March 30, 2010

Double Vision

I saw a patient today who incidentally complained of double vision.

"Look straight at me...

To the left...

And now, to the right!"

The misalignment was most evident when I first awoke this patient, but you can still see that the left eye does not track well, especially when looking to the right. (Hint: look at the slight difference in the reflection between the eyes, subtle but present in all photos.)

I was able to diagnose this patient's underlying condition, which is practically pathognomonic for...

Med students: do you know what it is?


Left-sided internuclear ophthalmoplegia, caused by an injury to the medial longitudinal fasciculus...

And the most common source of this lesion is multiple sclerosis. This patient has chronic relapsing, remitting multiple sclerosis (curiously, the patient didn't have any visual problems until a week ago.) We prescribed an eye-patch. I was graciously given permission to photograph the eyes for educational purposes and spread the word.

Sometimes double vision can be "monocular," signifying astigmatism in the affected eye. When it is "binocular," requiring BOTH eyes to be open to create double vision, then you worry about cranial nerve and ocular muscle defects.

March 24, 2010

How to Feed the World?

How to feed the world ? from Denis van Waerebeke on Vimeo.

A strikingly simple message that everyone can (and should!) listen to.

March 10, 2010

Interesting Optho Cases

Here's some of the cases that I had on my Optho service.  Really, that should be "Ophthal" cases, but no one seems to pronounce the "ph" anyhow.  I'm not sure if this is of interest to anyone else, but reviewing this list helps me remember what I've seen. 


Most interesting/unexpected

  • Ruptured globe -> repair -> enucleation to prevent sympathetic ophthalmia
  • Herpes zoster opthalmicus
  • Narrow angle glaucoma s/p laser peripheral iridotomy (visible via retroillumination!)
  • Congenital cataracts, amblyopia
  • Anterior uveitis, HLA B27(+), tx w/ MTX
  • Anterior uveitis, secondary to psoriatic arthritis (striking case of dactylitis!)
  • Exposure keratopathy secondary to CN VII palsy s/p parotid tumor resection
  • Pterygium vs pinguecula
  • Grave's ophthalmopathy
  • CN IV palsy secondary to meningioma
  • Metallic foreign body removal (rust from car) w/ 18 gauge needle, wet Q-tip and Algr brush

Routine but important!

  • Corneal abrasions vs ulcers
  • Floaters and flashes: vitreous detachment vs retinal detachment vs ocular migraine
  • Conjunctival stye vs chalazion
  • Background vs proliferative diabetic retinopathy
  • Open angle glaucoma
  • Age-related Macular Degeneration
  • YAG laser
  • Cataract surgery

Glad that Ophthalmologists Know What the Heck they are Looking at

  • Pseudophakic bullous keratopathy
  • Choroidal melanoma s/p proton beam radiation
  • Pigmented basal cell carcinoma
  • Irvine-Gass cystoid macular edema secondary to atopy and cataract surgery