Blog

A 49YO female was involved in a motor vehicle accident 30 years ago. Her retina showed signs of pigmentary retinopathy from the ocular injury, which could be mistaken for retinitis pigmentosa (RP). Unlike typical RP, our patient had multifocal, sectoral, unilateral findings. Learning Point:  Intact photoreceptors inhibit RPE migration. Photoreceptor loss from numerous causes, including… Read More

Our patient is a 15YO boy with quite pronounced bilateral optic nerve drusen visible clinically, as well as on OCT (only right eye pictured). ODD will often hyperautofluoresce on fundus autofluorescence (FAF). Although central vision was good, he complained of increasing peripheral vision loss due to drusen compressing the surrounding nerve fibers. Learning Points: Optic… Read More

Our patient is a 31YO female with acute vision loss of 20/60 in her right eye with classic MEWDS findings. Granular foveal changes (Jampol spots) and scattered white spots are seen in the outer retina. The spots appear hyper-autofluorescent on fundus autofluorescence imaging. Fluorescein angiography shows multifocal wreath-like hyperfluorescent staining lesions. Acute cases will also… Read More

Our patient was HIV positive with a CD4 count of 9. There is an isolated nerve fiber layer infarct (cotton wool spot, CWS) in the right eye and two CWS in the left eye. Learning Points: Cotton-wool spots are nonspecific and are found in many disorders, including hypertensive and diabetic retinopathy. They can also be… Read More

This patient has classic posterior segment findings of Harada disease, including multifocal exudative serous retinal detachments. Choroidal inflammation produces a markedly thickened choroid with overlying chorioretinal folds (seen in both eyes as variably radiating outer retinal folds). The OCT scans show multifocal serous detachments with bacillary detachments. Fluorescein angiography shows multiple subretinal leaks with pooling… Read More

This healthy 31YO presented with sudden vision loss in her right eye. The fundus image shows a single yellow subfoveal lesion, which appears as a hyperreflective pillar extending into the outer nuclear layer on OCT. The differential includes solar retinopathy, laser pointer maculopathy, whiplash maculopathy, acute retinal pigment epitheliitis (RPEitis), and central serous retinopathy. There… Read More

This 68YO presented with a known history of having a “questionable parasite” in his right eye. He was treated with oral and IV antibiotics at another facility many years ago. Despite the extensive subretinal fly larva tracks, OCT shows surprisingly subtle subretinal changes. Vision is 20/30. Learning Points: Larvae can be found in different parts… Read More

What an interesting operculated retinal break. What do you think this dog is thinking?

This is a beautiful example of papilledema in a patient with idiopathic intracranial hypertension (pseudotumor cerebri). This patient had an opening lumbar puncture pressure of 28 cm H2O. Note the absence of lipid, which, for some reason, is much more common in patients with malignant hypertension or neuroretinitis. Learning Points: Remember that papilledema is not… Read More

This 16YO patient with pigmented paravenous chorioretinal atrophy has excellent central vision of 20/20 OU but with significant nyctalopia. Posterior segment findings include attenuated retinal vessels, bone spicules (intraretinal migration of the RPE along retinal capillaries), and optic disc pallor. The bone spicules in this patient are primary perivascular, indicating the likely diagnosis of pigmented… Read More