Clinical pictures: Eye problems

A variety of conditions affecting the eyes, described by Dr Philip Marazzi.

Anisocoria

This 50-year-old woman is demonstrating this abnormality of her pupils, of different sizes. It is not uncommon, affecting up to 10% of the population. It is defined as a difference of more than 0.4mm, which is clear in this case. This was not a new abnormality for the patient, but if it presents as a new sign, it must be investigated because it may be a sign of serious underlying pathology such as in Horner's syndrome, where it is likely to be associated with ptosis on that side. Cataract

This 79-year-old woman has a dense cataract. Unlike most of our elderly patients, her problem has been present since she sustained an injury to the eye at the age of nine. She could not remember details but thinks she was poked with a stick.

Traumatic cataracts often have a stellate shape, although clearly not in this case. She has never wanted surgery because she was told it would be pointless, but has decided she has little to lose.


Trauma

This is another case of trauma to the eye. This young woman went to work for a charity in Southern Asia. On her first day, a ceiling fan fell off its mounting and struck her eye. The eye was badly damaged and she required emergency surgery at the time and following her return to the UK. She had a vitrectomy and lensectomy. One year later, she has done remarkably well, with good restoration of her sight and only occasional visual problems in very bright light.


Episcleritis

This middle-aged woman presented with an acute red eye. She complained of soreness of the eyeball and associated headache. There was no sign of purulent discharge and the left eye was unaffected.

This condition is due to an inflammation of the episclera. It is usually benign in nature with spontaneous resolution within two weeks. Occasionally, it may be associated with more serious underlying conditions such as inflammatory bowel disease.


Cataract

This 79-year-old woman has a dense cataract. Unlike most of our elderly patients, her problem has been present since she sustained an injury to the eye at the age of nine. She could not remember details but thinks she was poked with a stick.
Traumatic cataracts often have a stellate shape, although clearly not in this case. She has never wanted surgery because she was told it would be pointless, but has decided she has little to lose.


Keratoconus

This young woman has an abnormality of her corneas which manifests as a cone shape. Her case is relatively mild, and the visual disturbance is corrected fairly easily with contact lenses.

The condition may continue to develop, causing increasing visual problems into middle and old age.

If the visual problems deteriorate significantly, surgery and corneal transplant may be required.


Basal cell carcinoma

The skin of the face is exposed to sunlight as much as any other part of the body. Although we are becoming increasingly aware of the risks of sunburn, malignancies on the face remain common. The skin around the eyes is not spared.

This elderly man presented with a non-healing raised lesion on the upper eyelid. It had been present for some months and was slowly growing. It appeared to be a basal cell carcinoma and was subsequently excised.


Conjunctival varix

This woman presented in a state of great anxiety after a friend noticed this appearance on her eye. She thought she had a worm in the eye. In fact, it was a blood vessel and referral to the local eye clinic confirmed the diagnosis. The patient was reassured and no action was required.


Periorbital oedema

This young woman presented with a markedly swollen left upper eyelid. The probable trigger for this acute episode of angioedema was not obvious. She was treated with
high-dose antihistamines, ranitidine, montelukast and a short course of oral steroids. She had no oral or respiratory symptoms, so no adrenaline was required. She has had no other episodes.

Dr Marazzi is a GP in East Horsley, Surrey

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