachment
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Myelinated Nerve Fiber Layer Right Eye (white area)1371 views62-year-old man myelinated nerve fiber layer in the right eye. OD 20/25, OS 20/30.
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Amelanotic Nevus Initial Visit1369 views
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Sturge-Weber Encephalotigeminal Angiomatosis - Facial Hemangioma and Asymptomatic Ipsilateral Diffuse Choroidal Hemangioma1368 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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"Jelly Bumps" Soft Contact Lens1367 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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Juxtafoveal Retinal Telangiectasia (Telangiectasis) - MacTel - Striking Gray Ring in Macula1366 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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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment1364 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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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1363 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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Eales Disease1361 views
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Retinal Detachment with Dislocated IOL Lens1360 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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Morning Glory Syndrome, Optic Nerve1358 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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Best Disease - SD OCT Line Scan1357 views
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Progressive Outer Retinal Necrosis 77 Year Old Woman with CLL (Acute Retinal Necrosis) (PORN - ARN)1354 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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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram 1353 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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Optic Nerve Head Drusen B-Scan 1351 views57-year-old woman has optic nerve drusen in both eyes.
VISUAL ACUITY: OU 20/20.
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Subhyloid Hem with PDR1347 views
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Proliferative Diabetic Retinopathy - Vitreous Hemorrhage and Tractional Retinal Detachment Left Eye1346 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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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - SD-OCT Line Scan Inner retinal edema1346 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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Weiss Ring -Vogt Ring - Posterior Vitreous Detachment1343 viewsChronic Floater - 10 years
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Proliferative Diabetic Retinopathy - Moderate - mild NVD with NVE 1343 viewsVenous beading, vascular loops and NVE are visible on photos
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Capillary Non-Perfusion - Severe Non-Proliferative (Background) Diabetic Retinopathy - Type I - 20 Year Old Man Diabetic 16 years1341 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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Pigmented Choroidal Mass Right Eye - Melanoma vs. Nevus vs. Unilateral Melanocytic Proliferation - Initial Visit B Scan1341 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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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1339 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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Myelinated Nerve Fiber Layer Right Eye (white area)1338 views62-year-old man myelinated nerve fiber layer in the right eye. OD 20/25, OS 20/30.
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Correctopia - before laser iridoplasty - 20/60 vision1336 viewsIris is occluding visual axis
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Low Tension Glaucoma - Arrows show nerve fiber layer defect1332 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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Gonioscopy, Pigment Dispersion Syndrome1332 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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Optic Nerve Drusen - Line Scan over Optic Nerve1330 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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Horseshoe Retinal Tear with bridging blood vessel1330 views
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Recurrent Macula Off Retinal Detachment - Corrugated Shallow Appearance1328 views
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Dilated Conjunctival Blood Vessels1327 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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Nonproliferative Diabetic Retinopathy with Circinate Hard Exudates1324 views
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Hypertrophy of the Retinal Pigment Epithelium1322 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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Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1321 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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Ectopia Lentis - Marfan's Syndrome - Intermittent Pupillary Block Glaucoma Right Eye1319 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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Posterior Staphyloma and Geographic Atrophy Myopic Degeneration1318 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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Cone-Rod Dystrophy 1315 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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RD with PVR1315 viewsRD with Proliferative Vitreoretinopathy
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Uveitis - Iris Nodule - Koeppe Nodule1313 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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Acute Central Serous Retinopathy - Classic Smokestack on Fluorescein Angiogram 1313 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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Normal Infrared Image1312 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 1312 views
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Macular Branch Retinal Vein Occlusions (2) Left Eye - No Macular Edema (yet) 1311 views77-year-old woman with two macular branch retinal vein occlusions in the left eye OD 20/25
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1311 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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Propionibacterium acnes endophthalmitis with capsular plaque and uveitis1310 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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Closed Funnel Retinal Detachment Under Silicone Oil - NLP Vision1310 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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Retinal Pigment Epithelial Detachment with no Sub-Retinal Fluid...1310 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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Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - FAF1310 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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Gonioscopy; Scattered Peripheral Anterior Synechiae1310 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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Flower Cataract1310 viewsPatient with ahmed tube and flower cataract
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Central Serous Retinopathy Acute - Fundus Autofluorescence1308 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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Ophthalmomyiasis interna1307 viewsOphthalmomyiasis interna
track of Ophthalmomyiasis like linear
rarely image
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Gonioscopy; Scattered Peripheral Anterior Synechiae1305 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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Frosted Branch Angiitis1304 views
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Acute Annular Outer Retinopathy - VA loss 2 days Right Eye Only - 25 Year Old Woman- AZOOR - White Line Around Fresh Lesions1300 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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Normal Fundus Autofluorescence1300 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 1300 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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Eales Disease - Fluorescein Angiogram1300 views
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Choroidal Melanoma1297 views
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Juvenile Xanthogranuloma1297 viewsPresented with hyphaema after minor trauma
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Post- treatment1295 views
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1294 views
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Ectopia Lentis and Cataract - Marfan's Syndrome1289 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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Vitreous Hemorrhage from Retinal Tear - Acute Posterior Vitreous Detachment1288 views
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Gonioscopy- Pigmentary Glaucoma Suspect1288 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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Post- treatment1288 views
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Central Serous Retinopathy - Acute1287 views49-year-old man sees a spot in the central vision with a red halo for 2 weeks OD is 20/50, OS is 20/20
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Twig Branch Retinal Vein Occlusion - Recurrent Macular Edema with extended interval Lucentis Therapy after first 6 monthly Injections1287 views39-year-old man has a macular branch retinal vein occlusion with macular edema. He had an excellent response to Lucentis for his first 6 treatments. He was last here 6 weeks ago and his vision seems OK to him. OD 20/40.
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Choroidal Rupture and small Hemorrhage - Assault1285 views34 year old man. The patient reports he was assaulted by a couple of adolescents near downtown St. Petersburg about forty-eight hours ago. He reports the pain in the left eye has significantly improved, but his vision is a little fuzzy and he sees some floaters in the left eye. 20/125 OD, 20/20 OS. Pinhole improves in the right eye to 20/50. IOP: 15 OD, 13 OS.
SLIT LAMP EXAMINATION: Biomicroscopy reveals 3+ pupillary reaction OD, 2+ OS with no afferent pupillary defect. EXTENDED OPHTHALMOSCOPY: Extended funduscopy with Volk 90-diopter lens and fundus drawings of both eyes reveal a clear view with no posterior vitreous separation. C/D ratio is 0.2. There is no vitreous debris or hemorrhage. Large retinal vessels and macula are healthy. The retinal periphery, inspected with scleral depression for 360° shows no retinal tears, breaks, or detachments.
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Fundus Flavimaculatus - Stargardt Disease - 20/50 OD 20/200 OS 61 Year old Fundus Autofluorescence os1285 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 Peripheral Retinal Degeneration1284 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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Asteroid Hyalosis - Benign Calcified Deposits in the Vitreous1281 views75 year old woman with 20/30 vision and dense asteroid haylosis
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Gonioscopy; Scattered Peripheral Anterior Synechiae1280 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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1279 views
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Central Serous Retinopathy Acute - Fundus Autofluorescence1277 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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Juxtafoveal Telangiectasis - MacTel - Retinal Telangiectasis - Both Eyes - Crystals1273 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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