Interesting and Artistic Images
An Eye Adrift: Free-Floating Lamellar Cataract
By Muhammad Saad, MD
A lamellar cataract floats freely in the anterior chamber, creating the appearance of weightlessness.
Christmas Love: Removal of an 80-Year-Old Cataract
By Rodolfo Bonatti, MD
After 80 years of observation, the Christmas cataract has reached the stage for surgical removal.
Dragon in the Eye: Viral Keratitis With Geographic Ulcer
By Bharat Gurnani, MBBS, DNB, FCRS, FACS, FICO, FAICO(RefSx), FAICO(Cor), MRCSEd, MNAMS
This photograph shows an ulcer caused by viral keratitis, with fluorescein staining highlighting a shape reminiscent of a dragon.
Sinking of the Titanic: IOL Dislocation in Pseudoexfoliation Syndrome
By Tarun Sood, MS, MCh, FAICO
This image depicts a dislocated IOL-bag complex in a 67-year-old man with advanced pseudoexfoliation syndrome.
Zonula in Sight!
By Emilio Panero, MD
A 26-year-old woman with a history of Marfan syndrome and diabetes presents for a routine eye examination.
Rare and Unusual
A Star in the Eye: Blue Dot Cataract
By Sana Nadeem, MBBS, FCPS, ACMEd
A well-defined, star-shaped, blue dot cataract is visible in the anterior cortex of the left crystalline lens of a 14-year-old girl. She has 20/20 BCVA OS. The right eye exhibits a subtle blue dot cataract restricted to the peripheral cortex.
Conjunctival and Corneal Argyrosis
By Vincenzo Maurino, MD
These images (A and B) illustrate a rare case of silver deposits in the conjunctiva and Descemet membrane that are secondary to the prolonged use of makeup containing silver. An OCT scan (C) reveals the depth of corneal deposition.
Microsporidial Keratitis
By Sindhupriya Chanda, MBBS
Multiple fine-to-coarse raised epithelial lesions have a stuck-on appearance and positive fluorescein staining.
Shattered Iris: ICE Syndrome Following COVID-19
By Huzaifa Farooq, MBBS, FCPS
This image shows iridocorneal endothelial (ICE) syndrome, specifically the essential iris atrophy subtype, in a 30-year-old woman following a COVID-19 infection.
Silent Invader: Recurrent OSSN on Eyelid Margin
By Bharat Gurnani, MBBS, DNB, FCRS, FACS, FICO, FAICO(RefSx), FAICO(Cor), MRCSEd, MNAMS
This photograph demonstrates ocular surface squamous neoplasia (OSSN) with irregular, raised, reddish nodules along the eyelid margin and adjacent conjunctiva. The lesions reflect the invasive potential of OSSN, which can involve the cornea, conjunctiva, and eyelids. The entity is often linked to chronic UV exposure, immunosuppression, or human papillomavirus infection.
Slit Lamp
A Setting Sun: Morgagnian Cataract
By Aish Ramamurthi, MD
This photograph shows a hypermature Morgagnian cataract with a distinct brown nucleus that is sinking within a milky white cortex.
Dendritic Pathways: Herpes Zoster Keratitis
By Lourdes Maria Vindel Valle, MD
A corneal lesion extends from limbus to limbus. The medusoid pattern of a dendritic ulcer caused by herpes zoster illustrates the virus’ path across the cornea.
Electric Shock Cataract: Star-Shaped Opacity
By Hassan Sajjad, MD
This early star-shaped cataract developed within weeks following electrocution.
Encircled
By Melissa Yuan, MD
This image shows a ring of broken posterior synechiae in a patient with HLA-B27–associated uveitis.
Stardust Vision: Congenital Blue Dot Cataract
By Bharat Gurnani, MBBS, DNB, FCRS, FACS, FICO, FAICO(RefSx), FAICO(Cor), MRCSEd, MNAMS
This photograph depicts a congenital blue dot cataract, with small bluish opacities scattered across the lens that resemble tiny stars. These opacities are typically stable but may progress, potentially affecting the patient’s vision if they enlarge or increase in number.
