Dr. Veda
Final year resident, Chennai
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Cornea › Pterygium
Double headed pterygium with pseudoexfoliation
Double-headed pterygia are a rare benign fibrovascular overgrowths of the nasal and temporal bulbar conjunctiva onto the cornea, which have mostly a triangular appearance. The development of pterygia is multifactorial, including environmental irritants, for example long-term ultraviolet-B damage, wind, dust, chemicals, air pollution and hereditary factors. A pterygium can usually be diagnosed by slit-lamp examination.
Retina Vitreous › Retinitis pigmentosa
Fluorescein angiography of Stargardt’s disease
Stargardt disease (STGD), is the most common childhood recessively inherited macular dystrophy. The genetically based condition is due to mutations in the ABCA4 gene on chromosome 1 that encodes a retinal transported protein. The disease results from the accumulation of visual cycle kinetics-derived byproducts in the retinal pigmented epithelium (RPE) with secondary photoreceptor dysfunction and death. Fundus flecks, seen as small irregular hyperfluorescent lesions over the “dark-choroid” background, suggest a diagnosis of Stargardt disease.
Retina Vitreous › Posterior vitreous detachment
Vitreo macular traction
The following must be present on at least one OCT B-scan image: (i) Partial vitreous detachment as indicated by elevation of cortical vitreous above the retinal surface in the perifoveal area (ii) Persistent vitreous attachment to the macula within a 3-mm radius from the center of the fovea (iii) Acute angle between posterior hyaloid and inner retinal surface (iv) Presence of changes in foveal contour or retinal morphology (distortion of foveal surface, intraretinal structural changes such as pseudocyst formation, elevation of fovea from the retinal pigment epithelium (RPE), or a combination of any of these three features) (v) Absence of full thickness interruption of all retinal layers Additional features: Foveal pseudocyst, macular thickening, retinal capillary leakage (typically isolated VMT alone does not cause leak on fluorescein angiography), macular schisis, cystoid macular edema, retinal detachment Symptoms: Reduced or distorted vision
Retina Vitreous › Central retinal artery occlusion
Fundus photo showing cherry red spot
The causes of cherry red spot in the macula: 1. Vascular a. Central Retinal Artery Occlusion (CRAO) — arteritic and non-arteritic b. Acute occlusion of retinal circulation following cataract surgery (phacoemulsification) c. Compromise of choroidal/retinal circulation due to intraorbital hemorrhage or mass d. Macular infarction (from retinal artery/vein occlusions, carotid artery occlusion, malignant hypertension, diabetes, radiation retinopathy, posterior uveitis, systemic inflammatory vasculopathies, trauma) 2. Metabolic Storage Diseases a. GM2 gangliosidosis (Tay-Sachs disease, Sandhoff disease) b. Niemann-Pick disease (Types A, B, C, D) GM1 gangliosidosis type 1 (Generalized gangliosidosis/Landing disease) c. Sialidosis / mucolipidosis type 1 (cherry red spot myoclonus syndrome) d. Farber disease (Farber lipogranulomatosis) e. Metachromatic leukodystrophy f. Galactosialidosis (Goldberg Cotlier syndrome) 3. Inflammation a. Retinitis involving the central retina (progressive outer retinal necrosis, subacute sclerosing panencephalitis) 4. Drug Toxicity Quinine Carbon monoxide Dapsone poisoning Methanol Intravitreal gentamicin 5. Trauma a. Commotio Retinae (Berlin's edema) — pseudo-cherry red spot b. Optic Nerve Avulsion c. Saturday Night Retinopathy d. Leukemic infiltrates of the optic nerve head