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This 20YO female presented with a 5-year history of photopsias in her left eye. Vision was 20/20 bilaterally. There were subtle pigmentary changes surrounding the left optic nerve (a brighter semicircular lesion in the left nasal macula is an artifact). Fundus autofluorescence shows more dramatic peripapillary changes with outer borders of hyperautofluorescence. Optical coherence tomography… Read More

This patient presented with unilateral diffuse optic nerve edema with some splinter hemorrhages and possible inferotemporal lipid. Optic nerve OCT confirms markedly increased retinal nerve fiber layer thickness. The differential diagnosis for a unilaterally acutely swollen nerve is quite long and includes arteritic (AION) and non-arteritic (NAION) anterior ischemic optic neuropathy, infectious causes (including syphilis… Read More

This patient presented with asymptomatic 20/30 vision OD and subtle macular thickening coming from an optic nerve pit along the temporal aspect of the optic nerve. OCT shows a direct communication between the pit and the prominent inner macular schisis. Patients can also have subretinal fluid, which our patient did not. The left eye was… Read More

This 77YO female was initially examined with 20/60 vision OD, 20/30 vision OS, and bilateral vitelliform lesions (only right eye pictured) consistent with Adult Best (adult-onset foveomacular vitelliform dystrophy). A complete posterior vitreous detachment (PVD) was noted in her right eye. Seven months later, vision decreased to counting fingers OD due to a new full-thickness… Read More

This patient presented with hemorrhagic retinal vasculitis, one of the posterior findings of Behcet’s disease. Vascular occlusions can cause optic atrophy, retinal neovascularization, and vitreous hemorrhage. Anterior segment findings include uveitis and a sterile hypopyon (not present in this patient). Learning Points: Behcet disease is a systemic vasculitis that includes the classic triad of oral… Read More

This 67YO female was referred with 20/30 vision and asymptomatic retinal findings. There was a tear-drop-shaped, variably pigmented chorioretinal scar in the temporal macula. The associated increased choroidal pigmentation is best seen in the red-channel image. The OCT shows some unexpected findings. There is either a coloboma or posterior staphyloma causing marked posterior displacement of… Read More

This patient presented with blurred vision from an area of active retinitis nasal to a prior toxoplasmosis scar. An OCT B-scan shows full-thickness retinal necrosis and scarring temporally, with a foveal bacillary detachment. Tiny vitreous cells are scattered above the retina. Fluorescein angiography shows staining of the inflamed retina and pooling within the bacillary detachment…. Read More

This patient has a melanocytoma, which is a benign melanocytic tumor intrinsic to the optic nerve. There is pigmentation noted within the superonasal portion of the optic disc. Learning Points: Melanocytomas can sometimes enlarge and spread into the adjacent retina and choroid, and can very rarely undergo malignant transformation. Most patients are asymptomatic, but some… Read More

This 23YO patient presented with a few days of a temporal blurred spot in his left eye. Vision was 20/20 OD and 20/25 OS. The left fundus has confluent outer retinal white spots centered around the optic nerve and extending into the macula. These lesions also had an unusual perivascular distribution more peripherally. Fluorescein angiography… Read More

This is an Optos ultra-widefield fluorescein angiogram of a patient with proliferative diabetic retinopathy. Despite recent panretinal photocoagulation (PRP), there is persistent large disc neovascularization. Extensive capillary nonperfusion is noted superotemporal to the disc and temporarily. Prominent venous beading is also noted inferotemporally. Additional PRP was added. Learning Points: Panretinal photocoagulation has been around since… Read More