Slideshow: Presentations of Ocular Disorders

This slideshow features cases and photos of various ocular disorders featured in an article from the Consultant archives. Included are cases of corneal abrasions, retinal detachment, neuroretinitis, and more. 

A 36-year-old male presented to the emergency department with an accidental shot to his right eye by an “airsoft” plastic pellet gun, from a distance of approximately 10 feet. He had intense pain in his eye, with blurring of vision and photophobia. He usually wore corrective glasses, which were unavailable at the time. 

Visual acuity was 20/200 in the left and 20/400 in the right eye. Pupils were reactive to light bilaterally. Redness and inflammation in the conjunctiva of the affected eye were present. A well-defined round area of fluorescein uptake was visible in the center of the cornea measuring 2x2 mm, consistent with a corneal abrasion. 

A 28-year-old male presented with the main complaint of pressure-like discomfort behind both his eyes, and a “spot” in his central right eye vision for about two days. Eye examination indicated photosensitivity, decreased visual acuity to 20/400 with a central scotoma, diminished color perception, a trace afferent papillary defect and optic nerve papillitis in his right eye. His left eye was normal. 

He was empirically treated for cat scratch disease (CSD) with doxycycline and a prednisone taper. Elevated bartonella henselae IgG and IgM antibodies would confirm the initial diagnosis soon thereafter, and his fundus exam shows optic nerve head edema, cystoid macular edema and star seen in neuroretinitis ten days after presentation. Also note the circumferential retinal microfolds (Paton’s lines) best seen at the temporal margin of the disc.

The combination of optic disc edema, retinal edema, and macular exudates forming a stellate-like star is indicative of neuroretinitis, which is seen in about 1% to 2% of CSD cases.

A 30-year-old Hispanic male was referred from his optometrist for evaluation of an “air bubble” and iritis in his right eye. The patient had a history of trauma to his right eye with retinal detachment that was repaired in Mexico 12 years prior to this visit. His vision never recovered after the retinal detachment repair. He denied any pain or redness in his right eye.

A silicone oil droplet located superiorly in the anterior chamber was in a slit lamp evaluation. There were also many small spherules of silicone oil floating in the aqueous convection currents seen in the anterior chamber.

Silicone oil is usually temporarily placed in the vitreous cavity for giant retinal tears and following perforating globe injuries. It is sometimes not completely removed post-operatively. In cases where there is a breach between the vitreous cavity and anterior chamber, silicone oil may migrate into the anterior chamber.

A  70-year-old man presented complaining of a black area in his left eye vision, which extended out from the nasal center. There was no accompanying eye pain, but there was a feeling of pressure behind the left eye. The patient noted that he fell and hit his head about a week prior to his vision changes.

In Figure A, the retina temporal to the optic disc is detached and bullously elevated. The detachment extends shallowly into the macular area which accounts for the patient’s poor vision. In Figure B, the image focus is on the detached retina. The whitish-yellow appearance represents loss of the underlying choroidal red reflex. 

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Reference:

Luni FK, Brown J, Adhi M. Ocular disorders. Consultant. 2013;53(8). https://www.consultant360.com/articles/ocular-disorders