External Photography Bonanza

I'm trying to collect my best images from patients seen in clinic this month to share with optometry students or curious patients.  Here's a photographic review of January at the office:

Conjunctival Cyst

Typically these resolve on their own, often with encouragement from frequent artificial tears and or steroid drops or ointments.  For more information, see this post.

Herpes Simplex Keratitis
This virus typically presents (in my experience) as a dull persistent irritation.  Your eye has been mildly red, mildly uncomfortable, and vision seems a little off.  Often I am seeing it after you have been bothered for a few weeks.  With an incubation of that long, herpes simplex's tell-tale corneal disruption (called dendrites) is easily visible.  If your doctor sees the virus too early in its life span, these dendrites may not have yet formed, making it harder to diagnosis.  It is also true that if it incubates too long, the cornea is just a complete mess and the dendrites will have merged into something that can look like a bacterial or fungal ulcer.  The point here is, if you have an irritated eye that just isn't healing or responding to your doctor's treatment, you need to be seen again!  Sometimes herpes will reveal itself only after an initial misdiagnosis.

Herpes Simplex Dendrites with NaFL staining

Herpes Simplex Dendriteis with Rose Bengal staining

Peripheral Corneal Infiltrate; Marginal Ulcer
See that white spot near the pupil of this image?  It is actually located on the superficial cornea, and is a small infiltrate or ulcer.  Technically this particular patient had an infiltrate since the overlying epithelial defect was much smaller than the size of the stromal opacity.  But I have heard these called marginal ulcers just as often as peripheral infiltrates. The real treatment for a sterile infiltrate is steroids, but I usually just do a antibiotic combo with Zylet or Tobradex.  Kill the inflammation and any bacteria in just 1 drop!  A small stromal scar will often remain after treatment, so that is why getting these diagnosed and treated quickly is important.  They are most commonly associated with blepharitis and meibomian gland dysfunction, and not necessarily in just contact lens wearers where the cornea is more susceptible to infection.

Posterior Blepharitis
It wouldn't be January without a lot of meibomian gland issues.  This time of year the cold weather constricts the meibomian glands in the upper and lower eyelids, limiting the amount of tear film leaving the gland opening with every blink.  As those tears get backed up inside the gland, they harden and become even more difficult to blink out normally!  The result: a thick, milky tear film that leaves the eyes dry and blurry between blinks.  Your best relief is to get those tear glands working again, encouraging the glands to open and express with daily warm massage.  Aim for the eyelash line with a gentle circular motion, and you will see results in the way your eyes are feeling within a week or two (depending on how long your glands have been clogged for).  Sometimes medication is needed to get the glands working again at their best level, so steroid ointments and oral minocycline are common treatments.

Don't you just want to get all that thick, milky, hardened tear film junk out of those glands?  If you do, you will make a very happy optometrist because I do this all day long for a living.