Surgical Complications
Cobweb of Complication: Fibrinous Membrane Following Cataract Surgery
By Kirandeep Kaur, MBBS, DNB, FPOS, FICO, MRCSEd, MNAMS
This cobweb-like fibrinous membrane developed in the anterior chamber following cataract surgery. Delicate, thread-like structures form a hazy layer over the IOL that reduces visual clarity and is indicative of postoperative inflammation. Such membranes can hinder healing and visual recovery and may require antiinflammatory therapy or surgical intervention.
Dead Bag Syndrome: Pre- and Postoperative Comparison
By Mark F. Pyfer, MD, FACS
The photograph at left shows a dilated view of the anterior chamber in the eye of a patient who underwent routine phaco cataract extraction 14 years earlier (A). The patient reported crescent-shaped glare and shadows, despite no history of trauma or additional surgery. The diagnosis was dead bag syndrome. The image at right was taken following an IOL exchange (B). A three-piece lens with a 6.5-mm optic was placed in the sulcus with optic capture. The patient’s postoperative UCVA was 20/20.
The DSAEK Graft Takes a Detour
By Giovanni Scalia, MD
Inferior dislocation of a Descemet stripping automated endothelial keratoplasty (DSAEK) graft is observed 1 week after transplantation. The graft rests lower in the anterior chamber than anticipated. A visible gap between the graft and the host cornea’s curvature indicates incomplete adherence or migration. The displacement may require repositioning of the DSAEK graft to promote healing and optimize the patient’s visual outcome.
Wrapped in a Cocoon: Phimosed Capsular Bag With IOL
By Mallikarjun Heralgi, MD
Four years following cataract surgery, a patient presents with reduced vision, total capsular bag phimosis, subluxated IOL, and pseudophacodonesis in the right eye. The foldable IOL with a contracted optic and haptics is located within a fully phimosed capsular bag. Surgical intervention involved removal of the IOL–capsular bag complex via an anterior corneoscleral tunnel, an anterior vitrectomy, and placement of a posterior iris-claw lens. The patient’s vision improved postoperatively.
PKP Dehiscence With Uveal Exposure
By Michael Moussa, MD
This image depicts exposed uveal tissue resulting from graft dehiscence in a patient with exposure keratopathy following a penetrating keratoplasty (PKP).
Trauma
Pigmented Zonules and Traumatic Cataract
By Muhammad Saad, MBBS, FCPS
This detailed image showcases the intricate appearance of pigmented zonules—thread-like fibers that suspend the lens within the eye—alongside a mature traumatic cataract. The delicate pigmentation of the zonules, often unnoticed, is brought into sharp focus, emphasizing the resilience and adaptability of the eye in response to injury.
Resilient Vision: Full Visual Acuity Despite Pars Plicata Trauma
By Hashem Abu Serhan, MD
The eye of a young male patient sustained trauma when a steel rod penetrated the pars plicata. Despite the injury, his visual acuity remained 6/6.
Pediatric Ocular Trauma from Fishing Hook
By Manmeet Singh, MBBS, MS, FCRS, FIOL, FDCR
The images depict the eye of a 7-year-old pierced by a fishing hook, resulting in corneal perforation, lens damage, and an eight ball hyphema. Injuries of this nature carry substantial risks to visual rehabilitation, highlighting the importance of safety awareness within the fishing community.
Phacocele
By Joobin Khadamy, MD
The photograph displays the eye of an 81-year-old patient with traumatic phacocele due to a fall. The crystalline lens has visibly dislocated into the subconjunctival space, indicating an indirect scleral rupture near age-related scleral plaques. Subconjunctival hemorrhage and hyphema accompany the lens displacement. These images underscore the importance of promptly recognizing phacocele in elderly patients; age-related ocular weakening heightens the risk of traumatic injury.
Metallic IOFB in the Anterior Chamber
By Gio Campagna, MD
A metallic intraocular foreign body (IOFB) rests in the anterior chamber of the eye of a 25-year-old male machinist who sustained a work-related injury while adjusting an aluminum rail. Remarkably, no obvious entry wound is visible. The IOFB was carefully removed via a paracentesis incision, and intracameral moxifloxacin as well as intravitreal vancomycin and ceftazidime were administered. The patient experienced an excellent postoperative recovery with 20/20 vision and no evidence of intraocular infection.
